Pulmonary Rehabilitation

Pulmonary Rehabilitation is Delayed for Patients Who Need It After Covid-19 Recovery

Sheba Medical Center has the only pulmonary rehabilitation unit for Covid-19 patients who underwent a long period on a ventilator. Due to a lack of beds, many victims must wait weeks for critical treatment.

At Sheba’s rehabilitation hospital, the pulmonary ward has only 10 beds assigned to Covid-19 sufferers. The medical team at Sheba had forewarned Israel’s Ministry of Health about this problem and had recommended adding beds to the department, but with no avail.

Prof. Amitai Ziv, director of the rehabilitation hospital at Sheba, explains that the line for these beds continues to grow with coronavirus patients from both Sheba and other hospitals. He recently sent a letter to Dr. Vered Ezra, head of the medical division of the Health Ministry, in which he wrote explicitly, “In light of the fact that the unit we’ve opened has only 10 beds, and in light of the expected growing need for pulmonary rehabilitation, we recommended advancing the opening of more beds across the country focused on pulmonary rehabilitation.”

As a result of the bed shortage, continuity of care is lacking. Pulmonary treatment can be critical for the survival of some patients who are taken off the ventilators. As one health professional at Sheba expressed, “Everyone was hysterical about the ventilators, but without being able to continue care properly, all the effort goes down the drain.”

The pulmonary rehabilitation department at Sheba is equipped with a total of 20 beds dedicated to treating patients who are scheduled to be weaned off respiratory devices. Since the start of the Covid-19 pandemic, the patient composition has changed. Fewer surgeries have been performed and less road accidents have occurred, while hospitals have been admitting hundreds of patients with coronavirus who require life-saving ventilators. In response, Sheba divided the department and assigned half the beds to Covid-19 victims.

Severe cases of Covid-19 are often marked by pneumonia in both lungs. Lung function is typically compromised, and patients need a long period of mechanical respiration, about two to three weeks.

“When the disease is at its peak, the patient is sedated and on a ventilator,” Ziv explained. “Respiratory muscles are totally weakened, and we are essentially giving the respiratory system a rest by respirating him mechanically. As the illness passes, we get signs that show the patient can start to breathe on his own in a limited fashion, and that’s when we start the process of having the machine provide partial support.”

That means the rehabilitation process begins while patients are still connected to ventilation, at a stage when they are still actively infected with the novel coronavirus – which is why the rehabilitation ward must be split into distinct units.

The Health Ministry replied to Sheba’s request by stating, “Indeed, some of those patients who are ventilated need pulmonary rehabilitation. At this point the patients are rehabilitated primarily at Sheba (even though sometimes the rehab can start or be completed in the hospital ward). Sheba has the potential to open more beds. We are also looking into opening pulmonary rehabilitation in other institutions.”