With this correspondence, we would like to briefly outline a practical perspective about a possible integrative and effective management in spa settings of COVID-19 long-term sequelae, with a keen focus on post-infective lung damage and fibrosis, which is expected to become epidemiologically relevant in the general population. In order to outline a standard/baseline model of care, we think that it can be useful to refer to already existing rehabilitative plans with a long-standing tradition in Italy, such as those ones prescribed for work-related respiratory diseases like pneumoconiosis, in which long-term outcomes share some clinical characteristics with post-infective lung fibrosis. Such programs include diagnostic procedures (spirometry, ECG, blood tests) and treatments like respiratory physio-kinesiotherapy and postural drainage of the lungs; mechanical pulmonary ventilation for rehabilitative purposes, with or without drugs, along with standard medical and, when required, oxygen therapy; inhalation therapies with mineral waters; physical activity and psychological support. In conclusion, we believe that spa facilities can be a proper setting for respiratory rehabilitation and that already existing programs employed in occupational medicine can be a good starting point to plan rehabilitative strategies for post-COVID-19 patients. In particular, health spa centers can be useful not only to offer tailored programs of physical rehabilitation but also to provide patients with a psychologically supportive and health-promoting environment. Further studies on the topic are advised to properly assess and quantify with adequate outcome measurements the beneficial effect of a spa-based rehabilitative program in post-COVID-19 patients.

中文翻译：

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水疗中心 COVID19 后患者的呼吸康复：从理论到实践的第一步

通过这封信函，我们想简要概述一个关于在水疗环境中对 COVID-19 长期后遗症进行综合和有效管理的实际观点，重点关注感染后肺损伤和纤维化，预计这将成为在一般人群中具有流行病学相关性。为了概述护理的标准/基线模型，我们认为参考在意大利具有悠久传统的现有康复计划可能是有用的，例如那些为与工作相关的呼吸系统疾病（如尘肺）开出的计划，在这些长期结果与感染后肺纤维化有一些共同的临床特征。此类计划包括诊断程序（肺活量测定法、心电图、血液检查）和呼吸物理运动疗法和肺部体位引流等治疗；用于康复目的的机械肺通气，有或没有药物，以及标准的医疗和必要时的氧疗；矿泉水吸入疗法；身体活动和心理支持。总之，我们认为水疗设施可以成为呼吸康复的适当场所，并且现有的职业医学项目可以成为为 COVID-19 后患者制定康复策略的良好起点。特别是，健康水疗中心不仅可以提供量身定制的身体康复计划，还可以为患者提供心理支持和促进健康的环境。