The celebrations are inspiring and newsworthy, as video captures patients leaving the hospital after weeks of fighting COVID-19 and finally reuniting with their loved ones. Yet for many of these people, they’ve come a long way and likely still have a long way to go in their recoveries.
“We say that for every day you’re down with a serious illness like COVID-19, it takes 3 days to get back to where you were before you got sick,” said Mary Russell, DO, medical director at TIRR Memorial Hermann–The Woodlands and assistant professor of physical medicine and rehabilitation at The University of Texas Health Science Center at Houston (UTHealth). TIRR Memorial Hermann, with its main hospital located in the Texas Medical Center, offers inpatient rehabilitation for people who have experienced a life-altering injury or illness. With the pandemic, the hospital has seen its share of patients who require rehabilitation from COVID-19 and what the U.S. Centers for Disease Control & Prevention calls “post-COVID conditions.”
Dr. Russell says the most common conditions following a COVID-19 infection, especially in patients who have been hospitalized for several weeks, include blood clots, pressure wounds, weakness, low energy reserves and fatigue, and dysregulated blood pressure that can cause light headedness and instability. She says some patients also have critical illness myopathy, characterized by profound limb and lung weakness from being immobile for an extended period.
“Proning patients, or laying them on their stomachs, to help with breathing during the acute phase of COVID-19 creates some problems that need to be corrected to restore function and reduce the pain that can sometimes accompany this positioning,” Dr. Russell said. Typically, medications can help with these complications, she notes, but patients often also need a combination of physical, occupational, speech, cognitive and behavioral therapy for 2 to 3 weeks after being discharged from the COVID-19 unit or ICU.
Carolina Gutierrez, MD, a physician affiliated with TIRR Memorial Hermann who specializes in physical medicine and rehabilitation, especially for cancer patients, says even patients who were not hospitalized during their infection may benefit from the intense daily inpatient rehabilitation necessary following this type of infection.
“Usually, our patients have 3 hours of rehabilitation a day, 6 days a week” Dr. Gutierrez said. “We break those 3 hours into shorter sessions, but inpatient rehabilitation focuses on restoring function with a goal of independence for the patients.”
Physical therapy helps strengthen muscles weakened and stiffened by immobility. It also helps improve cardiovascular and respiratory function, mobility and walking, which can be lost through the disease process and ventilator usage. It also increases endurance that is diminished by weakness, decreased energy and fatigue.
Occupational therapy, Dr. Russell points out, helps rebuild upper body strength and restores the ability to perform the activities of daily living, such as eating, dressing, bathing, cooking and using the bathroom.
Speech therapists also work with recovered COVID-19 patients to help them overcome swallowing problems that can occur following extended sedation, feeding tube placement or ventilator usage. Speech therapy also helps patients strengthen their weakened voices, which often occurs when one is unable to take deep breaths to produce sound.
Cognitive therapy helps with deficits that can occur if the virus has affected the brain, as with stroke or encephalopathy, Dr. Russell says. Dr. Gutierrez compares that lost cognition to “chemo brain,” which cancer patients describe as a “fogginess” when trying to think or recall events from their short-term memory.
Dr. Gutierrez notes that behavioral therapy from mental health professionals helps patients overcome depression and anxiety that can occur from prolonged illnesses, like COVID-19. Survivors often cannot recall substantial amounts of time during their illness and realize their bodies and minds have been impacted by the virus.
“Our team understands that these patients face a long journey, with lingering impairments, so we celebrate their progress,” Dr. Gutierrez said. “After spending several weeks with us, they often continue therapy at one of our outpatient rehabilitation centers and see us for their follow-up at our medical clinic.”
“It’s good to know that fewer cases of COVID-19 are requiring hospitalization now that the vaccine is available,” Dr. Russell said. “The best way to prevent these lingering effects is to protect yourself from severe disease.”