City doctors call for setting up of rehabilitation centres for post Covid care

In the light of the World Health Organisation (WHO) stressing the need for a post Covid care centre doctors in Karnataka call for rehabilitation facility for the patients who recovered from the virus after undergoing treatment in ICU.

Highlighting the importance of post Covid care, Dr C.N. Manjunath, director of Sri Jayadeva Institute of Cardiovascular Sciences, tells The Hans India,

"Post Covid evaluation is important as some of the patients may have residual lung problems and there could also be a remote possibility of heart and pancreas issues. So those on the path of Covid recovery if they face breathlessness, fatigue and body pain should be re-evaluated. Pulmonary lung function test is important so if they have any evidence of residual lung dysfunction then they need respiratory rehabilitation."

"If the symptoms persist then blood investigation need to be done. Those who were in ICU for a long term then they need counselling. However, there is no need for any separate establishment as there are physicians," he stated.

District Health Officer, Dakshin Kannada, Dr Ramchandra said the post Covid rehabilitation centre was started by KS Hegde Medical College and at Ayurveda Medical College which concentrates more on treating cases of trauma.

Bangalore Medical College and Research Institute (BMCRI) has recently started a post Covid care clinic.

Director and Dean at BMCRI, Dr Jayanti CR says 87 percent of the recovered Covid patients can have one persistent symptom after two months. "It is imperative to come up with a post Covid care clinic. Twenty-seven percent complain of joint pain and 63 percent have persistent fatigue. Very rarely we come across cases of strokes and heart failures. My anthology says impotence could also be a problem but this is an ongoing study. In fact my centre has done 220 studies on Covid."

Rajinish Menon, Founder & CEO, Sukino Healthcare that has launched a 'Respiratory Distress' initiative which is care for patients suffering from respiratory problems Post Covid-19 states, " For us, round-the-clock care has always been a priority, and the Covid-19 pandemic has only further increased the need to bring respiratory rehabilitation to the forefront. While we still try and understand the after-effects of COVID-19, it is important to create an atmosphere that prioritizes patient management, especially since the severity of the disease's long-term respiratory complications remain to be seen. A major factor that reiterates the same is that post the initial illness, most people were found to have persistent lung abnormalities, indicating that a sizable proportion of patients need the best recuperative care support even after being discharged."

He adds that once the patient is admitted, a detailed assessment is carried out by Sukino Healthcare's medical consultants, therapy team consisting of physio, occupational, respiratory therapists, and clinical psychologists. "They map out the therapy sessions and fine-tune a goal-oriented treatment plan depending on the condition of the patient. Throughout the treatment, the progress of the patient is assessed every week with the Borg Dyspnea Scale, six minutes' walk test, 12 minutes' walk test, TUG scale, and the Cough Sputum Score. With our unique and multidimensional approach, patients show remarkable progress within a month," Menon said.

Elaborating on the importance of rehabilitation for those who were hospitalised or admitted in the ICU, Dr. Justin A Gopaldas, Consultant, Critical Care Medicine, Manipal Hospitals says, "As the lungs are primarily damaged, post Covid, pulmonary complications are the leading cause of morbidity. Depending on the severity of infection, post-Covid symptoms may include shortness of breath, cough, lower energy levels, lesser activity tolerance, difficulty in performing daily tasks, muscular weakness, reduced concentration, difficulty in swallowing etc.

We have referred around 12 to 15 cases from ICU. They were 60 years of age and above having comorbidities and their saturation level was low. A few of them were on high-dependency units (HDU) with lung severely compromised. This rehabilitation recommendation becomes the need of the hour to prevent lung getting damaged further and the patient has faster recovery."

Ace Multi-Speciality Hospital has established a post Covid rehabilitation centre where a multidisciplinary expert team is constituted and four evidence-based classes of intervention (exercise, practice, psychosocial support, and education particularly about self-management) are used.

"Knowledge of the disease process and which tissues are likely to have been damaged is important in the rehabilitation process. The disease determines both what impairments are likely or unlikely, guiding assessment, the general prognosis and planning of rehabilitation. The whole range of individual problems arising after Covid-19 and their relative frequency is not yet known.

Nevertheless, apart from its effects upon the respiratory system, the virus can affect the heart and cardiovascular system, the brain directly (encephalitis) and indirectly (eg secondary to hypoxia or vascular thrombosis), the kidney and renal function, blood clotting and the gastrointestinal tract; the virus has also been found in semen.

The complexity and variability of the damage caused by COVID-19, coupled with the pre-existing disabling long-term conditions that many patients will have, means that there is no single, COVID-19 specific method to determine the need for rehabilitation. This is actually the situation for almost all diseases, and a generic method for identifying people who might benefit from rehabilitation should be used," said Dr JAGADISH Hiremath, Medical Director, Ace Multi-Speciality Hospital.