When Ayub Ali, 55, a COVID patient, thought of returning to work after getting discharged from hospital, he realized that he could not walk even small distances without his heart rate increasing. He had to be readmitted to hospital. Ayub has a family history of heart disease, but did not have a pre-existing condition. He had borderline diabetes and hypertension. "The echo was okay, but a CT Chest revealed that I had developed lung fibrosis," says Ayub Ali. He says he is not alone. Some of his friends who recovered from COVID-19 also had to come back to the hospital emergency with complaints of breathlessness and chest pain.
"After recovering from COVID-19, some of the patients come in with reduced heart function and heart attack or even stroke. This could be owing to the damage to the small vessels caused by COVID-19 that leads to excessive clotting during the course of the disease," says Dr Afsana Begum, Internal Medicine Consultant at United Hospital. COVID-19 is known to attack the endothelial cells that line the blood vessels, leading to clotting across the body.
"After the acute phase of COVID-19 is over, patients come back to hospitals with varied symptoms such as shortness of breath, lethargy, body aches, itchy throats, skin rash and joint pain even four to six weeks later. Patients also have severe weakness with loss of appetite and smell, leading to anxiety and depression," says Dr Afsana.
"We have got patients who have recovered from coronavirus disease (COVID-19) coming back to the hospital with low oxygen saturation and secondary infections", says Dr Rawshan Arra Khanam, Consultant Pulmonologist of United Hospital. The most common sequelae, that doctors have seen in patients who have recovered from severe symptoms of COVID-19 is residual lung fibrosis, wherein the lung capacity decreases as the lung tissues harden after healing from an injury.
"I have found almost all hospitalized COVID-19 cases to be associated with rehabilitation needs related to the consequences of prolonged oxygen support, immobilization and bed rest. They experience varied degrees of impaired physical and respiratory function, as well as psychosocial challenges, as a result of the illness and hospitalization. These may include impaired lung function, physical deconditioning and muscle weakness, delirium and other cognitive impairments, impaired appetite and psychosocial support needs. There is a need for post COVID rehabilitation in such patients which may be amplified by underlying health conditions and decrements in health, associated with ageing," says Dr Rawshan.
United Hospital post COVID Rehab program is designed with careful crafting of pre-assessment and post-assessment Consultations of Pulmonologist, Physiatrist and Nutritionist, along with necessary investigations at different times to assess the status and progress, coupled with rehab sessions for restoring breathing adequacy and functional normalcy. The program ends with the caregiver and the patient coming together to an agreed consensus on the progress achieved through the rehab sessions, closing the program with a certificate.
In COVID-19, the virus disproportionately affects the fragile elderly and those who are overweight or obese with diabetes and hypertension. Further many of COVID patients quickly deteriorate, meaning they require immediate respiratory assistance, hence most stop eating as soon as they get admitted to the hospital and demonstrate inability to tolerate oral nutrition support. Clarifying the role of nutrition support in post COVID rehab, Ms Chowdhury Tasneem Hasin, Chief Nutritionist of United Hospital says, "for these patient groups, lack of enough nutrition support during the disease journey takes its toll to which respiratory difficulties add an extra layer of complexity, preventing patients from eating effectively. It is difficult to keep these patients in a stable condition unless the nutritional balance is appropriate and timely nutrition support continues even post COVID".
Dr Naima Siddiquee, Physical Medicine & Rehab Specialist of United Hospital says, "the post COVID Rehab program has documented improvement in the health outcomes of COVID patients with reduction of complications associated with hospital stay, as the program aims to optimize the patient's recovery and reduce the experience of disability".
Rehabilitation interventions can help address many consequences of severe COVID-19, including physical, cognitive, and nutrition impairments, and also provide psychosocial support. For older patients, and those with pre-existing health conditions, being more vulnerable to the effects of severe illness, post COVID rehab can be particularly beneficial for maintaining their prior levels of independence. This program also helps to ensure patients do not deteriorate following hospital discharge and require readmission.