As I retired from practice in 2009 I have refrained from commenting on current issues which you are all being confronted with and I am not – but the covid-19 situation changes by the day and so thoughts as it may relate to rehabilitation professionals may be helpful.
It is now clear that SARS-CoV-2 (covid-19) is a complex disorder affecting many parts of the body and that the initial triad of headache, cough/breathlessness and fever greatly underestimates the variety of clinical presentations. Non-respiratory symptoms now include gastrointestinal symptoms e.g. diarrhoea, taste or olfactory disorders e.g. anosmia, or neurological symptoms e.g. dizziness and ischaemic or haemorrhagic stroke [1]. Other neurological symptoms include altered mental state, Guillain-Barre syndrome or acute necrotising encephalopathy. Testing for covid-19 should now be considered in patients with acute neurological events during the pandemic [1].
Cardiovascular symptoms are now being seen that include myocardial injury particularly in those with severe symptoms relating to myocarditis, myopericarditis, cardiac arrythmias and heart failure. A hypercoagulable state has been reported that may result in pulmonary embolus or other thrombo-embolic events [1].
Other symptoms include musculoskeletal symptoms, and ocular manifestations. Emotional disorders are beginning to be seen and include depression, anxiety and post-traumatic stress disorder [2].
Other problems that health professionals are likely to face include the deconditioning that occurs when patients are in intensive care (particularly if they were ventilated). Patients who have required intensive care for more than a few days often have wider physical, cognitive and mental health support needs following discharge from acute settings [2]. Post viral fatigue syndromes are likely to be seen and some may be prolonged if the experiences of post hepatitis or post-glandular fever fatigue are anything to go by.
Rehabilitation will require a person-centred approach, but is likely to involve improving physical strength and stamina alongside optimising psychological health and addressing neurological rehabilitation needs when necessary [2].
The BSRM report naturally concentrates on the general problems faced by those who have experienced covid-19 and does not focus on the problems of those of working age. It does refer to the need for vocational rehabilitation (VR) during the community phase of rehabilitation but one does regret the loss of Hospital Resettlement Officers who used to be part of the rehabilitation teams in the 1980s. As community rehabilitation is poorly developed in the UK numerically, it follows that many will get no VR other than that offered by the Department for Work and Pensions through their job centres.
Reflecting on some of those with stroke whom I have seen, one in particular stands out. He was a young middle aged, and previously fit, man but presented with a dense hemiplegia which clearly would result in long-term disability. I met his wife several times and she appeared pleasant and interested but possibly a rather placid person. One day my secretary told me that she had asked to see me in my office. I opened the door in answer to the knocking and in strode an older woman who without any preamble said, “What are you doing to my son?”
It immediately was clear who ‘wore the pants’ in that family – Mother! (my secretary did not deduce that it was a different Mrs… who wanted to see me). This reminds us that disabling illness can affect those of different generations as much, or sometimes more than, partners/spouses [3].
I am happy to discuss any of the issues raised in these reflections with colleagues who can email me at andrew.frank1 at btinternet.com and head the email VRA – professional reflections.
Dr Andrew Frank
Trustee and Past-Chair, VRA
References
- Vetter, P., et al., Clinical features of covid-19. BMJ (Clinical research ed.), 2020. 369: p. m1470.
- Phillips, M., et al., Rehabilitation in the wake of Covid-19 – A phoenix from the ashes 2020, British Socity of Rehabilitation Medicine: London.
file:///C:/Users/andre/AppData/Local/Microsoft/Windows/INetCache/IE/F5DUOZDU/covid-19-adviceforspecialistrehabilitationsetting-published25-3-20.pdf
- Frank, A., The family and disability. Some reflections on culture. J R Soc Med, 1989. 82: p. 666-668.
https://www.researchgate.net/publication/20623951_The_Family_and_Disability_-_Some_Reflections_on_Culture_Discussion_Paper