COVID-19 survivors may overwhelm neurological rehabilitation services

By Michael Woodhead

9 Jul 2020

Australia’s subacute services may be coping with COVID-19 thanks to the flattening of the curve but neurological rehabilitation services will be quickly overwhelmed if numbers increase beyond their current levels, according to experts.

Associate Professor Steven Faux, Director of Rehabilitation and Pain Medicine at St Vincent’s Hospital, Sydney, and colleagues warn that rehabilitation units are already working at capacity managing their usual caseload of patients with strokes and spinal injuries and are currently not prepared to meet needs of survivors of COVID-19.

Rehabilitation needs in the recovery phase following a second wave of COVID-19 will be “broad, complex and include cognitive, motor and respiratory sequelae to the infection, acute respiratory distress syndrome, and the thromboembolic response, they say in a commentary article published in the MJA.

“In Wuhan, China, 36% of those with severe COVID-19 had neurological complications such as stroke, critical care neuropathy, and the complications of prolonged bed rest (eg, venous thromboembolism, disseminated intravascular coagulation, acute kidney injury, delirium anxiety, post-traumatic stress disorder),” they write.

“In Italy, rehabilitation physicians have been treating post-extubation dysphagia, impaired mobility, critical care myopathy and neurocognitive losses.

They note that the US has set up special post-acute units dedicated to post-COVID-19 disability, with rehabilitation teams treating patients battling persistent hypoxia, stroke and mental illness.

“The majority of patients who are ventilated for more than 7 days suffer complications that require rehabilitation, 60% are unable to walk, and 17% die within a year,” Dr Faux and colleagues say.

“One-third suffer neurological complications, many require inpatient rehabilitation for over 3 weeks, and some take over 150 days to regain their capacity to walk independently. Others with stroke or cardiac complications of COVID-19 will require rehabilitation for up to 6 weeks, with some requiring lifelong support.”

Acoording to Dr Faux, Australia needed to plan now to manage COVID-19 survivors in subsequent waves, looking at options such as mobile rehabilitation teams, greater use of private hospital capacity and the use of tele-rehabilitation options.

“This will require the same vision and leadership that made our acute COVID-19 response world leading, collaborative and publicly supported.

“Australia and New Zealand have avoided this so far, but it is because we have planned well. We now need to prepare for the recovery phase because surviving may not be the same as living.”

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