COVID-19 Rehabilitation: What Medical Help Is Available For The Many Post-Coronavirus Patients Who Still Have Symptoms Months On?

When news of a novel and highly infectious coronavirus first emerged, many people were slow to take it seriously, and quick to point out that many other things we run a risk of encountering on a daily basis are both more deadly and more common. Although much of the world woke up to the very real dangers of COVID-19 soon after their initial denial, which was based on a lack of information, COVID deniers are still among us. 

They may see COVID-19 as "nothing but a mild respiratory infection, like the cold, unless you're already old or sick", and they may not care about flattening the curve and protecting themselves and those around them enough to even wear face masks, keep their distance, or wash their hands properly. 

Pulmonary rehabilitation programs, which can include education, guidelines for physical exercises, breathing techniques, dietary recommendations, and psychological support, are typically reserved for patients who suffer from serious chronic lung diseases such as asthma, chronic obstructive pulmonary disease, and cystic fibrosis. 

As more and more post-COVID patients are discharged from hospitals, whether after extremely serious clinical conditions or after a moderate case, some countries — very notably the United Kingdom, which has been a pioneer in this field — are offering the pulmonary rehab programs that have long benefited other lung patients, along with occupational and physical therapy and home help where necessary. 

It ain't over after it's over: What do we know about the long-term health consequences of COVID-19?

Though we have all grown used to hearing and speaking the word "COVID-19" daily since the beginning of 2020, we have to keep in mind that this virus is still new in the grand scheme of things, and as time goes on, more and more research will emerge.

One study conducted in Italy, parts of which were truly ravaged by the coronavirus, sheds some preliminary light on the percentage of people confirmed to have had COVID-19 who continue to suffer from symptoms after the virus is cleared from their body and they no longer have "acute COVID-19". 

Patients were interviewed, on average, around two months after they were first diagnosed with COVID-19, to find out how they were doing. The study found that, at the time of interviewing patients:

• 87.4 percent of the participants still had at least one lingering symptom, while only 12.6 percent of study subjects had completely recovered from COVID-19, without lasting symptoms.
• 32 percent — very nearly a third — had one or two long-term symptoms after having COVID-19.
• 55 percent of ex-COVID patients who were interviewed suffered from three or more lasting coronavirus symptoms months on. 
• The most commonly seen after effects of a coronavirus infection were fatigue that does not improve with normal rest (seen in 53.1 percent of patients), long-term shortness of breath (43.4 percent of cases), joint pain and discomfort (27.3 percent), and chest pain (27.1 percent of patients). 
• 44.1 percent of participants reported that their quality of life was worse than it was before they were infected with COVID-19. 

Even people who had "milder" cases of COVID-19, and who were completely healthy when they contracted the virus, can continue to suffer from this "post-COVID syndrome" in the aftermath. 

That is, of course, why COVID-19 rehabilitation programs can be so very beneficial. 

What does COVID-19 rehabilitation entail?

Post-COVID rehab programs should be tailored to each patient, depending on their needs, and can therefore vary dramatically. 

As David McWilliams, a physiotherapist at Birmingham's Queen Elizabeth hospital in the UK, which has been at the forefront of coronavirus rehab programs, explains, COVID patients with the most severe cases have to be placed in induced medical comas to help them preserve strength and recover, while they are on ventilation. 

"We know they can lose somewhere in the region of 20 percent of their muscle in the first seven days", he explained. When these patients wake up, they are confused, and surrounded with strangers in full protective gear rather than their loved ones. They may not remember what even happened to them — and are very often so weak that they cannot talk or sit up. 

Such patients require around-the-clock care from a dedicated medical team. It can take as many as four physiotherapists to help patients of this kind sit up — and their road to recovery can last many months and take incredible efforts on their part and the part of the team guiding them. 

Post-COVID rehab is not only reserved for people who were in the ICU after being infected with the coronavirus, though. As we have already seen, people with milder cases, including in some cases those who were allowed to recover at home rather than being hospitalized, continue to suffer from ongoing health consequences. 

In the UK, patients will be given support, which may involve attending COVID-19 rehab clinics in person (with everyone in full protective gear), as well as a information in the form of a COVID-19 patient rehabilitation booklet, to help them recover. Those with severe breathing difficulties will also be prescribed supplemental oxygen.

What can you do, then?

The World Health Organization currently has a booklet, also available as an online PDF, called Support for Rehabilitation Self-Management after COVID-19- Related Illness. This booklet is specifically geared toward patients who are recovering from the effects of COVID-19 at home mostly on their own.

It covers things like: 

• Physical positions that can help patients find relief from breathing difficulties — like lying on their side with pillows propping up their head, or sitting on a chair and leaning forward sharply. 
• Breathing exercises, like slow and controlled breathing, to increase the oxygen you take in. 
• Instructions for simple exercises, like lifting your knees while sitting on a chair or stepping up and down one step a few times, to help you recover some physical strength. This includes strict guidelines to stop exercising if you feel rough.
• Since some post-COVID patients find it hard to eat and drink, advice on how to do this most easily, such as sitting up completely and eating in a quiet place without distractions.
• Cognitive exercises for people who are suffering from "brain fog" after being in the ICU with COVID-19. 
• Tips for post-COVID patients on managing daily tasks by breaking them into small chunks. 

Those patients with "post-COVID syndrome" (not a recognized medical term — yet) who live in jurisdictions where no post-COVID support is offered may benefit from reading this booklet carefully and trying to implement it at home. Those who live in places where the post-COVID rehab stage is well-managed may, meanwhile, even receive in-home care and physiotherapy sessions. 

Hopefully, as awareness that a coronavirus infection can leave long-term consequences, more people who continue to struggle with debilitating symptoms after having tested positive for COVID-19 will be able to take part in COVID rehab programs. Those who still haven't been infected can, meanwhile, learn something too.