The legacy of COVID-19 on critical care—Is there an upside?

The world changed for critical care practitioners in March 2020. For many, it began with a warning from colleagues in Italy. A social media message, which went viral, warned, “The current situation is difficult to imagine…Our hospitals are overwhelmed by COVID-19,” and it cautioned, “Don’t make the mistake to think that what is happening is happening in a 3rd world country.” It concluded, “My friends call me in tears because they see people dying in front of them and can only offer some oxygen. PLEASE STOP, READ THIS AGAIN AND THINK.”

Similar stories of fear and uncertainty, of hopelessness and exhaustion, emerged from subsequent epicenters. At the same time, the situation brought forth a sense of urgency to act, prepare, and, once the cases arrived, do our best to care for an unprecedented deluge of patients experiencing, and suffering from, severe respiratory failure. So many (too many) patients died, especially in those initial waves.

For our international critical care community who lived through this time, what is the legacy of the pandemic? The story, as is often the case, is an evolving one. The first wave enacted a significant toll on the mental well-being of critical care health care professionals. In a cross-sectional survey of European intensivists, 46%, 30%, and 51% of physicians experienced symptoms of anxiety, depression, and severe burnout, respectively. The impact of the pandemic worsened with subsequent waves and was felt across critical care health care professionals. Through interviews, we learned that the impact of the pandemic mapped closely to Maslow’s hierarchy of needs. Hungry, fatigued, unable to take breaks, and often scared, clinicians reported feeling exhausted—or worse, given the threat to their basic physiological and safety needs. Above the basic needs of Maslow’s hierarchy are psychological needs, including love, belonging, and esteem. At the top of the hierarchy is self-actualization, the opportunity to achieve one’s full potential, which relates to concepts of resilience and posttraumatic growth.

Meeta Prasad Kerlin, Mark E Mikkelsen