The complicated rehabilitation after severe cases of COVID-19

Because the new coronavirus affects different organs, specialists must work interdisciplinarily in the rehabilitation of patients, explains German doctor Andreas Dösch to DW.

DW: Prof. Dösch, your clinic also treats COVID-19 patients who have survived a very severe course of the disease. What is special about the rehabilitation of these patients?

Andreas Dösch: The special thing about COVID-19 is that it not only affects the lungs. It is a multi-system disease and we learn something new every day. Although pulmonary symptoms are primary in many patients, there are also, for example, patients in whom the heart is affected. Or there are neurological complications, kidney changes, or skin complications.

Something that requires close contact between doctors and patients. This means that patients must be treated by different specialists in an interdisciplinary way. It is a great effort, because the patient must be fully understood.

The patients who survived this serious disease in intensive care, were in some cases in a coma for several days and then, after an initial healing phase, they come to you and have to be completely rehabilitated. Where does it start?

Before reaching us, patients receive early mobilization during the intensive care process and, if necessary, afterwards in the control room. We also see patients after discharge from the hospital.

In order for us to work effectively with the patient, certain minimum exposure criteria must be met. Some of the patients continue to receive oxygen and we have to discuss the process and where to start very carefully with patients. The goal is clearly to improve breathing difficulties. We try to increase the strength of the respiratory muscles and improve overall endurance.

And then patients can slowly return to their normal lives?

As a specialized clinic for pulmonary rehabilitation patients, we naturally have a lot of experience with patients with severe pulmonology. However, one should not think that these are all very sick patients. The courses are very different.

The infection can take any form, from an asymptomatic course to treatment in the intensive care unit. The most important thing is that we adapt our measurements to each patient. This includes evaluating what the patient can achieve. Not everyone is bedridden, some may already move around the room or can climb one or two stairs. We have to take this into account when choosing measures.

For example, we have patient-friendly exercise programs, from a single course, where patients first learn to maintain balance, to sequential training, that is, more sporty exercise therapy. This has to be related to the general state. We also offer respiratory gymnastics at various performance levels. We assemble this individually for the patient.

Aside from helping the lungs, what can rehabilitation do for the other affected organs?

The cardiovascular system must also be examined as part of the procedure. This includes an electrocardiogram and ultrasound cardiography. In the laboratory, blood samples are analyzed for certain enzymes that tell us something about cardiac burden.

In this way we can take therapeutic measures to improve blood pressure. High blood pressure, in addition to diabetes mellitus and certain cardiovascular and lung diseases, kidney disease or cancer, are also a risk factor for severe COVID-19 courses. Obesity is also a risk factor. Therefore, we try to understand and treat the patient in its entirety.

This can range from monitoring blood pressure to a nutritional medical consultation or weight loss therapies. It can also include established concepts to quit smoking. All this makes the treatment very complex. Not only medical knowledge is required, but the advice of physical therapists, dietitians, or speech therapists plays an important role. COVID-19 has also been shown to cause typical odor and taste disorders. We are also working with the supervision of otolaryngologists.

How long does this rehabilitation last?

It can take three to six weeks, depending on the patient's progress, previous illnesses, and the course of the illness. So far, we have cared for about 30 coronavirus patients at our hospital. The vast majority of them, over 80 percent, have shown a clear improvement in their symptoms over the course of rehabilitation.

Based on your experience with the course of the disease, what should we all consider?

My recommendation is to take the disease very seriously and respect the recommended protection measures and contact restrictions.

We have not only risky patients in the clinic, but also some young people who are in the prime of their lives without any previous illness. It is extremely important that we continue to be able to control the course of the disease. But for this, it is important that we apply the current recommendations.

Prof. Dr. Andreas Dösch is Chief Physician of Internal Medicine, Cardiology and Pulmonology at Asklepios Klinik in the German city of Bad Salzungen (Thuringia). Its main objective is the rehabilitation of patients suffering from chronic obstructive pulmonary disease or lung cancer. Since the onset of the new coronavirus pandemic, it has also treated numerous patients with COVID-19. Dösch is also engaged in social medicine, nutritional medicine, and metabolic disorders.

Source: Fabian Schmidt for DW