As it became clear that some COVID-19 survivors began to face a unique, difficult path to recovery, physicians at Shirley Ryan AbilityLab rehabilitation hospital in Chicago knew that they had to take action, sometimes re-engineering entire health care spaces.
"Knowing patients were spending weeks in a hospital bed, on ventilators or often put into a prone position, I thought, 'what happens next?' and I wanted to be involved," said Dr. Leslie Rydberg, attending physician at the rehabilitation hospital's COVID Care Unit. "The first thing we needed to figure out is how to reconfigure our system to this disease, to a complete isolation unit."
The problem is, isolating patients in acute care settings isn't conducive to rehabilitation and "getting patients up and walking," said Rydberg.
The Streeterville facility decided to block off a wing on the 20th floor that includes a full rehabilitation gym in addition to patient rooms.
The Centers for Disease Control and Prevention say a "prolonged illness" due to COVID-19 is "common" in hospitalized adults, but it also can occur "even among persons with milder outpatient illness, including young adults." These so-called COVID "long-haulers" face persistent symptoms and can experience "prolonged absence from work, studies, or other activities," according to the CDC.
Rydberg said the AbilityLab rehab unit faced a wide variety of ailments, including damage from tracheostomy tube placement, "severe swallowing dysfunction requiring feeding tube placement; large pressure ulcers; significant muscle weakness and atrophy; large amounts of weight loss; mild cognitive dysfunction; and severe impairments in endurance."
Given the wide range of possible responses to COVID, the rehabilitation process often requires much more cross-collaboration among different disciplines in the facility. While non-COVID patients normally come for one specific issue, the COVID unit had to transform into a place where a variety of team members are involved, given the myriad of ways the virus affects the body, said Shirley Ryan AbilityLab CEO Dr. Joanne C. Smith.
"They're all things we've seen in different settings, but having them all in the same unit presented a big learning curve," Rydberg added. "Addressing these challenges really calls for collaboration with the entire interdisciplinary rehabilitation team."
Among the 150 patients who've already undergone intensive rehabilitation in the unit, many are "seeing significant recovery and functional improvement," with others moving out of inpatient care to outpatient settings. The 30-bed unit facility can be expanded and contracted as needed.
Doctors say that these "long-haulers" show that more attention should be paid to the long-term effects of COVID-19 and how it could transform approaches to medical care and research in the future.
"For instance, take COVID pneumonia," Rydberg said, referring to one of the potential complications of COVID-19. "Now, physiatrists are starting to partner with pulmonologists in the outpatient setting to look at the long-term effects of these infections and to see what role exercise and supervised therapy can play in the ongoing recovery process."
This story first appeared in our sister publication, Crain's Chicago Business.