Nutritional strategies for the rehabilitation of COVID-19 patients

The assessment of nutritional status, swallowing capacity, and masticatory function is highly recommended as part of the normal clinical practice. Here we propose a protocol for nutritional screening and interventions in COVID-19 patients (Table 2). However, these critical aspects contributing to the individual’s health are often neglected in normal times. It is not surprising that they have been frequently overlooked during the COVID-19 pandemic as soon as the clinical focus has been shifted towards the treatment of the coronavirus infection. The fact that the standard assessment of the nutritional status can be more challenging during the COVID-19 pandemic does not justify such superficial approach, especially in those patients developing the most severe forms of the disease (and thus at risk of wasting syndromes). In this scenario, clinicians may still rely on rapid screening tools able to identify people at risk of malnutrition, swallowing disorders and/or masticatory problems. Direct interviews with the patient about recent dietary patterns or weight changes might be difficult to conduct because of the severe respiratory conditions as well as for the presence of other comorbidities (e.g., cognitive decline, low level of consciousness). There might also be difficulties at retrieving information from caregivers or relatives due to the lockdown and the limited access to the hospitals. In this context, telemedicine may represent a possible solution for both monitoring the patient as well as obtaining additional information from family members.In conclusion, the nutritional status should be assessed in all patients, especially today in those affected by COVID-19. The evaluation should be conducted at the admission and at every major change of the health status. The preliminary data coming from the San Raffaele hospital about malnutrition and dysphagia should foster reflections on the importance of early detecting malnutrition and/or swallowing impairment in order to potentially prevent the most serious consequences of COVID-19. The role of nutrition cannot be any longer overlooked (independently of the SARS-CoV-2 infection), given its relevance for the patients and the healthcare systems.