Contents
We are dealing with an expert how the rehabilitation process should go for those who have suffered from the disease.
Professor, Secretary General of the RNMOT, Chief Freelance Specialist-Pulmonologist of the Ministry of Health of the Russian Federation for the Central Federal District
Life after COVID
The pandemic has changed the understanding of the role of medicine. All countries of the world, including Russia, paid attention to the technical equipment of medical institutions, scientific support and the organization of medical care. It is quite obvious that it is necessary to develop the direction of staged treatment: outpatient, inpatient and sanatorium. Methodological recommendations for the rehabilitation of patients who have undergone coronavirus have been developed, based on the results of studies confirming that COVID-19 negatively affects small vessels. The data indicate that the consequences of the disease are damage to the respiratory system, cardiovascular pathology, endocrine disorders, and psychological problems.
Rehabilitation of patientswho have undergone COVID-19 should be comprehensive and take into account not only pathological changes in organs and systems, the severity of which is determined by the severity of the disease and the volume of tissue changes, but also possible lesions associated with side effects of drugs (cardiotoxicity, hepatotoxicity) and medical interventions, among them intubation. Comorbidity is also taken into account.
Extent of the problem
In most cases, with an asymptomatic or mild course of the disease, changes in the lungs are completely reversible. In severe forms, unfortunately, there is a very high probability of irreversible pathologies, among them pneumosclerosis. But even if it does appear, it is unlikely to seriously affect the respiratory function. Recovery is going well, if serious complications such as myocarditis, renal failure, and liver failure have not developed.
Subtleties of rehabilitation
It must be remembered that the disease is not limited to two weeks. There is some peculiarity in the development of coronavirus infection, and it is associated with the slow development of the inflammatory response. The process of subsequent tissue regeneration is slow. Asthenic syndrome persists for a long time. In this regard, an important part of rehabilitation is drug support and non-drug recovery methods. One of the most important points is the so-called recruitment of poorly ventilated areas of the lungs. This is also important from the point of view of preventing pneumosclerosis. Patients should understand that they should refrain from great physical and emotional stress, because asthenic syndrome, unfortunately, will limit the possibilities.
Professional approach
Methodological recommendations for the rehabilitation of patients will be improved upon receipt of new data. All of the activities currently proposed are feasible in most healthcare facilities and at home. But a doctor’s consultation is required, he must determine the volume of activities, their frequency and duration. Unfortunately, there are questions to which we cannot yet fully answer. For example, it is quite obvious that thrombosis can develop against the background of the transferred infection. And, naturally, treatment with direct anticoagulants comes to the fore. The question immediately arises: how long to use them? There is no answer yet, but it will appear soon.
On the second round
Many patients are interested in the likelihood of re-infection. There is no data yet to confirm that it is possible. Such a phenomenon is unlikely, based on human biology and the biology of the virus. Re-infection is presumably likely in patients with severe immunosuppression, such as HIV-infected, and in patients receiving immunosuppressive drugs for some other reason. However, there is no documentary evidence yet.