Why is post COVID care so crucial? It is time home nursing and Rehabilitation Centres step in..

The COVID-19 pandemic or the coronavirus pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. Thereafter, the outbreak was declared to be a Public Health Emergency of International Concern in January 2020, and a pandemic in March 2020. As of 13 October 2020, more than 37.8 million cases have been confirmed, with more than 1.08 million deaths attributed to COVID-19.

The infection by the corona virus has been classified into mild, moderate and severe. It is to be noted that the total coronavirus cases in India stands at 73,70,468 cases with death toll at 1,12,161 as of mid-October 2020. Interestingly, our recovery rate is also high with 64,53,779 cases.

It is heartening that most COVID 19 infection cases are mild and do not require hospitalization with recovery more or less complete in 3-4 weeks with home isolation and treatment. According to the Union Ministry of Health and Family Welfare (MohFW), around 80% of people recover from COVID-19 without any special treatment (1).

However, recent clinical and research data reveal that the disease in the severe or sometimes even in the moderate form often attacks the lungs and can affect organs like the kidneys, heart, and even brain resulting in death in several patients (6,7,8,9). As doctors and scientists try to comprehend the intricacies of the coronavirus infection, a new chapter now opens up on post COVID complications. It has become clear that post COVID care, especially for the elderly and patients with co-morbidity is crucial for at least an additional 2-3 weeks (may be more) post hospitalization (3). Although it is too early to know the long-term effects of this infection; it is understood that it is of utmost importance that post COVID patients continue to get proper medical attention along with nursing till they are clinically well enough to manage themselves independently. Around one in six COVID-19 patients get a severe infection and have difficulty in breathing, with senior citizens and those with comorbidities being particularly at risk even during the post hospitalization phase (5,10,11,12).

In this context, Rehabilitation Centres may play an important role in supporting and filling in the gap in the community healthcare system at large (4). Fortis hospital is launching its “post-COVID OPD” thereby emphasizing the importance of post COVID care. Speaking on its need and what patients go through after recovery from COVID-19, Dr Rahul Pandit, Director-intensive care, Fortis Hospital, Mulund, Mumbai, says, “COVID is a new disease and it has only been seven months since it has been formally announced and India has been four months into it. There were a number of concerns that came to our notice in our patients after recovery and it prompted us to have a comprehensive outpatient clinic for them. Hence, this post-COVID OPD”. Apollo Homecare is coming up with a virtual home monitoring service for post COVID patients. Concerns ranging from fatigue, cardiac issues, renal problems, respiratory problems to mental health issues, etc. are being taken up for post COVID patients by various medical facilities all over the globe. It is a general understanding by the healthcare system at large that post COVID care is now one of the needs of the hour.

Prof. Randeep Guleria, Director of All India Institute of Medical Sciences, N. Delhi, Dr. Naresh Trehan, Chairman, Medanta and Dr. Hemant Thacker of Breach Candy Hospital, Mumbai have emphasized the importance of post COVID care and have suggested that post COVID Rehabilitation Centres may play a crucial role in mitigating issues relating to post COVID recovery (3). Patients who have co-morbid ailments like diabetes, hypertension and cardiac issues need particularly strict monitoring of their blood pressure, blood glucose levels, oxygen saturation, etc. post infection for proper treatment. It has also been reported that radiological recovery takes more time than the clinical recovery. Post hospitalization rehabilitation care would certainly contribute to the recovery of post COVID elderly patients and patients with co-morbidity and also reduce the load on the primary healthcare system (4, 13).

Centers for Disease Control and Prevention, USA is of the view that the COVID-19 pandemic is far from over (2). While physicians, researchers, patients, technicians and healthcare workers continue to battle COVID-19 on the front lines, policymakers and donors with CSR are trying their best to contribute and make a difference (4). There needs to be a comprehensive plan for preventing and managing post-COVID-19 complications and supporting patients and families experiencing delayed morbidity and disability as a result.

 REFERENCES

  1. “Home – Ministry of Health and Family Welfare – GOI”. mohfw.gov.in. Retrieved 12 October 2020.
  2. CDC (11 February 2020). “Coronavirus Disease 2019 (COVID-19)”. Centers for Disease Control and Prevention. Retrieved 24 April
  3. On India Today’s special show Newstoday with Rajdeep Sardesai, top doctors including AIIMS Chief Dr. Randeep Guleria and Dr. Naresh Trehan share their thoughts on tackling post-COVID complication. https://youtu.be/-IH9FLCIOr8
  4. David H Jiang & Rozalina G. McCoyl. Planning for the Post-COVID Syndrome: How Payers Can Mitigate Long-Term Complications of the Pandemic. Journal of General Internal Medicine 2020: 1-4, doi: 10.1007/s11606-020-06042-3
  5. Ohtake PJ, Lee AC, Scott JC, et al. Physical Impairments Associated with Post-Intensive Care Syndrome: Systematic Review Based on the World Health Organization’s International Classification of Functioning, Disability and Health Framework. Phys Ther. 2018; 98: 631-45.
  6. Thompson BT, Chambers RC, Liu KD. Acute Respiratory Distress Syndrome. N Engl J Med. 2017;377: 562-72.
  7. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury with Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020.
  8. Helms J, Kremer S, Merdji H, et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med. 2020.
  9. Corrales-Medina VF, Alvarez KN, Weissfeld LA, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015; 313:264-74.
  10. Koma W, Neuman T, Claxton G, Rae M, Kates J, Michaud J. How Many Adults Are at Risk of Serious Illness If Infected with Coronavirus? Updated Data: Kaiser Family Foundation; 2020.
  11. Koerth M, Bronner L, Mithani J. Why It’s So Freaking Hard to Make A Good COVID-19 Model. FiveThirtyEight. 2020; 31:2020.
  12. Harmon A. Why We Don’t Know the True Death Rate for COVID-19. The New York Times. 2020.
  13. Coronavirus Aid, Relief, and Economic Security Act. United States; 2020.