Despite the onslaught of news about the COVID-19 pandemic, I hear nothing, anywhere about the painful and difficult rehabilitation process awaiting the survivors.

This is similar to a war in many ways, where enormous sums are spent sending soldiers out but, historically, only a fraction of that is earmarked for the arduous return. We are not prepared.

Viruses such as the corona or influenza types have evolved with the main objective of making the most copies of themselves. To do so, they penetrate the cells in the body and hijack the protein-making machinery to make exact copies of the virus. It’s like a car factory modified to produce paperclips.

The virus has to be careful not to produce too many copies of itself, or it will risk killing the host, which stops that infected individual from spreading it further. If the virus is too aggressive and kills too often and too quickly, it becomes less successful in spreading a disease.

Asymptomatic carriers, people who got infected but don’t know it, are very effective in disseminating the disease. In the case of COVID-19, some estimates suggest that about 50% of people who are infected belong to that category.

The other 50% will have varying degrees of illness and many will require hospitalization, sometimes with severe respiratory problems and a cascade of events that can lead to circulatory collapse and death. Predisposing conditions such as diabetes and cardiopulmonary disease greatly increase the chances for a poor outcome.

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The ones who survive moderately severe and severe illness will need medical and rehabilitation care perhaps for years.

Based on previous respiratory viral epidemics, we can assume that many survivors will recover only part of their lung function. That means varying degrees of reduced vitality, shortness of breath, decreased capacity for taking care of themselves, lung infections, falls, and decreased mental capacity among other related aftereffects.

The damage to the musculoskeletal system can be severe due to prolonged inactivity in the hospital bed, poor nutrition, multiple harsh medications and invasive treatments. We can expect loss of muscle mass, stiffness and freezing of the joints, and loss of bone calcium with increased chances for fractures.

The brain function and the psychological well-being of survivors are expected to suffer. Episodes of hypoxia, or decreased blood oxygen, can lead to confusion, hallucinations and other neurological dysfunction.

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Less dramatic but no less important, is the development of chronic mental conditions such as depression, anxiety and panic attacks. Just being in the hospital, sick and scared, is enough to shake one’s mental strength. Add to this the banning of one’s family from the hospital room, kept away by the risk of infections to themselves, and a gravely ill patient loses the support and hope provided by their loved ones.

Chronic pain will become an important issue during recovery. We expect that many of the survivors will develop generalized pain, a mixture of muscle and joint damage, weakness, decreased oxygen to the muscles and alterations of brain chemicals that regulate pain sensation. 

Pain can be a consequence of the treatment itself. For example, the intense compromise of the lungs caused by the viral infection often requires multiple interventions to the thorax, including chest tubes inserted between the ribs. Nerve pain can develop as a complication from chest operations.

Rehabilitation will require a multidisciplinary approach involving different medical specialties, physical and occupational therapy, nutritionists, psychological support, social workers and others.

In the meantime, many rehabilitation facilities have furloughed their employees and reduced their staff to a minimum. It will take time to ramp up to what could be hundreds of thousands of patients in need of a physical and mental recovery program. We are not prepared.

A new methodology for treating these patients is needed. The number of inpatient and outpatient facilities is inadequate. We don’t know to what extent health insurance will cover the treatment of these individuals, and the loss of income suffered by patients and their families during this economic downturn will only magnify the problems. 

An intense, daily, exercise program geared toward the respiratory and musculoskeletal systems will likely form the basis of any rehab program. A combination of a brief, intensive rehabilitation program, followed by an at-home exercise routine supervised by the health care professional through telemedicine may be our best option.

Solid pain management techniques – analgesics, antineuralgic medications, nerve blocks – will enable patients to participate in an accelerated rehabilitation program and may provide them with the stepping stone required to begin the long journey to recovery.