Patients with ARDS, COVID-19 face significant financial effects in
recovery
Long hospitalizations lead to large medical bills, with serious physical
and emotional consequences for those recovering from critical illness

Date:
June 3, 2020
Source:
Michigan Medicine - University of Michigan
Summary:
Researchers have been investigating the downstream effects of
acute respiratory distress syndrome, or ARDS, for years. As the
COVID-19 pandemic rages on, their work has relevance for hundreds
of thousands of new patients.



FULL STORY ==========================================================================
It begins with shortness of breath. And for approximately one third of patients, acute respiratory distress syndrome, or ARDS, ends in death. For those who survive, their lives are often turned upside-down. Michigan
Medicine researchers have been investigating the downstream effects of
ARDS for years.

As the COVID-19 pandemic rages on, their work has relevance for hundreds
of thousands of new patients.


==========================================================================
"The way COVID-19 kills patients is by depriving them from oxygen,"
says Theodore (Jack) Iwashyna, M.D., professor of critical care
medicine. "But only a third or fewer of COVID-19 patients who develop respiratory failure die. Most survive, and we need research that helps
them not just survive but really heal." A team led by Iwashyna wanted
to look more closely at how being hospitalized for ARDS affected people
months after they were discharged. They interviewed dozens of patients
from around the nation. "As we knew from past research, people had new disabilities ranging from general fatigue and weakness to where they
couldn't remember things," says Katrina Hauschildt of the U-M department
of sociology and first author on the study. "A lot of people had emotional difficulties coming to terms with just how sick they had been -- a kind
of PTSD from being in the ICU." "What I didn't expect," says Iwashyna,
"was the lasting chaos into which surviving respiratory failure threw
some of our patients and their families.

Patients described problems coming not just from medical bills --
although there were plenty of those -- but also from losing their jobs
and losing their insurance." Given the magnitude of recession hitting at
the same time as patients are trying to recover from COVID-19, Iwashyna
and Hauschildt are worried this could be devastating for many families.

One 55-year old man described having to give up his small business
because he could not work after getting out of the intensive care unit
(ICU). "I had to sell my business. I'm on disability now...I owned a
fire prevention company...We used to clean the kitchen exhaust systems in restaurants throughout the state. Degreased the restaurants, like their
exhaust hoods in the kitchen and on the roof...Yeah, I sold everything."
The team found that many respiratory failure patients experience what
is known as financial toxicity, defined as the financial burdens and
related distress of medical care. In turn, this financial toxicity led
to additional negative effects on their physical and emotional recovery.



==========================================================================
With hospitalization for ARDS often resulting in weeks of high intensity
care, patients end up with medical bills ranging from tens of thousands
to, in some cases, millions of dollars, and the proportion covered by
insurance varied substantially.

One 49-year old male survivor of ARDS told the study team "I barely
make it, or my bills are pending like electricity, things and other
stuff." Said another 55-year old woman "I had to pay my rent, my food
and medicines and all that so I was a little bit short ... They were
kind of difficult to pay after the hospital ... Because I had to get
more medicines and all that." The team reported several consequences of hospitalization including emotional distress related to insurance issues
and unpaid bills, reduced physical well- being due to the inability to
receive follow-up care due to cost, an increased reliance on family and
friends to help cover expenses and other material hardships. Said one
patient: "In the next couple of months, I may end up being homeless
because of the financial aspect of it." While these cases may seem
extreme, they were not rare. And many patients described having to
make hard choices about whether they could afford rehabilitation --
and stopping early when their coverage ran out, even though they were
not yet recovered. A 51-year old man told the study team "[Physical
therapy] was very short, a couple weeks maybe; then it was over, and I
just laid around basically. My insurance did not cover any more, so they
had to cut me." Another patient, a 61-year-old woman, described not
having the equipment when she tried to go home: "I could pick one item
that I wanted," of the hospital bed, wheelchair, and walker she needed, "because the insurance would only pay for one item." Hauschildt says the
study outlines the need for doctors to be more aware of the financial
toxicity faced by survivors of ARDS, including those recovering from
COVID-19. "One of the biggest things any doctor involved in follow up
care can do is anticipate that patients might have real financial burdens
and know what resources are available so they can help," she adds.

However, she notes, what's available is really up to policy makers. For example, the study found that patients who were already on public
insurance before their illness reported less of an out-of-pocket
financial impact.

"Communities that put a safety net in place for ARDS and COVID-19
survivors will ultimately have better healing and recovery. People
who heal are able to return to work and care for others and their
communities; people who don't aren't." This work was supported by the
National Institutes of Health, National Heart, Lung and Blood Institute as
part of the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network. The patients who participated in these interviews gave their
consent for their words to be quoted, and were all about nine months
after having had moderate to severe ARDS.


========================================================================== Story Source: Materials provided by
Michigan_Medicine_-_University_of_Michigan. Original written by Kelly
Malcom. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Katrina E. Hauschildt, Claire Seigworth, Lee A. Kamphuis,
Catherine L.

Hough, Marc Moss, Joanne M. McPeake, Theodore J. Iwashyna. Financial
Toxicity After Acute Respiratory Distress Syndrome. Critical
Care Medicine, 2020; Publish Ahead of Print DOI:
10.1097/CCM.0000000000004378 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/06/200603132559.htm https://www.sciencedaily.com/releases/2020/06/200603132559.htm

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