“It’s like a tsunami, it takes you physically and mentally”: affected by the coronavirus, they have come close to death and now begin long weeks of rehabilitation, still marked by resuscitation but also loneliness in the face of the disease.
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Never-known fatigue
“It’s good, very good!”. This Tuesday morning, a physiotherapist at the Clemenceau University Rehabilitation Institute in Illkirch-Graffenstaden (Bas-Rhin), encourages Georges, 77 years old. Leaning on parallel bars, it swings back and forth on a board placed on cylinders. If his eyes sparkle with humor behind his glasses, the septuagenarian, who spent eight days in intensive care, is quickly out of breath under his surgical mask.
“After what we have experienced, we come back from afar”, says this Strasbourg resident who describes the “apocalyptic visions” of artificial coma but now wants and can project himself again into the future.
On leaving the hospital, “I thought I could go home but I recognize that I could not have done 10 meters”, he notes, describing “a fatigue that we have never known “.
In the same room – a recently converted dining room for the needs of the pandemic – another patient turns the pedal of a rehabilitation bike from his wheelchair.
At the Clemenceau Institute, which has opened two 18 and 20 bed units dedicated to Covid-19 in its centers in Illkirch and Strasbourg, physiotherapists, occupational therapists, speech therapists and other psychologists are working to get very weak patients back on their feet by illness.
Weight loss, muscle wasting, undernutrition
Massive muscle wasting, malnutrition, with patients who have lost 10 to 15% of their weight, swallowing disorders related to intubation, breathing difficulties … For patients undergoing intensive care and referred to this center, the rehabilitation work will take at best 6 weeks but more often three to six months.
“They have the double pain: they had Covid, with a muscular and neurological attack, and in addition they have all the effects related to inactivity”, explains the chief doctor Marie-Eve Isner. “In a week of immobilization, you lose 10% of your muscle mass.”
A team of doctors and interns is responsible for identifying resuscitation patients at Strasbourg University Hospitals who will need to stay in this center, after a transition to intensive care, whether they have developed a particularly serious form of the disease or suffer from other pathologies complicating their recovery.
The center has reorganized to accommodate them, in addition to the patients it was already following for a stroke, multiple sclerosis or Parkinson’s disease, and who contracted Covid-19. His doctors have done a lot of documentary research to define the most efficient management in the face of a still mysterious illness, additional “verticalization tables” have been acquired, nursing and physiotherapy schools have come to reinforce them.
Relearn all the gestures of daily life
Some convalescents who arrive at the center cannot even sit still and all have to relearn the gestures of daily life. “We go through the sitting position, the standing position, walking, exercise training,” explains the head of the technical platform, Julien Przybyla, referring to very divided sessions to limit fatigue.
But rehabilitation also involves “rethinking a life project”, insists Marie Velten, care coordinator. She considers it essential for these patients, weakened psychologically by the confinement, to establish relationships with the nursing staff, while visits remain prohibited.
Neurological and cognitive sequelae
Besides the physical difficulties, the patients “have a lot of nightmares, they have a sensitivity to what happened in the intensive care unit”, adds the nurse Vanessa Beague. “We take a lot of time with them, they need to talk.”
For Professor Isner, “we may see neurological and cognitive consequences, there is a clear tropism of this virus for the nervous system”, even if it is too early to say with certainty.
The institute’s effort to help the Covid-19 patients to rebuild promises to be long-term. His doctors expect to see patients arriving at the end of next week who have spent around three weeks in intensive care and whose care will be even heavier.
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