COVID-19 patients treated in Mater Dei Hospital’s intensive treatment unit are experiencing symptoms of post-traumatic stress disorder six months after being discharged, according to the preliminary results of new research.
The ongoing study of the general and mental health of 200 ITU survivors has so far found that former patients are experiencing anxiety and depression as part of the long-term effects of critical illness due to the coronavirus.
One of the researchers, Denise Mifsud Bonnici, said the PTSD symptoms may have been connected to the environment that patients had to endure.
“PTSD, anxiety and depression could be the result of having to manage COVID in a particular way, with doctors in PPEs [personal protective equipment] and patients unable to see anyone’s face, including those of their relatives,” Mifsud Bonnici, a resident specialist in anaesthesia and intensive care, said.
The final results of the study – among the first worldwide into the long-term effects of critical illness due to COVID – could be important in informing future treatment and after-care for all ITU survivors.
“While measures to stop infection cannot be changed, we learned to improve things as we went along, such as having WhatsApp calls at crucial times in their treatment.”
In the case of COVID patients, the study could inform changes in anything from nursing care to pulmonary rehab and, possibly, psychological and psychiatric assistance, Mifsud Bonnici said.
PTSD is an anxiety disorder caused by very stressful or frightening events and symptoms can develop weeks, months or even years later.
Mifsud Bonnici described as “significant” the degree of quality of life impairment six months on from hospital discharge but said she had to wait for the statistical analysis to quantify it.
She is one of a group of eight researchers – all intensive care and anaesthesia doctors, involved with COVID patients at the acute phase of their illness – who are conducting the research.
They are attempting to shed light on what happens to the patients who survived acute care, in some cases more than four weeks of intensive care treatment.
The study is expected to be significant globally due to the “excellent” percentage of patient participation the Maltese scenario allows for and the lack of research on the long-term effects of critical illness due to the novel coronavirus.
It is targeting the approximately 200 patients who have survived ITU and, while aiming for 100 per cent participation, it should reach around 90 per cent.
The study capitalises on the fact that Malta has one main hospital, where every patient needing critical care ends up.
Focusing mostly on how the patients are performing at home in everyday life, it has a particular emphasis on mental health issues resulting from the experience.
It is looking into whether they can walk long distances without being short of breath, can carry heavy objects, even get dressed without any assistance and look after themselves in general.
“It is important to know what has happened since the surviving patients left the unit and hospital to go home and how much their life has continued as before,” Mifsud Bonnici explained.
The only physical ailment it is focusing on is acute respiratory distress syndrome (ARDS) that COVID-19 caused, with participants undergoing lung function tests, the results of which have not yet been analysed.
The fact that many of the participants experienced the prolonged use of ventilators for the same illness as a group over a short period of time helps to paint a picture that can eventually be compared to other critical illnesses due to other causes, Mifsud Bonnici said.
So far, of the first 120 COVID ITU patients in Malta, most of the 70 survivors have been interviewed and only a couple have declined while the researchers are confident other logistics can be overcome to reach everyone.
They were interviewed from around six months after they were discharged, with the last patients leaving hospital in January 2021.
The first group is aged bet-ween 38 and 79 and, although the study suggests the younger are recuperating well physically and can return to baseline function, this may not be the case as regards PTSD, Mifsud Bonnici said.
The study could lead to the introduction of early intervention to stem psychological effects and a good follow-up from when patients leave the unit, with a focus on their emotional well-being.
“As soon as they leave, we need to be talking about the psychological affects and how to pre-empt them,” Mifsud Bonnici said.
The virus infection brought about weakness in patients, who had to be weaned off the ventilators and Mifsud Bonnici is not surprised they may not be at baseline function six months later.
Having said that, the patients had suffered an infection and, hopefully, they should return to normal life as in other cases.
“What is becoming clear, however, is that it does not end as soon as they leave the door,” she said.
“We realise there is more to be done and it is important for us to know what happens next.”
While the initial findings may be demoralising, a lot of good has also emerged from the non-scientific aspect, with a “great sense of closure” resulting from the interviews after the team of medics took the patients under their care in the ITU.
From the human angle, it has been “quite rewarding” to speak to them again, Mifsud Bonnici said, adding that they spent the first minutes expressing “eternal gratitude” and asking how they could help.
The last patients should be interviewed in December when the data will be analysed and published before possibly moving on to the second stage of understanding how they are faring one year down the line and to compare their quality of life.