Rehabilitation of COVID-19 patients

The coronavirus-2 (SARS-CoV-2) pandemic has dramatically transformed the organization of public and private health organizations of the Lombardy region, the Italian region where the viral spread has been more quick and intense (1).According to the data available on the 8 th of April 2020 from the beginning of the epidemic at the end of February, 139,422 cases and 17,669 deaths have been reported in Italy, which may underestimate the real incidence.The rapid spread of the virus has upset all hospital organizations.The Rehabilitation Hospitals, as well as the rehabilitation units of multidisciplinary institutes, have considerably changed their activity.The need for medical assistance to an increasingly higher number of patients forced the hospitals to improve the volume of intensive care beds and to convert the rehabilitation departments in COVID-19 beds.San Raffaele Scientific Institute, a large tertiary hospital and research centre in Milan, Italy, was immediately involved in the management of the public health emergency (1).After the first COVID-19 case of San Raffaele Scientific Institute of Milan, dated back on 25 th February, the 3 Rehabilitation Units were merged to create dedicated beds for coronavirus cases in less than one week.Furthermore, regional laws relieved the outpatient activities of the Rehabilitation Departments to reduce the viral spread.The nurse staff have been sent to the new COVID-19 Rehabilitation Department created for those patients coming from the Intensive Care Units.At this moment, about 40 patients are hospitalized in the Rehabilitation Department at San Raffaele Hospital.The acute respiratory syndrome caused by SARS-CoV-2 syndrome may be characterized by mild respiratory diseases or moderate-to-severe pneumonia, which can cause Acute Respiratory Distress Syndrome (ARDS) and multi-organ failure.In SARS-CoV-2 pneumonia, bilateral interstitial infiltration with serious alteration of the ventilationperfusion ratio and probably shunt, cause hypoxic respiratory insufficiency (2).Acute hypoxemia may cause obstinate dyspnoea with the need of oxygen therapy administration through High-flow nasal oxygen (HFNO), or through the application of a non-invasive positive pressure, c-PAP or NIV (with oronasal or face masks, helmets) (2, 3).Unfortunately, in case of O 2 saturation worsening, orotracheal intubation and invasive mechanical ventilation are mandatory.The pulmonary parenchyma presents focal haemorrhages and necrosis, even up to a haemorrhagic infarction.The alveolar exudate can consolidate causing