The COVID-19 Rehabilitation Pandemic

Sarah De Biase; Laura Cook; Dawn A. Skelton; Miles Witham; Ruth ten Hove


Age Ageing. 2020;49(5):696-700. 

In This Article

How COVID-19 Illness Changes Function

COVID-19 is a respiratory infection with multisystem manifestations.[2] It ranges in severity from asymptomatic infection to severe, fatal illness. In the respiratory system, COVID-19 may cause viral pneumonia with widespread pulmonary infiltrates, profound breathlessness and hypoxia. Hypoxia may be slow to resolve, requiring prolonged supplemental oxygen use and desaturation on exertion. In those who are severely unwell with COVID-19, a hyperinflammatory state may cause multiple organ dysfunction, including myocarditis and heart failure.[3] This hyperinflammatory state, combined with immobility and poor food intake (nausea, vomiting and diarrhoea are prominent symptoms in some patients) are all risk factors for acute sarcopenia—the loss of muscle mass and strength seen in acutely unwell patients.[4]

Other manifestations of COVID-19 are now recognised that are of particular relevance to rehabilitation needs. Delirium—often severe and prolonged—is common in older people, and other neurological manifestations have been described, including Guillain–Barre syndrome and encephalitis.[5] The risk of venous and arterial thromboembolism after COVID-19 appears to be very high, including stroke with its attendant physical and cognitive deficits. In addition, survivors of severe illness [particularly those admitted to intensive care unit (ICU)] may experience post-traumatic stress disorder. COVID-19 illness may therefore affect physical, cognitive and psychological function in multiple ways; a combination of low muscle strength due to frailty and impaired endurance due to cardiorespiratory disease is common, complicated by cognitive and psychological deficits.

It is clear that COVID-19 disproportionately affects older people; this is the group most likely to require hospital admission, and this is the group most likely to die from COVID-19 infection.[6] People living with frailty and multimorbidity (who are more likely to be older) are also likely to be affected more profoundly. Rehabilitation strategies need therefore to address not only the wide range of deficits caused by COVID-19 illness but also need to be able to deliver rehabilitation to people with a high burden of pre-existing frailty and illness.