Twenty-one weeks of rehabilitation after three weeks of intensive care

Jenny Zwiggelaar recently started working through the window with some patients. She is standing on the grass in front of their house and together they do the agreed exercises, the patient behind the glass. Zwiggelaar is a lung physiotherapist and works with lung patients who have to move every day despite their difficult breathing. In addition to their lung disease, they may have other conditions that also require them to monitor their sugar and blood pressure. Pre-eminently people who should not contract the coronavirus.

Tomorrow Zwiggelaar will do exercises for the first time with a patient who received Covid-19 and who survived. That patient has just been released from the hospital. “She can’t go out yet, but she wants to. She also wants to cook again. ” Local residents used to do that for her husband, now he cooks himself.

More and more corona patients are coming home. 539 of them survived an intensive care admission and have gone home. Another 585 survived the ICU, but are still in the hospital. 661 patients did not survive the admission. 884 are still in the ICU.

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More than 10,000 people were admitted to hospital, many of whom are still there or stay in a rehabilitation facility. Their body defeated the virus themselves, they only received help with breathing in the hospital, anticoagulants, blood pressure risers and sometimes antibiotics.

But they are not all ready by any means.

Normally, the patient has to rehabilitate for one week each day in intensive care. For Covid-19 patients, who have been in IC for an average of three weeks, this is therefore 21 weeks.

Pulmonologist Gert-Jan Braunstahl in the Franciscus Gasthuis en Vlietland in Rotterdam, when he answers the phone, has just taken a patient from the ICU to a nursing ward. A man in his sixties. The man has a pressure wound on his face. “If you lie on your stomach for three weeks with muscle relaxants and respiratory sleep aids, that can happen.”

Nerve problems

Bedsores are just one of the consequences of being idle for weeks. Covid-19 patients lose an average of four to five pounds of muscle in ICU in three weeks, Braunstahl says. They can therefore not walk and hardly swallow. They also have nerve problems, as a result of which organs are not properly controlled by the brain. And the lungs are damaged. Because of the virus itself, but also because they have been artificially ventilated for weeks. “We expect one in five patients to have damaged lungs in the long run, which prevents them from coughing up and makes them more susceptible to infection.”

And for unknown reasons, they have clotting problems. Faster than in other patients with severe pneumonia, the blood does not clot well in Covid-19 patients, causing blood clots to come off and cause a pulmonary embolism or thrombosis.

The Francis normally has 12 IC beds, now 26, containing 18 Covid-19 patients. Most patients who leave the ICU are referred to a rehabilitation center or aftercare institution. Those who were alone in the nursing ward must return quickly for a check-up. “We don’t yet know exactly what is needed for that group. Physiotherapist, dietician and psychologist are on indication. ”

And then there is the psychological damage. Under normal circumstances, 40 percent of ICU patients experience posttraumatic stress from their stay, research shows. This is called the “post-ic syndrome”. It leads to fears, reliving, depressions, concentration disorders. Surrendered to unknown doctors and nurses and machines in one fell swoop is a traumatic experience.

In addition, you are in a ward where in normal circumstances one in five patients die around you – that can also be traumatic. A multiple of the Covid-19 patients on IC die. And for the Covid-19 patient, the doctors and nurses are also invisible, because they are covered with protective clothing.

“Who am I” sign

Ben Vermin, an intensivist in Spaarne Gasthuis in Haarlem, nowadays wears his name in large letters on his white jacket “I am AM”. Each bed has a “who am I” sign, with pictures of the patient, maps of his family, his hobbies. And a large clock with the date on it. Vermin: “That helps against the confusion that patients can get. If you lie in one place for weeks, without a day and night rhythm, you are more likely to get really confused. ” Normally, the Spaarne has 16 IC beds, now 34, of which 24 are for corona patients.

Vermin is aware of the psychological consequences for patients and loved ones. “It is now also traumatic for those close to us. They cannot get to their loved ones, they depend on information we provide over the phone. ”

Het Spaarne has a “calling team” of doctors who call family members every day. “Those conversations often last up to an hour. The family wants to know as much as possible: every detail can give hope or destroy it. ”

Building the condition after Covid-19 becomes a matter of small steps, says physiotherapist Jenny Zwiggelaar. She has completed online training with a few hundred other physiotherapists to help corona patients. “They are short of breath. We must always push their limits but not run too fast. They will need dietary advice because malnutrition is lurking – even in heavy patients. ”

The patients who were in the hospital will spend four months scribbling. Nobody dares to predict whether they will ever reach their old health level again.

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