One night in March 2020, Joy Wu felt like her heart was going to explode. She tried to get up and fell down. She didn’t recognize friends’ names in her list of phone contacts. Remembering how to dial 9-1-1 took “quite a bit of time,” she recalled recently.

Wu, 38, didn’t have a fever, cough or sore throat — the symptoms most associated with covid-19 at the time — so doctors at the hospital told her she was having a panic attack. But later she developed those symptoms, along with difficulty breathing, fatigue and neurological issues.

Wu, of San Carlos, California, believes she had covid — although, like many others who were unable to get tested early in the pandemic, she never got an official diagnosis. And, she said, its aftereffects continue to plague her.

Wu has struggled to get help from doctors, even those who take her symptoms seriously. “There’s no actual treatment,” she said, for people experiencing these lasting symptoms, often referred to as long covid. When seeking help, “you’re basically a guinea pig at this point.”

Patients will survive coronavirus—but that survival will likely come at a cost for some. Research on similar populations suggests that at least 50% of people who survive admission to an intensive care unit (ICU) can be left with what researchers now call “post-intensive care syndrome,” a constellation of emotional, cognitive, and physical symptoms that limit their functioning. Survivors of critical illness can often return to the world with memory problems and difficulty planning and processing that is similar to those with moderate traumatic brain injury or mild dementia. Other survivors experience post-traumatic stress disorder (PTSD), at an incidence ranging from 10% to 50%. Their caregivers, too, will often experience a cluster of adverse outcomes, including anxiety, PTSD, and depression.

Organizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.

In the early days of caring for critically ill patients with acute respiratory distress syndrome, sepsis or multiple organ failure, we were grateful when they survived their illness. We used any interventions we could think of to increase the likelihood of survival. We didn’t really think about what came after patients’ intensive care unit (ICU) experience; we were just happy they survived. However, we came to find out that despite our best efforts, these patients had a high risk of developing delirium and post-discharge sequelae.