For many patients recovering from COVID-19, discharge from the intensive care unit is just the beginning of a long road to recovery. Patients recovering after critical illness may face cognitive and physical changes, including a decline in bodily strength and thinking abilities, requiring comprehensive rehab.

But one of the most critical and seldom discussed issues that may face many of these COVID-19 survivors is the likelihood of unemployment after discharge due to an extended recovery process.

A five-year study, published online Sept. 16, 2017, in the journal Thorax, examined return to work in patients recovering from acute respiratory distress syndrome (ARDS) — a condition common in patients with COVID-19 that causes inflammation in the lungs with fluid buildup in the tiny breathing sacs due to extended ventilation. The study revealed that about 3 in 4 survivors lost earnings, with an average loss of $180,000 over five years.

“Over the five-year follow-up, about one-third of these patients never returned to work. The financial consequences are profound. A couple of weeks in the ICU can be life-altering for patients and their families,” says Dale Needham, M.D., Ph.D., study lead and medical director of the Johns Hopkins Critical Care Physical Medicine and Rehabilitation Program at the Johns Hopkins University School of Medicine.

Results from a one-year, multicenter national study showed that 44% of patients recovering from ARDS did not return to work within one year after their critical illness. The findings of the study showed that among these unemployed patients, 14% lost private health insurance and 16% needed government-funded coverage. Needham, who also co-led this study, notes that those who returned to work subsequently lost their jobs, or could not return to their normal type of work or work hours, compared with before their critical illness. Needham says this is why it is important to implement job-based rehab interventions for patients recovering from ARDS. Such interventions may help patients return to work sooner and even stay employed.

Needham warns that this silent aspect of the pandemic needs more attention before it becomes an unmanageable, yet potentially avoidable problem.

Needham is available for comment on unemployment related to recovery from COVID-19.

For information from Johns Hopkins Medicine about the coronavirus pandemic, visit hopkinsmedicine.org/coronavirus. For information on the coronavirus from throughout the Johns Hopkins enterprise, including the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University, visit coronavirus.jhu.edu.