Dr. Dov Albukrek, Director of Reuth Rehabilitation Hospital, Tel Aviv
The coronavirus exposed the Israeli public to the treatment given to severely ill patients in COVID-19 intensive care. Good care and dedication give these patients a real chance in coping with the disease.
However, ventilation can be quite damaging to the respiratory system and musculoskeletal tissues of COVID-19 patients, due to several causes: the violent inflammatory process, lack of oxygen in body tissues due to cardiopulmonary failure, high doses of anesthetics and muscle paralyzers, malnutrition (low levels of calories, proteins, minerals etc.), and a significant decrease in muscle mass. Malnutrition and the substantial decrease in muscle mass (over 30%) can also generate damage to the immune system, with all its consequences.
In fact, 10-20% of severe COVID-19 patients require ventilation even after their tests come negative to the virus. Many others need oxygen enrichment due to damaged lung tissues. Still others, recovering from the coronavirus, suffer from shortness of breath and very poor cardiopulmonary endurance, and may become so weak they cannot walk without assistance.
In addition to their physical problems, many patients exhibit clinical symptoms resembling post traumatic stress, and require psychological treatment.
The good news is that these conditions are reversible. In most cases, comprehensive, high-quality rehabilitation, focusing on respiratory rehabilitation, enables recovery, with the patient regaining his full physical and mental capacities.
Rehabilitation includes weaning from the ventilator as well as a general process of rehabilitation, led by physicians specializing in rehabilitation and geriatrics, together with a highly skilled team of health professionals – nurses, physiotherapists, occupational therapists, speech therapists, nutritionists and dietitians, rehabilitation psychologists, social workers and more. Treatment addresses respiratory problems and provides nutrition enabling recovery, while rebuilding tissues and muscle mass. It includes intensive work with advanced technologies to strengthen muscles and improve ranges of movement, as well as a special focus on cognitive and psychological aspects. All this in order to help the patient rebuild his world.
At Reuth’s Respiratory Rehabilitation and Long-Term Ventilation Ward, the road to full recovery is made shorter by providing patients with comprehensive rehabilitation treatment even before they are weaned from the ventilator and the need for respiratory support.
Even though full multi-professional rehabilitation is part of Israel’s Health Basket, in practice, due to lack of availability, awareness or both, many patients do not receive the rehabilitation that is essential to their health, independence and quality of life. Empowering the patient and his family by providing information on the importance of rehabilitation in general and respiratory rehabilitation in particular, has proved crucial to the ultimate quality of medical treatment.
The COVID-19 pandemic has exposed the need for bolstering respiratory rehabilitation and long-term ventilation at Israel’s rehabilitation and geriatric hospitals. Treatment that includes both weaning from the ventilator and general rehabilitation is necessary if the patient is to get back on his feet – in both senses. This is crucial for the individual, but also for society in general, preventing the deterioration of patients’ condition to the point where they are dependent on others and become a burden to society.
The Israeli health system is overburdened even in ordinary times. Some of the patients lying in the corridors in general hospitals are in fact waiting for a place in rehabilitation, including respiratory rehabilitation. Thus, moving patients to respiratory rehabilitation has another advantage from the viewpoint of the health system: it relieves overcrowding in general hospitals, enabling them to admit new patients.
At critical times like the present pandemic we may expect failure of the system in providing rehabilitation services, including respiratory rehabilitation.
Developing Israel’s respiratory rehabilitation system, adding beds and personnel, and giving the staff incentives to attain set goals will benefit the entire health system in ordinary times and enable its expansion, as needed, in an emergency.