Coronavirus victims who undergo lengthy periods on a ventilator need pulmonary rehabilitation – but are being forced to wait weeks for treatment due to a lack of beds in the sole such rehab unit in the country, at Sheba Medical Center at Tel Hashomer.
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The unit has only 10 beds allocated to COVID-19 victims. The hospital had warned the Health Ministry of the problem and had recommended adding beds to the department, but it was not done.
According to Prof. Amitai Ziv, director of Sheba’s rehabilitation hospital, there are both Sheba hospital patients and coronavirus patients at various other hospitals waiting for the beds, and the line keeps getting longer. In a letter he sent recently to the head of the medical division of the Health Ministry, Dr. Vered Ezra, Ziv wrote, “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.”
“There’s a problem here of continuity of care,” explained the director of one of the coronavirus units at Hasharon Hospital. “We have patients here who are lying and waiting. Everyone was hysterical about the ventilators, but without being able to continue care properly, all the effort goes down the drain. Some of the patients who come off the ventilators do not survive afterward; the pulmonary treatment is critical for them.”
Sheba’s pulmonary rehabilitation department, headed by Dr. Arie Wollner, has a total of 20 beds and treats patients who are slated to be weaned off respiratory devices. Since the pandemic began the nature of the patients needing respiratory assistance has changed, since there have been fewer road accidents and operations while hospitals have been admitting hundreds of coronavirus patients who need ventilators. As a result, Sheba split the department and allocated half the beds to COVID-19 patients.
One of the characteristics of severe COVID-19 cases is pneumonia in both lungs that seriously undermines lung function and requires lengthy mechanical respiration of two to three weeks. Around half the patients survive the ventilator period, but must undergo pulmonary rehabilitation afterward. The process generally starts when they are still connected to the ventilator; many of them at this stage are still harboring the virus.
“When the disease is at its peak, the patient is sedated and on a ventilator,” Ziv explains. “His 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 which show that 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.”
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The Health Ministry said in response, “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.”