A GRUELING PHASE

In Baltimore’s dedicated coronavirus rehab wards, patients relearn swallowing, dressing, even thinking

Lou Packett lasted mere seconds wheeling himself down the hallway of the new coronavirus rehab unit at the University of Maryland Rehabilitation and Orthopedic Institute. He had to stop for exhaustion.

He’d just lost 25 pounds from a frame he jokes could have used 10 more to begin with. He had spent April intubated and barely conscious as he fought the coronavirus at the University of Maryland Medical Center. Now, in May, he was the first patient admitted to this new COVID Recovery Rehabilitation Unit.

His weakness in breathing, swallowing and speaking was so stark that he expected it could be another month before he went home.

“When somebody last week made mention that there was a consideration that I would be out of here [Friday], I thought somebody had a three-martini lunch,” Packett, 69, said.

That goal, however, was met May 15, making him an early success story among area care facilities establishing units or dedicating themselves entirely

to COVID-19 rehabilitation. Locally, the University of Maryland’s unit and the Genesis Loch Raven Center in Parkville are two that serve only patients who are clear of symptoms but still too weak to go straight home.

Many Baltimore-area rehabilitation facilities treat recovering COVID patients alongside their regular rehabilitation programs, and have the means to do so safely — but operators say the few new, exclusive programs remove any risk.

For patients, rehab can be grueling, physically and emotionally, but rebuilds skills and confidence to manage on their own.

“We really saw that it was a huge need for patients that needed intensive, interdisciplinary care in order to improve their endurance, improve their swallowing, improve their cognition, improve their ability to take care of themselves — dress themselves, bathe themselves — and return home,” said Lori Patria, director of therapy services at the University of Maryland Rehabilitation and Orthopedic Institute. “That’s where we all want to go. That’s always the gold standard: returning home.”

An unmet need

COVID-19 does its worst damage on aging patients and those with underlying conditions. They already may take longer to recover from illnesses.

“It’s a false narrative to assume that people can leave the hospital … and they can go back home and have a quick and successful recovery,” said Dana Bradley, dean of the Erikson School for Aging Studies at the University of Maryland, Baltimore County. “That’s why rehab centers play such an important role in the treatment plan and getting people that have had COVID back to normal … Sometimes, this recovery can take a long time.”

Rehabbing COVID patients isn’t so different from rehabbing patients with, say, acute respiratory distress syndrome, according to Dr. Michael Dimyan, director of spasticity management and neurorehabilitation practice for the University of Maryland’s rehabilitation institute.

Both illnesses debilitate lungs and can weaken people “physically, emotionally, cognitively, and also create depression and post-traumatic stress.”

The difference, he said, “is that it usually doesn’t affect large populations all at once, and usually people are hospitalized for maybe a week at a time and their level of disability is not as severe.”

“Now we have this sudden situation where a large number of people are affected and they’re affected more severely because they’re being hospitalized for two, three weeks at a time, intubated and sedated … so they’re much more impaired.”

At his center, 134 rehabilitation beds are divided into four units. Staff converted the stroke unit for COVID rehab.

Those patients could have respiratory issues, swallowing deficits because of intubation, cognitive issues because of lack of oxygen early on, plus general weakness, Patria said. Leaders there saw a match for their team of attending physicians, rehab nurses, occupational therapists, speech therapists, physical therapists and recreational therapists to fill an unmet need.

The unit opened May 1 and has been slowly ramping up its intake, with Packett admitted May 5, one of 17 admissions over the last six weeks.

He’d already had part of his lung removed in February, after a cancer diagnosis. He was set to begin chemotherapy but instead was admitted to the emergency room at UMMC on March 31.

“That was the last thing I remember for about five weeks,” Packett said.

There were two weeks on a ventilator, and then a state of delirium through nearly the end of April.

He remembers about a week in the hospital before he switched to the rehabilitation unit, and was able to meet that aggressive discharge date, he said, because of intensive daily sessions.

His breathing exercises, at least, were familiar. After his lung surgery, he said, he had to take 10 deep breaths into an incentive spirometer, which measures and develops lung capacity. He progressed on it quickly back in February.

“I had to start all over again,” Packett said. “I’d almost gotten to the top of the food chain on it after my operation, but I almost had to start at the bottom after I had the COVID.”

He finished his speech therapy, though he is resigned to the fact that he left some of his cognitive reflexes back in the hospital bed. He also had an hour of physical therapy and an hour of occupational therapy each day.

He recently described the rehab to his brother.

“It feels like August two-a-days during a football season when we were in high school, because they do not let you sit down around here,” Packett said. “You’re here to get something done, and they’re here to help you make it happen.”

During an inpatient physical therapy session his final day, he tried part of his prescribed treatment for at home: five minutes of continuous walking every hour. When he arrived at the rehab unit, he made it halfway around the small track before he had to stop and take a breath. Ten days later, he boasted that he made it three-and-a-half minutes straight.

He has returned to his Franklin Square home, though chemotherapy is still pending when he’s strong enough.

“I would have never thought I was, one, emotionally ready for that, and, on top of that, I never thought I’d be physically ready,” he said. ”They’ve given me the confidence that I know I’ve got the basics. Now, it’s just up to me.”

‘An ideal center’

Genesis Loch Raven Center in Parkville had one of the state’s first widespread outbreaks in a nursing facility, with 88 residents and staff members testing positive in April.

Emily Painter, the executive there, said that experience with the virus made it “an ideal center” to have a program that solely admits COVID-positive patients because the staff already knew the protocols.

Still, it’s unique. Painter said theirs was the only facility that was accepting only COVIDpositive patients in the state, drawing from hospitals as far as the Eastern Shore and Southern Maryland “because they have nowhere to go.”

They had 16 previous patients who tested negative and were moved to a sister facility, then those residents who remained through their own outbreak were relocated to the second floor.

The first floor is for new residents coming from COVID-19 treatment at hospitals, with the first patients admitted on April 28. There were 72 patients admitted through last week, including 88-year-old Waneta Douce in May after an 11-day stay at the Greater Baltimore Medical Center.

A resident of Symphony Manor in Keswick, she became ill slowly, then went to the hospital April 24.

The rehab at Loch Raven Center, she said, wasn’t so different from what she’s experienced before, with a broken ankle. She was having occupational therapy and physical therapy. But a week into her time at the facility, said the strength she had before was back.

Her wit was intact as well.

“I just do what they tell me to do,” Douce said. “Maybe it’ll make me a little stronger and meaner.”

Douce was one of 29 successful discharges from the program, Loch Raven officials said.

Both the University of Maryland facility and Genesis Loch Raven are addressing what could be a continuing need.

Widespread reopening of businesses across the country could slow the gains made by drastic social distancing measures in the first months of the spread.

“I would love to be able to say that I think this is a very short-term thing — a novel need for a very specific amount of time,” Patria said. “But I think we’re going to still see people who end up being COVID-positive and need to be on ventilators.

“I think there is going to be an ongoing need as long as we don’t have medical intervention to prevent it.”