In Depth

Coronavirus: what we know about recovery

Outcomes are worrying for those Covid-19 patients admitted to intensive care

Boris Johnson has spent a second night in intensive care battling the new coronavirus.

Downing Street said the prime minister was “responding to treatment” and remained clinically stable in St Thomas’ Hospital in London.

Dominic Raab, the UKs de facto leader in Johnson’s absence, said he is “confident he’ll pull through”.

“If there’s one thing I know about this prime minister, he’s a fighter. And he’ll be back at the helm, leading us through this crisis in short order.”

What are the recovery rates for the new coronavirus?

The vast majority of people who get the new coronavirus will make a full recovery.

England’s chief medical officer, Chris Whitty, has said the ultimate mortality rate will prove to be 1% or lower. By contrast, the death rate for common flu is 0.1%.

A huge number of coronavirus infections have not been confirmed by testing, with many people staying at home if they have mild symptoms rather than going to hospital. Even more people may have been infected but not noticed, because the disease can be asymptomatic.

As Dr William Hillmann, from Massachusetts General Hospital in Boston, says in The Guardian: “Coronavirus is actually quite a significant spectrum of symptoms, from people who are entirely asymptomatic and would have no idea that they have it to people with very mild, cold-like symptoms – runny nose, congestion, sore throat – to people with more flu-like symptoms – high fevers, muscle aches, shortness of breath and cough.”

But once someone has been admitted to an intensive care unit (ICU), outcomes are more concerning. 

The Intensive Care National Audit & Research Centre (ICNARC) examined the outcomes of 2,249 patients admitted to ICUs with coronavirus in the UK.

Of those, around 690 had an outcome – meaning they had been discharged from ICU, or had died. Around half of those 690 died.

“Of the 2449 patients, 346 patients have died, 344 patients were discharged alive from critical care and 1559 patients were last reported as still being in critical care,” says the report.

Figures are more concerning for those put on a ventilator within 24 hours of admission to ICU. Of these patients, just 32% survive.

Of the 690 patients with known outcomes, almost all received support for their heart, and 143 received what ICNARC calls “advanced cardiovascular support”, reports Sky News.

“You’re protecting the organs trying to maintain good kidney function, good heart function and so you’re giving fluids, nutrition, trying to prevent secondary complications like new infections, pressure sores,” says Mervyn Singer, professor of intensive care medicine at University College London.

“There’s a whole package of care that needs to be delivered to try and obviously help the patient get over their primary condition. So in this case, lung failure, respiratory failure, but also to try and prevent this domino effect of other organs being compromised.”

As of Saturday, of the 2,449 ICU patients for whom data were available, just 15% have been discharged alive.

The figures appear to be concerning, especially when compared to China, which has more than 73,000 recoveries out of 81,000 cases – an 89% recovery rate. And Italy, which has more than 63,000 infections and 7,400 recoveries – a 12% recovery rate, according to The Telegraph.

But “in reality, these figures aren’t as alarming as they seem”, says the paper. “Early estimates suggest patients recover around 10 days after first falling ill, so it will still be another couple of weeks before our recovery rate begins to increase, as patients begin to improve.”

This pattern is seen in Italy and China, both of which are ahead of the UK in their outbreak progression.

Paul Hunter, professor in medicine at UEA, believes when we come towards the end of the outbreak peak, there won’t be a “big difference” in recovery rates between countries.

“If we start to flatten Boris’s sombrero we could see that recovery rate as a percentage rising sooner,” he said.

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What is it like to recover from coronavirus?

“There’s something called post-intensive care syndrome, which is very, very well recognised. So patients who are critically ill have had the stuffing knocked out of them and it can take actually weeks or sometimes even months to fully recover,” says Mervyn Singer.

It is generally accepted that the more unwell a person is, the longer it takes them to recover. But even young, healthy people who have not been ventilated suffer after leaving hospital.

Faiz Ilyas, 24, was discharged from Bradford Royal Infirmary last week after eight days, including five in the hospital’s ICU. He was not on a ventilator, but told The Guardian: “When I get up and go to the bathroom or go to the garden, especially when I have a shower, I get really breathless afterwards. The doctors gave me exercises to utilise the whole of my lungs. They didn’t give me any timeframe [for getting better].”

Other factors such as muscle wastage and weight loss play a part when a patient has been in ICU.

Dr David Hepburn, an intensive care consultant at the Royal Gwent Hospital in Newport, wrote on Twitter: “If you end up on ITU [intensive therapy unit] it’s a life-changing experience. It carries a huge cost even if you do get better. As our patients wake up, they are so weak they can’t sit unaided, many can’t lift their arms off the bed due to profound weakness. They need to be taught to walk again, breathe again, and have problems with speech and swallowing.”

And an underestimated effect of being in ICU is the psychological impact. Illnesses from depression to post-traumatic stress disorder (PTSD) are associated with time spent in an ICU.

Patients can suffer hallucinations coming out of sedation, which can cause upsetting flashbacks at a later date, says the Guardian.

“They get better in time but it may take a year and needs an army of physiotherapy, speech and language, psychology and nursing staff to facilitate this,” said Hepburn. “The few weeks on a ventilator are a small footnote in the whole process.”

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