COVID-19 Rehabilitation

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Condition: COVID-19 is a multisystem disease caused by the SARS CoV-2 virus from the Coronavirus family. The disease is being increasingly recognized to have long-term effects, with symptoms persisting beyond 4 weeks, referred to as post-acute sequelae of SARS-CoV-2 (PASC) infection, or more commonly, Long-COVID and Post-COVID syndrome. 

Background: The COVID-19 pandemic started in late 2019 and continues to affect the globe. The virus spreads through the air by large droplets as well as smaller particles (aerosol). These particles generated by coughing can travel several feet and stay suspended in the air for several hours. Spread through contaminated surfaces is considered a less important mechanism.

Risk Factors: The risk of getting infected is associated with close (less than 6 feet) and prolonged (more than15 minutes over 24 hours) contact with persons with active COVID19 during the infective period (10-20 days since symptom onset). Compliance with social distancing and use of facemasks decreases the risk, while attending large gatherings especially within closed areas further increases the risk. The risk of a severe course of disease is related to age greater than 65 years, pregnancy status, medical comorbidities such as diabetes, cardiovascular disease, obesity, chronic lung disease, severe kidney disease, and an immunocompromised status such as transplant recipient, cancer and high dose steroids / immunosuppressants. Vaccines decrease the risk of severe disease.

History and Symptoms: Fever, cough and shortness of breath are the most common symptoms, while loss of smell and taste is among the most striking. Other non-specific symptoms include malaise, diarrhea, headaches and rashes. Severe disease can lead to additional impairments such as “brain fog” and severe generalized weakness.

Physical Exam: A comprehensive exam is required to understand the systems affected, with focus on general, cardiorespiratory, and neuromusculoskeletal systems.

Diagnostic Process: A nasopharyngeal swab sample is tested or the presence of the virus (PCR test). The illness is further categorized as mild (no shortness of breath), moderated (lower respiratory disease with oxygen saturation ≥94% on room air), severe (requiring oxygen greater than baseline), and critical (respiratory or multisystem failure).

Rehab Management: During the acute phase of the disease, the rehabilitation management of COVID19 focuses on mobilization, cardiorespiratory endurance and strengthening as tolerated while maintaining isolation precautions. Continued rehabilitation after prolonged hospitalization is best performed in an inpatient setting with a physical medicine and rehabilitation (PM&R) physician to enable safe return to the community. This care focuses on increasing independence in mobility, daily activities, cognition, nutrition and cardiorespiratory function with physical, occupational and speech therapy, while continuing close medical monitoring with a PM&R physician. Other goals accomplished include patient and family education, mental health optimization and community resources organization for safe discharge. Persons with COVID-19 should be screened after discharge for persistence of symptoms. Persistent symptoms beyond 4 weeks indicate PASC/Long COVID. Continued care by a team, including PM&R physician, primary care physician and other specialists is vital to ensure functional progress, medical stability and optimization of medical comorbidities. Close attention to mental health and facilitating access to self-management resources is key.

Other Resources for Patients and Families: CDC website, NHS website, peer support groups

 

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