Case Diagnosis: COVID-19 was primarily thought to be a respiratory illness but we have since learned that it affects the body systemically, with particular microvascular destruction. The systemic nature of the disease, dearth of consensus on best practices and a pandemic has led to prolonged recoveries and increased Rehabilitation needs especially in ventilator dependent COVID-19 patients

Case Description: We present a 58 year old female with past medical history of insulin-dependent Type II Diabetes and anemia who was admitted to in mid-April with chief complaint of fatigue and hyperglycemia found to have COVID-19 pneumonia. Day 5 after her positive test, the patient was intubated and ventilated. By Day 41, she had tracheostomy and PEG tube placement. After a prolonged stay in critical care, on day 62 she arrived to Acute Rehab. She was tracheostomy, ventilator and PEG dependent and her first Rehab admission lasted one week, as on day 69 she was readmitted to Acute Care for bilateral pneumonia recurrence.The patient returned to Rehab on day 79 and weaned off the ventilator. By day 90, she only required 2-3L of supplemental oxygen via nasal cannula. On day 108, she was finally decannulated and her PEG tube removed.

Discussions: One of the challenges for this patient has been the uncertainty regarding her level of infectivity. The patient has been tested 8 times throughout her 100+ day hospital LOS. 5/8 were positive—with no clear pattern. One of her positive tests, threatened to send her to a COVID unit where she would not receive intensive therapies. Another challenge was her severe muscle wasting and debility. Particularly, her ankle instability has made it difficult for her to start walking.


Conclusions: This case provides an opportunity to discuss ways we can approach rehabilitation of COVID-19 related critical illness neuromyopathy in the tumultuous landscape of the pandemic.