Authors (including presenting author) :
Lee T H (1), Teresa Yu K K (1), Yam CP (1)
Affiliation :
(1) Department of Rehabilitation, Kowloon Hospital
Introduction :
The novel coronavirus pandemic has imposed a great challenge to the healthcare system in Hong Kong. After acute illness, some patients may experience long-term consequences and present with various biopsychosocial needs. Rehabilitative services are crucial in helping those patients back into society. We report the demographics, clinical data, and outcomes of 33 Coronavirus 2019 (COVID-19) recovery patients who were transferred from Queen Elizabeth Hospital (QEH) and United Christian Hospital (UCH) to Kowloon Hospital (KH) for step-down management.
Objectives :
To review the step-down managment of COVID recovery patients
Methodology :
The clinical records of all COVID recovery patients who were admitted to KH during August 1, 2020 to December 24, 2020 were reviewed retrospectively
Result & Outcome :
In the above period, our hospital admitted 33 COVID patients. Their ages ranged from 55 to 96 years old with a mean age of 73.8 ± 8.5 years old. Most of the patients (n = 27; 82%) lived with family and the majority of them can walk independently with or without use of walking aids (n = 32; 97%). Co-morbidities were common in the patients, including diabetic mellitus (n = 16; 48.5%), hypertension (26; 78.8%), and hyperlipidemia (n = 13; 39.4%). Eight patients (24.2%) had smoking history, but only four patients (12.1%) had underlying chronic lung disease. Twelve patients (32.4%) required intensive care unit (ICU) care with mechanical ventilation. The median duration of mechanical ventilation was 11 days. The most common reason for admission to KH hospital was rehabilitation (n = 34; 92%). Other reasons included caring and placement issues (n= 16; 43 %), diabetes mellitus (DM) control (n = 14, 38 %), weaning off dexamethasone (n = 9; 27 %), and oxygen weaning (n = 8; 24%). Conventional physiotherapy and occupational therapy were provided for all COVID recovery patients using a multidisciplinary approach. Seventy-eight percent of patients (n = 26; 78.8%) were able to resume pre- or near pre-morbid mobility. Mean Barthel Index (BI) and Functional Independent Measure (FIM) score increased by 17.3 and 14.6, respectively. The mean length of stay was 22.8 days, and the majority of patients (n = 29; 90%) could continue to live at home. One patient failed to wean off oxygen and needed long-term oxygen arrangement. The mean age of our patients was 74 years old and on average had 3.2 co-morbidities. Our data represented the group of elderly patients with good functional status but with multiple co-morbidities who suffered from significant illness due to the COVID infection. Conventional rehabilitation showed beneficial effects as most patients could resume pre-morbid walking levels (78.8%) and were able to wean off oxygen usage (96.7%). Our series found that up to 24% of the patient (n =8) had mood problems, such as depression, anxiety, and adjustment reaction. Clinical psychologist and psychiatrist input were very important in the step-down management of COVID recovery patients. Up to 61% of the transfer-in patients (n= 20) were still SARS CoV2 positive with mean Cycle threshold (Ct) value of 33.5± 2.5. Nearly all of them (n = 31; 94%) already developed antibodies, and the mean duration of antibodies development was 17.5 days. Thus far, no reported incident of virus cross transmission in our hospital was found; therefore, using the combination of high Ct values and antibody development should be enough for defining COVID recovery patients with very low infectivity. Those patients could be safely managed in convalescence hospitals even when those are full of frail patients. Conclusion: As the battle against COVID may persist for a while before achieving complete eradication. The data allow us to have better understanding of disease influence on patients and may facilitate healthcare providers to formulate a more structural and efficient rehabilitation pathway in helping the COVID patients.
