Road to Recovery

Roughly 80% of people diagnosed with COVID-19 in the United States have not been hospitalized for it.

Of those adults who have been hospitalized, 91% had at least one reported underlying medical condition, most commonly hypertension, obesity, chronic metabolic disease or cardiovascular disease.

Among the 20% of people who are hospitalized with COVID-19, those who survive and are discharged from the hospital still may have a long journey of recovery ahead. They do not walk out of the hospital and return to “normal life.” In fact, many of them spend up to two weeks in an inpatient rehabilitation facility.

Northwestern Medicine Physiatrist Mahesh Ramachandran, MD, says his job is to “get COVID-19 survivors as close to their previous functional levels as possible” through inpatient rehabilitation at Northwestern Medicine Marianjoy Rehabilitation Hospital.

Dr. Ramachandran and his team often need to address neurological, cognitive, muscular, psychiatric and speech deficits that come with the disease and hospitalization.

Neurological Complications

At least one-third of people who have COVID-19 experience neurological complications, such as headaches, dizziness, difficulty concentrating, memory problems, decreased smell or taste, weakness or muscle pain. COVID-19 survivors are also experiencing higher incidents of stroke and other cardiac and pulmonary events, as abnormal blood clotting is a complication physicians and scientists continue to observe and investigate.

“While we’re not quite sure exactly what is causing these neurological manifestations of COVID-19, we see a common thread of elevated inflammatory markers, which means people are more prone to blood clotting, which can lead to more strokes, pulmonary embolisms or heart attacks,” says Dr. Ramachandran.

Post-Intensive Care Unit (ICU) Syndrome

“When a patient is on a ventilator in the ICU for a long period, they can develop ‘post-ICU syndrome,’” says Dr. Ramachandran. “We’re seeing a lot of this in our inpatient COVID-19 rehabilitation population.”

This syndrome can involve:

• Difficulty breathing, since the patient had breathing machines helping them for days or weeks. This is also related to difficulty speaking.
• Weakness or numbness in the legs, as the person experienced less blood flow to their extremities.
• Muscular atrophy, as the person was not using their muscles enough to maintain them during hospitalization.
• Encephalopathy, which means change in brain function, affecting memory and thinking.
• Psychiatric illnesses, such as depression, due to long periods of isolation.
• Difficulty swallowing, or dysphagia, which can result after long periods of dependence on a breathing tube and ventilator.

Rehabilitation and COVID-19

A multidisciplinary rehabilitation team comprised of speech therapists, occupational therapists, physical therapists, neuropsychologists, psychiatrists, chaplains and physiatrists can address the deficits left behind after a COVID-19 infection.

When these patients first enter rehabilitation, they typically have a hard time standing up, walking, getting out of bed, using the toilet, dressing and showering without assistance. Additionally, since COVID-19 attacks the lungs, the oxygen levels in their blood can drop very quickly with even a little bit of activity. They are also typically tachycardiac, meaning their heart rate can become easily elevated to roughly 110 to 120 beats per minute.

As patients gain the ability to function independently, they are able to go home, but many continue physical, occupational and speech therapy as outpatients.

“What’s been rewarding to me is that most of the COVID-19 survivors I have cared for have gone home having made significant progress from where they started, meaning that they’re able to do things independently now,” says Dr. Ramachandran. “It’s a great testament to these patients’ strength and the dedication of the entire rehabilitation team.”