The COVID-19 Rehabilitation Pandemic

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

Disclosures

Age Ageing. 2020;49(5):696-700. 

In This Article

Identifying who Requires Rehabilitation

As countries recover from the first peak of the COVID-19 pandemic, a coordinated and appropriately resourced approach to rehabilitation for the recovery phase is essential, to manage both the longer-term consequences of COVID-19 infection and to restore function lost as a result of the indirect effects of the pandemic response. Models of rehabilitation will vary from country to country, due to different health and social care systems and the different impact of COVID-19; rehabilitation needs may vary from minimal for those with minor symptoms to intensive, prolonged rehabilitation for patients who have had a prolonged stay on ICU or who have otherwise suffered a major loss of function.

The first requirement in redesigning rehabilitation services is to understand how many people need rehabilitation and who they are. Even before the COVID-19 pandemic, the Global Burden of Disease study[9] found high levels of disability in many countries—a need that is often not addressed by rehabilitation. Country-specific data would help to refine local estimates of need, and in the UK, the Rehabilitation Outcomes Collaborative minimum data set has been recommended for this purpose.[10]

In most countries, it is not yet clear what the scale of demand is from older people indirectly affected by the pandemic. The scale of this need will become apparent as older people re-engage with primary and secondary healthcare services, but consideration needs to be given to proactive case seeking; there is a risk that older people with impaired function will not present to health and social care services until a point of decompensation or illness, in part due to fear of catching COVID-19 from healthcare facilities. Rehabilitation services should, however, be able to identify those discharged from hospital with COVID-19 and those with a diagnosis of COVID-19 made in primary care. As COVID-19 testing is rolled out across populations at scale, the results will provide a platform for targeting a wider range of older people in need of specific post-COVID rehabilitation.

Not all older people who suffer from COVID-19 infection will require formal rehabilitation; the need will be dependent not only on the severity of illness, but on the degree of pre-existing frailty and functional impairment; factors that any screening systems for rehabilitation need to take into account. For those hospitalised with COVID-19 infection, early assumptions from National Health Service (NHS) England[11] estimated that 50% would require no input from health and social care, 45% would need support from health and social care, 4% would require rehabilitation in inpatient or intermediate care facilities and 1% would require new institutional care. Anecdotal data from the UK suggest an even greater percentage of people may require rehabilitation[12] in inpatient or intermediate care settings. Data from the global ISARIC survey[13] confirm that people most severely affected by COVID-19 will have had prolonged hospital stays, often spending much of this in bed, contributing to functional decline.

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