In terms of the long-term impact of the virus on the body, Prof Bolton said there is some awareness of longer-term scarring on the lungs. “We are aware that in a small proportion of patients there may have been some persistent scarring and that is different. There are also reports of small but noticeable proportion of patients having persisting changes we’d describe as fibrosis, and there have been recommendations from the British Thoracic Society on the follow up process for those who don’t seem to be recovering as we’d expect.”
The way that the virus impacts the lungs for some patients is a “major concern”, according to Dr Rupert Jones, a physician with special interest in pulmonary rehabilitation at the University of Plymouth. “You reach your maximum lung capacity at around the age of 18 to 20, and from then on lung function is declining. You don’t get it back, and if you have a major episode of pneumonia or TB that damages your lungs, that’s eating into your reserves.”
As with other experts, Dr Jones stresses that the longevity of Covid-19 isn’t clear, although there’s “emerging evidence that people are shedding the virus for months afterwards, so the virus isn’t going away”.
Stressing the importance of rehabilitation for Covid 19 patients, Professor Bolton says that there needs to be an “adaptive and coordinated” approach to the situation, given social distancing measures will require changes in traditional rehabilitative care, which often uses group work. “Many hospitals are trying to set up and/or deliver what they can to meet needs here and now, but a coordinated, funded approach is needed,” she added.
On what kind of rehabilitation Covid-19 patients are going to need, Professor Sally Singh, head of pulmonary and cardiac rehabilitation at University Hospitals of Leicester NHS Trust, says there’s a general feeling that an adapted pulmonary rehabilitation approach may be best.
“Given the symptoms that are being exhibited are predominantly respiratory related, I think there’s a general feeling that there’s a service provided [pulmonary rehabilitation] that had traditionally been focused on people with chronic lung disease,” she said. “There’s recognition that the most sensible approach might be to adapt that; there’s no appetite to reinvent the wheel.”
“The impact of being ventilated and on an ICU bed for weeks at a time is profound for your cognitive ability, and physical and mental wellbeing,” she added. “You’d hope that people can recover but it won’t be spontaneous and it’ll need to be supported.”
But capacity to support these patients remains a concern among rehabilitation experts.
“Rehabilitation services have never been as well-funded as acute services,” said Professor John Hurst, a professor of respiratory medicine at University College London. “The NHS has reorganised itself with incredible speed to address this acute peak, and it would be great to see that reorganisation and momentum to deal with the medium and longer-term patients.”
“From experience it is a slow recovery, but it’s a very variable thing. We’ve started a program of calling patients up who have been discharged to check on recovery and signpost them to resources, and we’re finding a high proportion still have ongoing symptoms and needs,” he said. “That’s of the hospital population. We know much less about people in the community.”
“What’s come through very strongly is the need to be holistic,” he added. “Yes, it’s a respiratory illness, but actually we’re also thinking about fatigue and mental health. Patients have been through a life-changing episode that’s like no other.”