We read with interest the overview of a COVID-19 recovery service developed by Rebecca D’Cruz and colleagues in the UK. This multidisciplinary approach, implemented in response to the expected long-term exposure to COVID-19 infections, will undoubtedly be of benefit to the patient

  • D’Cruz RF
  • Perrin F.
  • Birring SS
  • et al.

Providing Holistic Care for Severe COVID-19 Pneumonia: Anticipating Clinical Needs and Managing Resources. The construction of this clinical pathway is based, among many others, on an international level on prior knowledge of post-critical disease recovery and the earlier pandemic of severe acute respiratory syndrome. However, there are other important lessons related to the restoration of critical care that need to be considered as services evolve. In particular, new financial problems and lower returns to employment have been found to be common among ICU survivors and their family members. A meta-analysis found that only 56% of patients who were employed prior to admission to intensive care medicine returned to work 12 months after discharge. Those who returned to work had a positive association between work and psychosocial health, including improvements in health-related quality of life and symptoms of depression

  • McPeake J.
  • Mikkelsen ME
  • Quasim T.
  • et al.

Return to employment after critical illness and its relationship to psychosocial outcomes. A systematic review and meta-analysis. Patients seriously ill from COVID-19 infection appear no different; The emerging literature shows that in both the UK and the US, patients reduced their return to work due to COVID-19 infection in the months following hospitalization

  • Chopra V.
  • Flanders SA
  • O’Malley M.
  • Malani AN
  • Prescott HC

60-day results in patients hospitalized with COVID-19., 4

  • McCue C.
  • Cowan R.
  • Quasim T.
  • Puxty K.
  • McPeake J.

Long-term outcomes of critically ill COVID-19 pneumonia patients: early learning.While combining employment and social counseling into a single recreational pathway dedicated to physical health may seem unrealistic, previous evidence suggests that integrated services that focus on broader social structures are feasible and effective. For example, the introduction of colocalized social counseling services in several health care facilities in England, UK has been linked to improvements in patient wellbeing and mental health, in addition to a reduction in measurable financial burdens

  • Woodhead C.
  • Khondoker M.
  • Lomas R.
  • Raine R.

Impact of in-place social counseling in health care: prospective quasi-experimental controlled study. This approach has also proven useful and acceptable to patients and caregivers in restoring critical care. 6

  • McPeake JM
  • Henderson P.
  • Darroch G.
  • et al.

Social and economic problems of survivors in the intensive care unit, which were identified through structured social counseling. Support can take the form of social and rehabilitation staff who take part (in person or virtually) in follow-up services or who have clear referral channels.

Providing person-centered, integrated care after a severe COVID-19 infection is critical. However, to be truly effective, care needs to transcend health and social boundaries to ensure that major socio-economic inequalities are not exacerbated. We would suggest that these healthcare facilities that offer specialized COVID-19 recovery services are well positioned to provide this integrated, holistic care.

We do not declare any competing interests. JM is funded by a research grant (PD-2019-02-16) from the THIS Institute at the University of Cambridge, Cambridge, UK.

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Article information

Publication history

Published: February 05, 2021

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DOI: https://doi.org/10.1016/S2213-2600(21)00019-9

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© 2021 Elsevier Ltd. All rights reserved.

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Linked articles

  • Providing holistic care after severe COVID-19 pneumonia – authors’ response
    • We are grateful for the opportunity to respond to correspondence from Joanne McPeake and colleagues highlighting the socio-economic challenges faced by critical disease survivors, particularly with regard to returning to work. As the authors describe, these difficulties are undoubtedly applicable to the post-COVID-19 cohort. Indeed, the COVID-19 pandemic has increased existing social inequalities, making the economically disadvantaged more vulnerable to COVID-19 exposure and mortality, as well as adverse effects on employment.

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  • Providing Holistic Care for Severe COVID-19 Pneumonia: Anticipating Clinical Needs and Managing Resources
    • The COVID-19 pandemic continues to pose extraordinary challenges for doctors, patients and health services around the world. In anticipation of considerable stress from multisystem and psychological morbidity, many organizations have set up clinical services after COVID-19. An exponential increase in the number of cases at the height of the pandemic required the rapid implementation of follow-up pathways that evolved in response to clinical needs and in the absence of robust COVID-19 specific data by extrapolating post-critical disease evidence and observations during previous coronavirus outbreaks made.

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