Many COVID-19 Patients Will Need Rehab Long After Infection Is Over

• A March study published in the journal Lancet found that hospitalized survivors from China experienced a myriad of ailments after having COVID-19.
• About 42 percent had sepsis, 36 percent had respiratory failure, 12 percent had heart failure, 7 percent experienced acute respiratory distress syndrome, and 7 percent had problems with blood clotting.
• Experts are learning now what kind of rehab these patients will need to fully recover.

New research has found that the novel coronavirus can affect a variety of bodily systems in addition to the lungs. As a result, survivors may have to deal with a wide range of ailments long after the virus has passed.

It can take 6 weeks or longer for patients in critical condition to fully recover, the World Health Organization reported.

Those who were treated in the ICU may need help gaining mobility again even after the virus has left their system.

Even those never hospitalized for COVID-19 may need to go to rehab to help their injured lungs recover.

Symptoms linger after virus has passed

A March study published in journal Lancet found that hospitalized survivors from China experienced a myriad of ailments after having COVID-19. Of the survivors, just 1 percent were put on ventilators.

Still, 42 percent had sepsis, 36 percent had respiratory failure, 12 percent had heart failure, 7 percent experienced acute respiratory distress syndrome, and 7 percent had problems with blood clotting.

In the United States, the issues could be worse since a higher percentage of people are put on ventilators for longer stretches of time.

A July 2020 multi-state survey conducted by the Centers for Disease Control and Prevention (CDC) looked at symptomatic adults who tested positive for COVID-19 on an outpatient basis. Of them, 35 percent were not back to their usual health at 2 to 3 weeks after testing. Among those ages 18 to 34 with no chronic medical issues, 1 in 5 reported they were not fully recovered.

How an ICU stay can affect the brain

Doctors typically focus on improving physical strength and respiratory function in those were hospitalized. Lung, liver, gastrointestinal, kidney, and respiratory issues are common side effects of the coronavirus, especially in those who were older or had severe cases. But they aren’t the only issues survivors face.

“After having COVID-19, it’s very difficult for some patients to think clearly, to process things,” said Dr. E. Wesley Ely, co-director of the Vanderbilt University Medical Center’s Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center in Nashville, Tennessee.

The center studies intensive care unit (ICU) patients to understand the effects of delirium, which causes vivid hallucinations and delusions. Many patients have a hard time with executive functions such as paying attention and organizing information.

The CIBS Center has several studies looking at COVID-19’s effect on cognitive function, depression, post-traumatic stress disorder, brain health, and more. The center is also evaluating a new drug for ICU delirium.

Patients with COVID-19 can remain in an ICU far longer than the average of 3 to 4 days. Physicians report patients being on ventilators in the ICU for weeks or even months in some cases.

This puts them at a greater risk for post-intensive care syndrome (PICS), which is characterized as the physical, cognitive, and psychological changes that happen after an ICU stay.

Doctors are seeing PICS in COVID-19 survivors who were hospitalized — and in those who were not.

Delirium is sometimes seen with patients who need ventilators or sedation, but “anecdotally, the delirium has appeared worse for many patients with COVID-19,” Katharine Seagly, PhD, a clinical neuropsychologist and an assistant professor of physical medicine and rehabilitation at Michigan Medicine, noted in a statement.

The mental toll of a serious illness

Depression and sadness are common in people with PICS, but Ely is seeing it in COVID-19 survivors, who also report trauma and nightmares.

“All of these can happen to people who weren’t ever hospitalized,” Ely said. “It’s worse if you were.”

Some mental health issues may be due to isolation many survivors faced, but there may be biological links to blame.

Even minor symptoms of the disease can take a toll. Loss of taste and smell is a common symptom of the virus, and usually returns quickly — but not always.

“I’ve heard of some who got them back within a week, others still haven’t recovered after more than three months,” said Dr. Otto Yang, a physician at UCLA Health.

Rehabilitating after COVID-19

As a result of the ailments, many coronavirus survivors will need rehabilitation. But with a variety of conditions that can arise from a serious viral infection, people may need help from a variety of specialists including physical therapists, occupational therapists, speech therapists, and rehabilitation psychologists.

“The complexity and variability of the damage caused by COVID-19, coupled with the pre-existing disabling long-term conditions that many patients will have, means that there is no single, COVID-19 specific method to determine the need for rehabilitation,” Dr. Derick Wade, a neurorehabilitation professor at Oxford Brookes University and author of a report on post-COVID-19 rehabilitation wrote in Clinical Medicine Journal.

Patients who stayed in an ICU may have physical weakness, which can damage the nerves and muscles in the body, Dr. Sean Smith, an assistant professor of physical medicine and rehabilitation at Michigan Medicine, said in a statement.

That can make it hard to walk or do everyday activities, and they wind up needing rehabilitation.

Ely said weakness is common in those even without severe cases, or those without symptoms.

Some hospitals have rehabilitation teams dedicated to helping coronavirus patients, such as the program at Massachusetts General in Boston. They are focused on getting the patients up and moving as soon as possible to offset issues from being immobile.

“Bed rest is one of the worst things that can happen to the body’s musculoskeletal and nervous systems,” Smith said.

Inpatients being treated for COVID-19 should be mobilized as soon as it’s safe, he noted.

“We know from other diseases that cause ICU-level hospitalizations and neurologic disorders that the more — and earlier — rehabilitation occurs, the better the outcome,” Smith added.

Jason Kindrachuk, PhD, an assistant professor of viral pathogenesis at the University of Manitoba in Canada, said doctors don’t know much about long-term recovery from COVID-19.

“Unfortunately we are still in the early stages of COVID-19 in North America and recovered patients from the first waves of transmission are still providing early information on what recovery from COVID-19 looks like,” Kindrachuk told Healthline.

With the outbreak less than a year old, even experts are at a loss for what long-term issues will occur for people who recovered from early cases of COVID-19.

Amira A. Roess, PhD, a global health and epidemiology professor at George Mason University, said evidence from the SARS infection showed patients had long-term respiratory issues and other ailments.

That data can help us understand COVID-19, but it will still take time for experts to understand exactly the long-term consequences of COVID-19.

“There are long-term consequences of this disease that we simply won’t know about for a few more years,” Dr. Roess added.

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