26 Jun 2020
You’ve been hospitalized for COVID-19 due to a persistent high fever and severe difficulty breathing. You’ve been cared for in an acute care hospital for several weeks and are now ready to be discharged. But your story of beating the virus doesn’t necessarily end here. Recovery from COVID-19 is often not as simple as “making it through” and “heading home.” It may require a stay at a rehabilitation hospital.
When New York State Governor Andrew Cuomo declared a state of emergency on March 7 of this year, Burke Rehabilitation Hospital immediately went to work converting its inpatient therapy gyms to accommodate additional patient beds. Just ten days later, Burke took in its first COVID-19 case. Within the month, that number rose to 90 patients.
Burke holds a double license as an acute care hospital and a rehabilitation hospital, and was well-positioned to start treating COVID-19 patients. Mooyeon Oh-Park, MD, chief medical officer and senior vice president of Burke since April of 2018, said, “almost immediately, the pattern was changing” and patients being discharged from area hospitals after prolonged stays were in need of rehab.
She explained, “If a patient is in ICU (the intensive care unit of a hospital) for three, four, six weeks, those patients develop all kinds of medical problems,” including cognitive impairment, pulmonary issues and extreme fatigue, kidney failure and strokes from blood clots (which can lead to amputations), as well as pressure injuries (skin conditions related to long, complicated hospital stays).
According to Oh-Park, once a patient arrives at Burke, he/she is assessed, and individual needs are determined according to three domains: cognitive, physical and psychological. A care plan is then developed for the patient. The entire care team meets twice a week to review every patient’s progress and status.
It’s typical for medically ill patients to suffer some cognitive impairment, which is often transient, explained Oh-Park, citing that delirium is common for people with pulmonary issues who’ve had an ICU stay. The same can be said for patients who’ve been on ventilators.
There are also psychological implications of lengthy hospital stays as COVID-19 patients have been socially isolated and unable to receive visits from family members. Depression and even PTSD (post-traumatic stress disorder) can develop.
Burke was tasked with rehabilitating COVID-19 patients – not just physically and cognitively, but psychologically as well. This means addressing the whole person, which may include pharmacological support, initiating virtual connections with family, and engaging with the patient on a “more human” level, said Oh-Park.
Dr. Oh-Park commented that none of the healthcare professionals at Burke have ever seen or experienced anything like COVID-19. Their youngest patient recovering from the virus was just 20. The oldest was 90. Many patients in their 20s, 30s and 40s had suffered strokes. Some of the youngest arrived at Burke with compromised respiratory function.
As of early June, Burke had discharged about 225 COVID-19 survivors. The average length of stay has been 16 to 17 days, a typical time period for other rehab patients, but very much dependent on the patient’s specific needs. For example, if needs are strictly pulmonary (and Burke has a long-standing expertise in cardiopulmonary rehab), then rehab can focus on endurance training. In contrast, rehabilitation for stroke patients (another Burke specialty) would likely entail an intensive therapy program, combining physical, occupational and/or speech therapy as needed.
After discharge from inpatient rehab, at-home nursing care may well be needed, along with out-patient rehabilitation therapy services which can run weeks to months.
The ten Burke out-patient clinics which closed back in March are now reopening. Fortunately, leading up to the height of the crisis, the out-patient staff was retrained and brought to Burke’s main campus in White Plains. Additional help and staffing came from Burke’s sister hospitals including White Plains Hospital, a member of the Montefiore Health System along with Burke.
An inside look at Burke today is very different from the picture of it prior to this health crisis. The new protocols are strictly in place – the use of N95 masks, face shields, gowns and gloves, and therapies are delivered in the patient’s room (instead of in shared settings), requiring a bit more creativity and ingenuity to deliver services.