COVID-19 Update: Virus' Next Victims,
Life After the ICU

June 18, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.  

Here are the coronavirus stories Medscape's editors around the globe think you need to know about today.

A "Crisis" for Primary Care Doctors

The pandemic is hurting patients — and physicians — in multiple ways.

Tom Frieden, MD, MPH, former head of the Centers for Disease Control and Prevention, believes that primary care in the US is now in deep trouble, with its long-standing financial problems exacerbated by the fallout from the COVID-19 pandemic. 

He discusses these concerns with Kenny Lin, MD, MPH, a family physician and professor at Georgetown University School of Medicine and a regular contributor to Medscape.

"Without additional help from Congress, tens of thousands of primary care physicians could go out of business in the coming weeks. This is a crisis, and this will be very hard to rebuild," Frieden tells Lin. 

Post-Intensive Care Syndrome

Up to 80% of patients leaving the intensive care unit have documented a constellation of physical, cognitive, and psychiatric symptoms and doctors now fear that COVID-19 patients who have spent a significant amount of time in critical care will suffer similar consequences.

In short, the life they return to often looks nothing like the one they had before their illness — a phenomenon that has now been termed post–intensive care syndrome (PICS).

Some of these symptoms are thought to be because of the gravity of the illness, but others are believed to be the result of prolonged mechanical ventilation and the heavy sedation that often accompanies it.  And although the trouble starts in the critical care unit, it only becomes clear once patients leave.

"We're aware that survivorship issues are coming. There's going to be a wave of sick people who survived the coronavirus but are going to need more help," Gerald Weinhouse, MD, codirector of the Critical Illness Recovery Program at the Brigham and Women's Hospital in Boston, said.

Healthcare Workers "Still Scared"

In the US and worldwide, nurses, doctors, and other healthcare workers are taking stock of the psychological toll of the fight against COVID-19 — while fears of a 'second wave' also lurk in the back of their minds.

A study of 1200 Chinese hospital workers found 50% reported symptoms of depression and 44% reported signs of anxiety amid the outbreak there. Ensuring the mental health of frontline healthcare workers is critical to the world's recovery following this pandemic, the United Nations has said.

At one New York hospital, workers talk about how terrifying it felt early on, not knowing whether they would have enough protective gear. One endured his own case of COVID-19, and others saw young and healthy people like themselves get critically sick. Colleagues discussed drawing up wills.

"We're still in that grieving, recovery phase, but also, we know that time is critical before the next mini-surge or before the next peak," says Eric Wei, an ER physician who also oversees quality-improvement initiatives for New York City public hospitals.

Why Coronavirus Parties Are a Bad Idea

Current data suggest that about 80% of patients infected with COVID-19 do not get severely ill, so the concept of 'coronavirus parties' along the lines of 'chickenpox' and other parties — where people gather to deliberately try to infect themselves — has come to the fore recently.

However, there are numerous reasons why this is a very bad idea, says pediatrician Charlotte A. Moser, MD, in a perspective for Medscape.

First, the duration of immunity and protection from reinfection remain unknown, so intentional exposure may not lead to long-term immunity nor protect against reinfection — "the very goals of the action," she notes.

Second, intentional exposure also has community implications because neither presymptomatic nor asymptomatic transmission have been ruled out. So people with mild illness can transmit COVID-19 to others, who then become severely ill and, in some cases, die, she cautions.

Low Dose Radiation May Reduce Lung Inflammation

Low-dose chest radiation, usually given in a single treatment, may reduce inflammation in the lungs of severely ill COVID-19 patients enough to wean them off a ventilator or avoid it altogether. Several clinical trials of the treatment are underway or launching in the US and elsewhere, including Italy, India, Iran, and Spain.

The radiation is thought to positively impact the so-called "cytokine storm" that occurs in some patients who are severely ill with coronavirus, and is "another tool to try," says William Small Jr, MD, chair of the Radiation Oncology Commission for the American College of Radiology.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. More than 1500 throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

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