Coronavirus infection can damage the entire body and mind, not just the respiratory system. Global research confirms that SARS-CoV-2 can affect the brain, nerves, cardiovascular system, kidneys, and liver, individually or in combination. Any blood vessel may get clogged damaging that organ and can cause stroke, heart attack, lung infarction, kidney failure etc. There is a worry that a long term legacy of COVID-19 will be an upsurge of degenerative conditions like Parkinson's and Alzheimer's disease. Similar to the Spanish flu pandemic in the 19th century, we may have millions of 'encephalitis lethargica' in the 21st century with profound fatigue stricken population.
The virus is also thought to be responsible for 'cytokine storm' in the brain resulting in encephalitis or paralysis. A study from Italy published last week elicits 35% of the recovered COVID-19 patients suffer from musculoskeletal pain, numbness, physical frailty and functional immobility that may lead towards disability. Moreover, due to infecting both upper and lower respiratory tract, the respiratory fitness is deteriorating and speech, swallowing and vocal cord issues are being prominent. The virus is also affecting the nicotinic lipids in the blood causing stroke or heart attack that also fates towards disability. However, there are secondary reasons too. 5-15% of COVID-19 patients need oxygenation, bed rest, and critical care and prolonged staying in bed results in physical frailty, movement problems, chronic pain, and difficulties in activities of daily living. Mental health issues are a global concern. Our patients, families, health workers, and mass people are suffering from fear, anxiety, insomnia, and a spectrum of mental health issues.
Post COVID-19 rehabilitation is termed as a package of care that enhances a quicker recovery and early integration of recovered patients to his normal life. Research explores, 30-35% of total COVID-19 positive cases require rehabilitation services after being negative in real-time PCR tests. The Stanford Hall Consensus published in the British Journal of Medicine explains the service is provided by the teamwork of physicians, physiotherapists, occupational therapists, speech therapists, psychologists, and nurses. Pan American Health Organisation (PAHO) describes, the team interacts and plays a comprehensive role for the early recovery and complete care of the newly recovered cases of COVID-19.
On an optimistic note, Bangladesh has now an opportunity to integrate a multidisciplinary rehabilitation team in the COVID-19 care facility. Recently, Centre for the Rehabilitation of the Paralysed (CRP) started 'Post COVID-19 rehabilitation services' in Savar and Mirpur, Dhaka centre with the technical guidance from the specialist neuro-rehabilitation team from the East Kent University National Health Service (NHS) Foundation Trust (FT) Hospitals of the United Kingdom.
K M Amran Hossain is a Faculty and Researcher at the Bangladesh Health Professions Institute, Bangladesh.
Dr Mohamed Sakel is a Consultant Neuro-Rehabilitation Physician and Director at the East Kent University NHS FT Hospitals, United Kingdom.