Beyond the Ventilator: Recovery and Rehabilitation After COVID-19

While the long-term effects of COVID-19 are still unknown, many patients looking to return to normal life post-COVID are finding this more difficult than expected. Patients who were once in critical condition, and who have come off ventilators, are often referred to rehabilitation centers for a variety of immediate post-COVID support for impairments related to physical, cognitive and mental health.

A team from Spaulding Rehabilitation Hospital and Massachusetts General Hospital—Physical Medicine and Rehabilitation Physicians Jeffrey Schneider, MD, Joanne Borg-Stein, MD, Hannah Steere, MD, and Ginger Polich, MD; Rob Welch, MS, PT, MBA, vice president of Outpatient Services; and Nancy Milligan, RN, MS, manager of the Spaulding Outpatient Medical Clinic in Charlestown, MA—leads a new program dedicated to supporting patients recovering from COVID-19. This program involves a multidisciplinary team, including physical medicine and rehabilitation physicians who hold dual clinical appointments in both Spaulding and the Mass General Department of Physical Medicine and Rehabilitation.

When a patient leaves the hospital, they are typically deemed recovered or recovering, “and for some people that is a very rapid process,” says Dr. Polich. For others it may take a long time to get back to where they were before the virus, and for an unfortunate few, return to baseline may never be reached. 

Potential Barriers in Recovery

Patients recovering from COVID-19 may experience a range of symptoms that impact their everyday function including:

• Pulmonary issues, such as shortness of breath while walking or difficulty taking a deep breath
• Cognitive symptoms, such as inattention, or difficulties with memory or multi-tasking
• Musculoskeletal impairments, such as back pain, or limb weakness due to prolonged prone positioning during ventilation while hospitalized

 “One thing we hear quite often, especially from people who were fairly healthy before COVID-19, is how fatiguing it is to do the simple tasks,” says Milligan. “’I took a shower and then I had to take a nap for an hour and a half.’ That kind of impact in your life in the beginning of recovery is what stands out for most people. It is a marked fatigue.”

The Road to Recovery

A recovering patient’s post-COVID rehabilitation care team will determine the approach to care through a multidisciplinary approach consisting of:

• Physical therapy, to help with issues related to mobility and muscular deconditioning, or weakening of the muscles
• Occupational therapy, to help with activities related to daily life such as attention, memory and multitasking as well as more complex tasks such as paying their bills and planning a daily schedule
• Speech and language therapy, to help with issues that may be the result of the time on the ventilator such as communicating, swallowing and breathing
• Psychologists or psychiatrists, to help with issues such as post-traumatic stress, loneliness from physical distancing requirements during recovery and sleep disturbances

The care team also considers any underlying conditions that were preexisting the COVID-19 diagnosis that may be contributing to a slower and more strenuous recovery process.

For instance, if a patient prior to contracting COVID-19 had a heart condition and, as a result, struggled with cardiovascular endurance, the likelihood of endurance as a barrier to a speedy recovery is that much greater.

“How healthy you are going in certainly can have a great impact on the rate of recovery and your functional status coming out,” says Dr. Polich. “That said, we also have people who were very healthy before they were hospitalized with COVID-19, but might have suffered numerous complications, and thus face a prolonged recovery trajectory.”

Post-COVID Rehabilitation Program at Spaulding

Spaulding Rehabilitation Network has established a specialized program, dedicated to supporting patients who are recovering from COVID-19 after being hospitalized—amongst the first of its kind to appear in the country. When it first launched, the program began as wholly virtual, to abide by physical distancing protocol. Telemedicine, or online visits by computer or phone, continues to be a viable option for some patients seeking treatment and will be recommended by the patient’s care team, as appropriate.

“Some patients are not actually able to come in for a visit quite yet. The energy that it would cost them to come in for an in-person visit might be better spent toward recovery, and we will often, quite successfully, use telemedicine in that case,” says Milligan.

To ensure that the patient has access to a comprehensive system of support, the program is rooted in a multidisciplinary approach and is run by a team consisting of physiatrists, physical therapists, occupational therapists, speech language pathologists and case managers. The team at Spaulding also works with the patient’s primary care physician, and other providers, to ensure the care plan is tailored to the patient’s history, current case and recommended treatment techniques.

 As far as the length of time it takes for a patient to recover, this remains unknown. Spaulding and Mass General are working to collect standardized data to follow the patient recovery from COVID-19 over time to learn more about various recovery trajectories.

“Part of what we are wondering at this point is, is this going to be almost like the old Polio epidemic?” says Welch. “It may seem resolved, but will there be an impact 30 years down the road such as lung issues? Everybody is learning at the same time.”