Reply to letter re “Outcomes of a COVID‐19 Recovery Program for Patients Hospitalized with SARS‐CoV‐2 Infection in New York City: A Prospective Cohort Study.”

Abstract

Editor We thank the authors for their thought-provoking commentary in response to our recent article “Outcomes of a COVID-19 recovery program for patients hospitalized with SARS-CoV-2 infection in New York City: A prospective cohort study.” We agree that more literature supporting and studying technology-based innovation is critical, especially in light of the ongoing coronavirus diseases 2019 (COVID-19) pandemic and its ramifications that are likely to be experienced for a long time to come. As the authors described in their letter, our cohort did have differences in the numbers of patients engaged in home versus virtual physical therapy. Much of this had to do with the rapid implementation of such a program during a time of extreme strain on the health care system and extraordinary clinical need. Studies evaluating the efficacy and implementation of telehealth in treating different expanses of cardiopulmonary disease could increase access to care and help mitigate the long-term downstream effects of these conditions. This is extremely important for improving health equity in populations that are historically marginalized by our health care system. As the authors touched upon, many of those who were affected by COVID-19 in our New York City program were from underrepresented populations, including a high percentage of Hispanic and Black patients. Persistent vigilance and outreach to help continue to improve outcomes in those populations disproportionally affected by COVID-19 will be crucial as we as a nation continue to move forward. At the same time, all patients may not have equal access to high-speed wireless Internet and sufficient space available to conduct virtual rehabilitation. We will need a flexible and personalized approach that is individualized to patient needs. We also concur that more research should be undertaken to study the efficacy of virtual rehabilitation on those with persistent symptoms after COVID-19 infection or “long COVID.” Rehabilitation programs will continue to be at the forefront of care as higher numbers of patients experience these symptoms. We believe that physiatrists are among the best-positioned medical specialists to offer insights and continued innovation in treating these challenging sequelae of COVID-19. Given the role that pulmonary rehabilitation can play in improving quality of life and exercise capacity for those with pulmonary fibrosis, continued focus on delivery of rehabilitation programs to those with persistent symptoms after COVID-19 infection could help limit the longterm sequela as had been seen in the 2003 SARS outbreak. Continued emphasis on evidence-based interdisciplinary treatments and use of telehealth programs such as ours can be utilized to address other facets of COVID-19, including the cognitive and psychiatric sequelae that are being increasingly observed. Even among non-COVID-19 patients, a subset of patients may continue to desire telehealth services after the pandemic ends. Our institutions are studying ways to address cognitive and psychiatric symptoms using virtual/technology-based approaches, both for COVID-19 and for other neurologic and psychiatric disorders. We look forward to learning more about the experiences and outcomes of similar rehabilitation programs implemented during this pandemic as more literature becomes available. As a medical community, we have much to learn about this disease and the long-term sequelae, and we look forward to continued collaboration as a specialty to help fulfill the needs of these patients moving forward.