A new market for medical services has emerged and is actively growing in Russia - the rehabilitation of patients who have undergone COVID-19. Such programs are offered not only by hospitals and clinics, but also by sanatoriums. The health resorts are actively engaged in the formation of post-like health programs with the expectation of attracting clients who are not very active at this time of the year. Despite the fact that the virus itself and its consequences are still poorly understood, rehabilitation is based on long-known procedures to restore the body. The request from patients is still small, hoteliers admit, but it is growing noticeably along with the number of patients who have recovered and the number of complications after the coronavirus.
Those who have had COVID-19 feel the effect of the virus on their health for a long time after the official recovery. Most often, complications are observed from the respiratory, cardiovascular and central nervous systems, the gastrointestinal tract, and a number of patients also experience psychological problems.
According to experts, the consequences of the virus are no less dangerous than the disease itself. In this regard, the role of rehabilitation is increasing, which, according to doctors, should be carried out in several stages and take at least six weeks.
Ministry of Health warns
In July last year, the Ministry of Health developed and sent to the regions guidelines for the provision of medical rehabilitation to patients with coronavirus infection. They mainly concern medical institutions: the first stage - in intensive care units, infectious and therapeutic departments, the second - in round-the-clock specialized medical rehabilitation departments, the third - in a day hospital and polyclinics.
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In addition to the attending physician, specialists in physiotherapy exercises, physiotherapy and other specialists who have been trained in the restoration of the functions of external respiration, transport and utilization of oxygen by tissues, organs and systems, restoration of tolerance to stress, psycho-emotional stability, and everyday activity should participate in the process. The use of breathing exercises, manual therapy, osteopathy is recommended. It is also necessary to give patients aerobic exercise, the intensity and type of which are selected individually, taking into account their condition and physical capabilities, as well as resistance and resistance training to restore muscle strength. In addition, it is recommended to organize the work of a psychological support service.
The recommended duration of rehabilitation programs is 6 to 12 weeks. It is most effective to carry out it within two months after the end of the acute stage of the disease.
After discharge, the patient must spend 14 days in isolation, and then can be referred to a spa treatment for further rehabilitation. The specialists of the sanatorium and resort industry have finalized their programs taking into account the recommendations of the Ministry of Health and are already offering them to their clients today.
Eat. Walk. Breathe
Rehabilitation of patients who have undergone coronavirus infection should contain a full range of procedures that directly affect the affected organs and tissues, says Muslim Muslimov, chairman of the Business Russia committee on medical services.
The main complications of covid are on the pulmonary system, therefore, a large number of breathing exercises are needed, selected by the exercise therapy doctor individually for each patient. At the same time, physical activity is recommended, walking in the fresh air, best of all in the forest. The second very important point is diet.
“Nutrition is paramount in the framework of rehabilitation. In a quarter of patients who have undergone coronavirus, we see complications of gastrointestinal diseases. It is necessary to reduce the consumption of alcoholic beverages and heavy foods, and optimally appoint fasting days. We definitely recommend taking herbal sour teas - cranberry, mountain ash - to increase the volume of circulating blood,”the doctor explained.
In addition, inhalation, physiotherapy and massage are recommended. The rest of the procedures are prescribed individually, depending on the complications and the state of the patient's body. It is necessary to constantly monitor the rehabilitation of the rehabilitation physician. The minimum duration of the program is 10 days.
It is very good that sanatoriums have begun to develop and offer rehabilitation programs for patients who have undergone covid, the expert said.
“In the health care system, the best rehabilitation can be provided by the institutions of the sanatorium and resort profile. After all, it is their job to return people who have suffered a disease to a healthy lifestyle. It is ideal to send a person to the sunny coast, where he can walk and swim a lot, eat right,”Muslim Muslimov explained.
According to him, the arsenal of a sanatorium dealing with the rehabilitation of patients after covid should include the services of a sauna and a hammam, a cryochamber, a Charcot shower and hydromassages, mud therapy, simulators for unloading the spine, and lymphatic drainage equipment. It is also very good to undergo colon hydrotherapy (bowel cleansing), as it helps to restore the immune system.
But the most important thing is that a competent balneologist works in the sanatorium, that is, a doctor who deals with the medicine of a sanatorium-resort profile and can draw up an individual comprehensive rehabilitation program and monitor its passage. A doctor of this profile is also studying the effect of natural factors on the body, because the influence of the environment on human health is equally important.
“The influence of natural factors should not be underestimated. Rehabilitation on the Black Sea coast will be very different from rehabilitation in Moscow in winter,”the expert emphasized.
Request for the sea
Post-clotting rehabilitation is a completely new task, and today few spa facilities offer such services, says Sergei Romashkin, general director of the Dolphin tour operator.
Basically, these are specialized sanatoriums specializing in the treatment of the respiratory system. For one hundred such institutions, there are only 16 so far that have developed rehabilitation programs for patients who have undergone coronavirus. They are concentrated in the Krasnodar Territory, Crimea and Kavminvody - regions where even the air itself is considered curative. As a rule, the procedures recommended after pneumonia are offered - inhalations, pressure chambers, physiotherapy.
According to the expert, the tour operator has not yet received requests from tourists for such services.
However, interest in them is growing. So, in Yandex search queries, "rehabilitation after coronavirus" in May was met only 1,000 times, in October - 7,700 times, in November - 15,500, and in January - already 22,800 times. For comparison: the query "treatment in a sanatorium" in January was asked 450 thousand times.
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Hoteliers predict a surge in the popularity of spa rehabilitation programs closer to the summer, during the traditional holiday months. Although some interest is already noticeable, said Mikhail Danilov, medical director of the Association for Health Tourism and Corporate Health.
“The demand for such programs is not so high yet, but it exists, and we expect that in 2021 it will grow, given that the number of people who have been ill and recovered in our country is approaching 3.5 million people. You need to understand that not all those who have had covid disease are ready to undergo medical rehabilitation, and this is especially true of working citizens: after being forced out of the work process for a month, and in some cases and more, they want to return to work as soon as possible, without thinking that for a full recovery of the body, rehabilitation in a sanatorium is necessary. On the other hand, work is underway to optimize the patient routing process, including rehabilitation,”he explained.
It is also important that in the fall of 2020, sanatorium rehabilitation programs after the transferred covid were available only for purchase at their own expense, and now in a number of regions they have already begun to be implemented at the expense of compulsory medical insurance.
“Sanatoriums are already ready to work in this profile - there are at least 20% of such facilities among the industry participants. If there is a request, they can easily transfer most of their bed capacity, if not the entire number of rooms, to receive such patients,”explained Mikhail Danilov.
There is no need to completely re-profile the institutions - already known and applied methods are used in post-ovarian rehabilitation.
“The saturation of the treatment schedule for a patient under such programs reaches, on average, 6-8 types of physiotherapeutic and rehabilitation effects per day. In rehabilitation programs after covid, a large part is taken by measures aimed at restoring oxygen transport to organs and tissues, special gymnastics and psychological recovery, as well as numerous types of natural and physiotherapeutic effects,”the expert said.
For example, the program of the Peredelkino cardiological sanatorium center (Moscow) provides for group exercise therapy, various types of inhalations, chest massage, physiotherapy, laser therapy and ozone therapy.
The program of the sanatorium "Foothills of the Caucasus" (Goryachy Klyuch, Krasnodar Territory) is designed for adults who have had pneumonia. The course is based on three pillars: restoration of the immune system, restoration of the respiratory system and restoration of the gastrointestinal tract and liver affected during intensive antibiotic therapy in the treatment of coronavirus.
FGBUZ MRC "Sergievskie Mineralnye Vody" FMBA of Russia (Samara region) developed a rehabilitation program back in August 2020. It is primarily designed for patients who have had COVID-19, but is also suitable for people with chronic diseases of the upper respiratory tract and lungs. Among the procedures are oxygen therapy in a modern pressure chamber and halotherapy (salt cave). The procedures are aimed at reducing the number of complications after suffering respiratory diseases, restoring lung function.
The health resort "Lago-Naki" (Adygea) relies on the restoration of the central nervous system, as it is affected by the consequences of the coronavirus. At normal times, the health resort specializes in the treatment of diseases of the spine, but since September, guests have begun to receive requests for such services, and the institution has all the necessary procedures and equipment to provide them.
In Crimea, research institutes named after I. M. Sechenov, Research Institute of Pediatric Balneology, Physiotherapy and Medical Rehabilitation, Medical Academy named after S. I. Georgievsky, Kazan Federal University IN AND. Vernadsky.
All medical and health-improving procedures are carried out in combination with climatotherapy, since the Crimea has historically been a region for the treatment of respiratory diseases.
Yalta resort hotel PalmirPalace has always specialized in rehabilitation, and since January has launched a new program "Recovery" specifically for patients who have undergone coronavirus. It contains three blocks - diagnostic, wellness and treatment, says the hotel's medical curator Natalya Osadchaya.
“Compared to our other programs, it is richer. So, we added two specialists - a nutritionist and a psychologist. In addition, within the framework of the diagnostic unit, the patient, if necessary, can undergo medical examinations, including computed tomography and ECG, and take tests,”Osadchaya said.
According to the expert, it is better to choose autumn, winter and spring for health improvement, when the air is cleaner and the air temperature is lower than in the hot summer months.