WILL WALKEY, HOST: As more COVID-19 patients recover and are released from the hospital, inpatient rehab centers are being stretched to their limits. That’s because many COVID patients who are ready to leave the ICU aren’t quite ready to go home yet. Ventilators and ICUs can mean the difference between life and death for many coronavirus patients, but they can come with their own adverse health effects. And as Lucas Brady Woods reports, sometimes those effects can be severe.
LUCAS BRADY WOODS, BYLINE: Brian de Castro’s younger brother got COVID-19 in March. They live together and de Castro took care of him. Eventually, everyone in the family got it. Fever. Cough. Shortness of breath.
Then one night, de Castro couldn’t catch his breath. His fever spiked, and he had to be rushed to St. Barnabas Hospital outside of Newark, where he was immediately put on a ventilator.
BRIAN DE CASTRO: When they started intubating me, like putting the tubes on my throat, it was very, very hard to breathe. And they had put the anaesthetic in me, but I could still hear. And I heard the nurses say, he’s starting to code. His heart is gonna stop soon. What should we do? He might die. I was loopy.
WOODS He was on a ventilator, heavily sedated and basically unconscious, for two weeks.
DE CASTRO: When I woke up. I didn’t know where I was, and I couldn’t walk.
WOODS: It was his 39th birthday that day. But after laying in bed for two weeks, his leg muscles had atrophied.
DE CASTRO: They had a physical therapist to like, evaluate my situation and it was really hard to walk. I was just, I could only walk a couple feet and then I'd be super winded.
WOODS: So De Castro was transported via ambulance from the hospital’s ICU to an inpatient rehabilitation center. He was put on a floor designated entirely for patients recovering from COVID-19.
DE CASTRO: It helped me walk. It literally helped me walk again. At first I needed the help of a walker. And then I, you know, like after a couple days, I was able to get a cane.
WOODS: After about ten days in the rehab facility, De Castro was finally able to go home on May 8, It had been more than a month since he had last seen his family.
Bronte Cardenas is a physical therapist at Burke Rehabilitation Hospital and works with patients who are recovering from COVID. She says it doesn’t take long in an ICU bed for patients to lose their normal strength.
BRONTE CARDENAS: Your muscles start breaking down, you start getting weaker, even just one day. Continue that for a few days, a week, longer than that, you’re going to get really deconditioned.
WOODS: Without exercise or movement, being in the ICU can also affect a patient’s heart and their skeletal system.
CARDENAS: Your bones are becoming more brittle over time because bones need exercise to stay strong. So some patients can come out of two weeks on a ventilator or not on a ventilator and have osteoporosis. That makes it easier to break a bone.
WOODS: The ventilator’s breathing tubes can even damage patients’ vocal chords.
Cardenas says that she’s noticed a particularly wide spectrum of different conditions in her patients recovering from the virus.
CARDENAS: I’ve had patients who - they sit up in their bed and they can’t tolerate it and they have to lay back down because their oxygen levels are going down. But then I’ve seen patients who - they have clots, they have kidney issues, they suffered a stroke.
WOODS: She says the rehab facility where she works has been at or over capacity for more than a month. In the gyms, which are normally used for physical therapy exercises, equipment has been replaced with hospital beds. They’re now doing exercises with patients in their rooms and in the hallways.
WOODS: Dr. Marilyn Moffat is a professor of physical therapy at New York University, who specializes in cardiovascular and pulmonary rehabilitation.
MARILYN MOFFAT: People are realizing that more and more of these patients need physical therapy post-COVID-19. If they had been hospitalized, they need to be in the hands of someone who can guide them to get them back effectively and well.
WOODS: She says it’s naive to think people could recover on their own or without specialized help.
MOFFAT: you want to do it under the eyes of somebody who really knows the pathophysiology, who understands what has gone on in ICUs and all the concomitant problems of being intubated, and just don’t go off to somebody because some person has said oh here’s somebody who knows some exercise and you can do that.
WOODS: She says the rehab system is facing a surge as patients recover from the coronavirus. She thinks the system can handle the increase , but facilities will have to adapt.
MOFFAT: The intensity and the numbers are a problem only because of the shifting that one has to do in providing services. I think the social distancing, and the six feet, and the cleaning, and the protective equipment and all those things are gonna be maintained as far as I can see into the foreseeable future.
WOODS: Even though patients have recovered from the virus, facilities still need to take precautions to protect staff and other patients. Plus, it’s still unclear if recovered patients can get reinfected.
But even when patients do go home, Moffat says they’re still going to have a lot of work to do.
DE CASTRO (while doing exercises): Doing a toe stand exercise. I usually do three reps of 30.
WOODS: Before Brian de Castro left rehab, his physical therapists gave him exercises to continue on his own.
DE CASTRO (while doing exercises): When I raise my feet, my heels are up, I feel a little pain.
WOODS: But he’s starting to understand that recovery from the virus is a long process.
DE CASTRO: Mentally It is great to be back home. Physically I need to get my legs where it used to be pre COVID.
WOODS: It’s been three weeks since he woke up in the ICU. Making progress takes time, which he says can be frustrating.
DE CASTRO: I’m probably at like, I would say, 60 or 70 percent right now. I just want to be able to walk and stand up for long periods of time.
WOODS: De Castro says he’s had to learn to be patient during recovery. He plans to continue his treatment exercises, but he’s realized he doesn’t have the tools to get the results he wants on his own. So he’s already found a physical therapist to evaluate him at home, and is planning to find an outpatient clinic where he can continue his recovery.
Lucas Brady Woods, Columbia Radio News.