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COMMENTARY
Year : 2021  |  Volume : 14  |  Issue : 6  |  Page : 719-720  

Strengthening rehabilitation component in the management of COVID-19 cases


1 Member of the Medical Education Unit and Institute Research Council, Department of Community Medicine, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission04-Jun-2020
Date of Decision19-Jul-2020
Date of Acceptance24-Jul-2020
Date of Web Publication06-Jul-2021

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpaet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_304_20

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How to cite this article:
Shrivastava SR, Shrivastava PS. Strengthening rehabilitation component in the management of COVID-19 cases. Med J DY Patil Vidyapeeth 2021;14:719-20

How to cite this URL:
Shrivastava SR, Shrivastava PS. Strengthening rehabilitation component in the management of COVID-19 cases. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Dec 6];14:719-20. Available from: https://www.mjdrdypv.org/text.asp?2021/14/6/719/320707



The coronavirus disease-2019 (COVID-19) pandemic continues to rise in different parts of the world and is an indicator that we are yet to successfully contain the infection. Till now, 13,876,441 cases and 593,087 deaths have been attributed to the disease across all the affected nations.[1] The findings of a clinical study done in Wuhan revealed that almost four-fifth of the diagnosed individuals is asymptomatic, while 15% of the case lands up into severe forms requiring hospitalization and around 5% develops a critical infection (who essentially require admission in the intensive care units).[2] Rehabilitation is an important component of the management of COVID-19 cases, and it is crucial to merge the same with the emergency health planning done for the effective containment of the infection.[3]

Rehabilitation enables complete recovery of a diagnosed cases of the illness, especially in cases of severe and critical group of patients, and this is accomplished through improving health and functions of various systems, ensuring discharge of patients relatively earlier, and through minimizing the risk of readmission due to the development of postinfection sequels.[3] The need for rehabilitation becomes essential due to the aftereffects of mechanical ventilatory support and prolonged immunization owing to bed rest.[4] The consequences can vary from impairment in the pulmonary function (decreased lung capacity), muscle weakness, delirium, dysphagia (due to prolonged intubation), mental health illnesses, and psychological needs (owing to longer periods of isolation and staying away from family members). However, it is critical to note that the needs for rehabilitation becomes even more if the diagnosed cases are from the vulnerable groups (viz. elderly or people with underlying co-morbid illnesses).[3],[4]

The most important and critical component of rehabilitation deals with the respiratory support which is extended through mechanical ventilation and is done with an aim to ensure that airways are clean and pulmonary function is sustained.[3] In addition, neurological rehabilitation has to be provided to help the patients to recover from the complaints of dysgeusia and anosmia. Moreover, rehabilitation is also an essential aspect to improve the lung capacity, bed sores, weakness of the peripheral muscles, joint immobility, etc.[3],[4] The rehabilitation offered to COVID-19 patients is quite different from what is being offered in routine conditions primarily due to the fact that it is a multidisciplinary approach.

Upon considering these consequences of the infection, it is needless to say that rehabilitation is an integral and indispensable aspect of the medical management of the novel viral infection. In-fact, we have to understand that the provision of rehabilitative support to the infected patients essentially requires the concerted effort of different experts and has to be tailor made based on the presence of other predisposing factors (such as elderly, underlying disease, or development of complications).[3],[4],[5] At the same time, it is important to identify the needs of rehabilitation even for the non-COVID-19 individuals, like rehabilitation care personnel. Further, the component of rehabilitation should be continued to be delivered in community settings, and this is an important need which has to be planned by the policy-makers to ensure complete recovery.[4] In other words, the policy-makers should consider provisions for health financing, improve the capacity of involved rehabilitation personnel, including their numbers, expansion of telehealth services for non-COVID-19 patients, development of a protocol to enable early discharge, and finally formulate the health, social and community-related needs of the severe category of patients.[3]

Moreover, even the health-care establishments should improve their functional status by staying abreast with recent national guidelines, merging rehabilitation into infection prevention and control strategies (including ensuring adequate availability of personal protective equipment), enhancing the overall capacity of the health workforce, and arrange for an increase in the number of equipment required for rehabilitation.[3],[4],[5] Further, the rehabilitation needs pertaining to psychosocial support, clinical management, and infection control needs to be appropriately adapted and immensely strengthened.[3],[4]

In conclusion, rehabilitation is an important aspect in ensuring the complete recovery of the severe and critically ill category of COVID-19 cases. Thus, it is the responsibility of the policy-makers and the health-care facilities to improve their capacity and adapt to the rehabilitation needs of the patients as well as the rehabilitation personnel.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report – 180; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200718-covid-19-sitrep-180.pdf?sfvrsn=39b31718_2. [Last accessed on 2020 Jul 19].  Back to cited text no. 1
    
2.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.  Back to cited text no. 2
    
3.
Pan American Health Organization. Rehabilitation considerations during the COVID-19 outbreak. Washington: WHO press; 2020. p. 1-18.  Back to cited text no. 3
    
4.
Brugliera L, Spina A, Castellazzi P, Cimino P, Tettamanti A, Houdayer E, et al. Rehabilitation of COVID-19 patients. J Rehabil Med 2020;52:jrm00046.  Back to cited text no. 4
    
5.
World Health Organization. 2019 Novel Coronavirus (2019-nCoV): Strategic preparedness and response plan. Geneva: WHO press; 2020. p. 1-20.  Back to cited text no. 5
    




 

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