Ten months after being discharged from hospital for COVID-19, Rick Sterzer says he’s almost his old self again. But it has taken plenty of effort and numerous visits to at least half a dozen therapists and specialists to get him to this point.
When Mr. Sterzer left Winnipeg’s St. Boniface Hospital last May after more than five weeks there, including around three weeks in intensive care, he was physically weak. Previously a fit, retired firefighter measuring 5-foot-10 and 190 pounds, his weight dropped to 159 pounds. He relied on an oxygen tank. And he developed drop foot, an inability to control lifting his foot owing to nerve damage from all the time he spent in a prone position in intensive care.
“I’m actually quite lucky, quite healthy, considering I didn’t know I would be to this point, but it took a lot to get here,” said Mr. Sterzer, 66.
Mr. Sterzer’s recovery process highlights what some rehabilitation experts anticipate will be a wave of demand for rehab services and support for COVID-19 survivors. After pulling through the acute stages of the disease, many Canadians experience lingering symptoms and complications, whether from COVID-19 itself or from interventions, such as being put on a respirator, and prolonged bed rest in hospital.
To help them restore their daily functions, experts are studying the needs of these survivors and pushing for more – and greater accessibility to – rehabilitation services.
“One of the things that just isn’t being talked about, but as it pertains to COVID-19, is the ongoing crush of disability that’s going to be coming, around people who just can’t work and can’t do things that they typically could have pre-COVID,” said Toronto physiotherapist Adam Brown, who is working with Toronto’s University Health Network, or UHN, on a pilot study to provide guidance on best rehabilitation practices for those with persistent symptoms.
Mr. Brown, director of Cornerstone Physiotherapy, said his clinics are receiving calls every week from people with lingering COVID-19 problems. But, he noted, “I don’t think we’ve even begun to see the tip of the iceberg.”
Demand is expected to rise, he explained, as the number of infections grow, and as more people, who are waiting for their symptoms to resolve on their own, seek help.
The needs of COVID-19 survivors are varied. At the Ottawa Hospital Rehabilitation Centre, physiatrist Guy Trudel said he has seen patients needing assistance to regain the physical strength and endurance they’ve lost because of deconditioning while hospitalized with COVID-19.
Particularly for older patients with pre-existing mobility issues, spending weeks in a hospital bed or in intensive care puts them “over the edge,” Dr. Trudel said. “So we have to restore safe mobility, safe activities of daily living so they can return to their home or their residence.”
Some COVID-19 survivors need pulmonary rehabilitation for difficulty breathing and shortness of breath. That typically involves exercise, education on conserving energy and managing symptoms, and psychosocial support, said Marla Beauchamp, an assistant professor at McMaster University’s school of rehabilitation science.
The trouble is pulmonary rehab is already in high demand among people with chronic lung diseases, said Dr. Beauchamp. She said as little as about 5 per cent of Canadians with lung disease have access to it. If you then add a population of COVID-19 survivors who could also benefit from this type of rehab, the wait lists are likely to get worse, she said.
Preliminary estimates from a study Dr. Beauchamp is conducting of patients admitted with COVID-19 at four Southern Ontario hospitals suggest between 20 and 30 per cent still report symptoms, at three, six and nine months after they’re discharged. Among the roughly 100 study participants, 40 and older, enrolled so far, shortness of breath and fatigue appear to be the most common lingering symptoms.
Although there are clinics popping up across the country, specializing in the treatment of patients with persistent COVID-19 symptoms, they aren’t many, she said, noting people who could benefit from rehab immediately after the acute illness but don’t receive it may have trouble returning to work and other activities. “I think there’s a lot of potential implications of not rehabilitating fully right after.”
Still another type of rehabilitation COVID-19 survivors may need is for mood and cognitive problems. In Toronto, Robin Green, Saunderson Family Chair in traumatic brain injury and senior scientist at the Kite Research Institute at UHN, is piloting an educational program, delivered remotely, for people with a variety of persistent COVD-19 symptoms, including headaches, malaise, mood problems and cognitive problems, such as with their memory or attention.
The six-week program borrows from principles and interventions used for concussion patients, as there are some parallels between the two groups, Dr. Green said. It includes education about the illness, cognitive behavioural therapy, goal-management training, mindfulness-based stress reduction, energy conservation and self-compassion.
The main goals are to minimize the impact of symptoms on daily life, and to help people manage their symptoms, including recognizing when to seek physician help, she said.
But even as new COVID-19 rehab programs emerge, there is a need to ensure equitable access to them, said Mr. Brown, the Toronto physiotherapist. While some services are covered by provincial health plans, many others are covered by private insurance or require out-of-pocket payments. (Mr. Sterzer said his posthospital treatments, which ranged from seeing a respirologist to a massage therapist, were paid for by a mix of all three.)
Mr. Brown noted many individuals at highest risk of catching COVID-19, such as essential workers, are least likely to have robust rehab benefits. “There’s a larger percentage of people suffering from persistent symptoms who don’t have benefits than those who do.”
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