Establishing a Peer Support Program for Survivors of COVID-19

A Report From the Critical and Acute Illness Recovery Organization

Aluko A. Hope, MD, MSCE; Andrea (Annie) Johnson, ACNP-BC; Joanne McPeake, PhD, RN; Hali Felt, MFA, Carla M. Sevin, MD; Mark E. Mikkelsen, MD, MSCE; Theodore J. Iwashyna, MD, PhD; Caroline Lassen-Greene, PhD, MS; Kimberley J. Haines, PhD; Sachin Agarwal, MD, MPH; Rita N. Bakhru, MD, MSCE; Leanne M. Boehm, PhD, RN; Brad W. Butcher, MD; Kelly Drumright, PhD, RN; Tammy L. Eaton, MSN, RN, FNP-BC; Elizabeth Hibbert, BPhysiotherapy; Karen Sara Hoehn, MD, MBE; David Hornstein, MD; Heather Imperato-Shedden, MSW, LCSW; James C. Jackson, PhD; Janet A. Kloos, PhD, RN, APRN-CCNS; Anna Lewis, MSW, LCSW; Joel Meyer, MB, BCh, DM; Ashley Montgomery-Yates, MD; Veronica Rojas, MsC; Christa Schorr, DNP, RN; Dorothy Wade, PhD, MS; Cydni Williams, MD


Am J Crit Care. 2021;30(2):150-154. 

In This Article

Abstract and Introduction


Estimates from the coronavirus disease 2019 (COVID-19) pandemic suggest that about 20% of adults with COVID-19 are hospitalized, and in approximately 20% of those, severe acute respiratory failure develops that requires life-support treatments such as invasive mechanical ventilation.[1,2] Results of research from before the COVID-19 pandemic suggest that most of these adults with critical illness will survive to hospital discharge.[3,4] Survival, for many, will come with a legacy of new or worsening deficits in physical,[5] mental,[6,7] or cognitive health in the months to years after hospital discharge.[8,9] Post–intensive care syndrome has become the agreed-upon term for these new or worsening health problems that can persist beyond an acute hospitalization for serious illness.[8]

The psychosocial outcomes in survivors of critical illness include high rates of clinically significant anxiety,[10] depression,[11] and posttraumatic stress symptoms.[12] Related, many survivors are unable to return to work[13] and thereby suffer financial consequences that further the distress of survivors and their loved ones;[14] income loss by both the survivor and family members who curtail work to serve as caregivers may contribute further to their collective psychological distress.

The multiple challenges of providing recovery-focused care in the intensive care unit (ICU) during the pandemic, along with the stigma and social isolation unique to COVID-19 survivors, may contribute to a high level of psychological distress in COVID-19 survivors.[15] Urgent innovation is needed to mitigate psychosocial distress among COVID-19 survivors. In this review, we leverage the growing expertise within the Critical and Acute Illness Recovery Organization (CAIRO), an international multi-disciplinary organization committed to improving the quality of life of patients and families after critical illness, to (1) define peer support and provide a vision for its potential role in COVID-19 recovery and (2) summarize key strategies for developing and sustaining a peer support program during the pandemic.