Patients with ARDS, COVID-19 experience severe economic toxicity

Reviewed by Emily Henderson, B.Sc.June 3, 2020

It starts with shortness of breath. Acute respiratory distress syndrome (ARDS) is fatal in about one-third of patients. For those who survive, their lives are often upside down. Researchers in Michigan medicine have been investigating the downstream effects of ARDS for many years. As the COVID-19 pandemic rages, their studies relate to hundreds of thousands of new patients.

The way COVID-19 kills patients is to deprive them of oxygen. However, less than one-third of COVID-19 patients with respiratory failure die. Most are alive and need research to help them not only survive but really heal. “

Theodore (Jack) Dr. Iwashina, Professor of Critical Care Medicine

The team led by Iwashyna wanted to take a closer look at how people hospitalized at ARDS were affected in the months following discharge. They interviewed dozens of patients from all over the country. “As we knew from past studies, people had a variety of new obstacles, from general fatigue and weakness to the inability to remember things,” says Katrina Housechild of UM Sociology. He says. “Many people had emotional difficulties coming to understand how ill they were-a kind of PTSD from being in the ICU.”

“What I wasn’t expecting was the persistent turmoil that left respiratory failure hit our patients and some of their families. Although patients are not only medical expenses, they have many problems, But also because they lost their jobs and lost their insurance.” Given that patients are trying to recover from COVID-19 and the impact of the recession is great, Iwashina and House Child have found this to be a big deal for many families. I’m worried that it can be catastrophic.

A 55-year-old man explained that he had to give up on small businesses because he couldn’t work after leaving the intensive care unit (ICU). “I had to sell my business. I’m now in a disability… I owned a fire company… We used to be in a restaurant across the state. I was cleaning the kitchen exhaust system. I defatted the restaurant like a restaurant exhaust hood. On the kitchen and on the rooftop… yeah, I sold everything.”

The team found that many patients with respiratory failure are experiencing what is called an economic burden. It is defined as medical distress associated with financial burden. Second, this economic toxicity had an additional negative impact on their physical and emotional recovery.

Hospitalization for ARDS often requires weeks of intensive care, which can cost patients tens of thousands of dollars to potentially millions of dollars, and insurance coverage can vary significantly.

One of ARDS’s 49-year-old male survivors told the research team, “I rarely do or have bills pending, such as electricity bills.” Another 55-year-old woman said, “I was a bit short of money because I had to pay all the rent, food, medicine, etc…after the hospital they were a bit difficult to pay. .. I have more medicine and all of it.”

Teams are required to cover the psychological distress associated with insurance issues and unpaid bills, reduced physical well-being due to inability to receive follow-up care, and family and friends to cover costs and more. He reported several hospitalization results, including increased reliance on material difficulties. One patient said: “In the next few months, I may be homeless because of the financial side of it.”

These cases may seem extreme, but not rare. And many patients said they had to make strict choices about whether they could afford to rehabilitate, and stop early when coverage was exhausted, even if they weren’t recovering yet. A 51-year-old man told the research team.[Physical therapy] Very short, perhaps a few weeks. That’s it, so basically I just lay down. They had to cut me because my insurance no longer covered. “

Another patient, a 61-year-old woman, said she had no equipment when she tried to go home. “Due to insurance, I only have to pay for one item”I was able to choose one I wanted” for a hospital bed, wheelchair and walker. “

Hauschildt says the study outlines the need for physicians to be more aware of the economic toxicity facing survivors of ARDS, including recovery from COVID-19. “One of the biggest things doctors can do in follow-up care is to anticipate that patients may have a real financial burden and know the resources available to help them. “

However, she points out that what is available is really up to the decision makers. For example, the study found that patients who were already covered by public insurance before getting sick had little reported financial impact of out-of-pocket. “A community that has taken safety measures for survivors of ARDS and COVID-19 will eventually improve healing and recovery. Those who heal can return to work and care for others and their community. Yes, but not others.”

This study was supported by the National Institutes of Health and the National Cardiopulmonary and Blood Institute as part of the Prevention and Early Treatment of Acute Lung Injury (PETAL) network. The patients who participated in these interviews agreed to be quoted and had about 9 months of developing moderate to severe ARDS.