Date: 2 Aug 2020
Covid-19 symptoms are commonly expected to last for 7 to 14 days and in few cases, they may extend post discharge. The duration of how long these symptoms may last is now making heads turn, across the globe. These individuals who continue to suffer from Covid-19 symptoms (dyspnea, fatigue, recurrent cough etc) even weeks or months after their getting it, are being termed as “Long haulers”.
“Full of suffering but still recovering, the story doesn’t seem to reach its end for many.” says physiotherapist Dr Ashwini S. (PT) who has been working with Covid-19 patients in Pune, India.
Corona virus has affected millions around the world. Even though the mortality rate is low, the morbidity rate is high – leading to an eye opener for the healthcare system. She adds, “The situation becomes challenging when those who contracted the disease get into the long haulers’ zone. The patient’s ADL (Activities of Daily Life) get hindered and prevent them from feeling recovered – not being able to carry out work to their usual limit.”
‘COVID-19 causes far more symptoms than first suspected’, reported NDTV India [1] based on a study that found that 87 percent of the recovered hospital patients were still suffering at least one symptom 60 days after falling ill.
They continue to experience symptoms such as fatigue, headache, cough, shortness of breath, chest pain, increased heart rates and gastrointestinal and neurological symptoms for weeks or even months following the initial symptoms; often these symptoms might come and go repeatedly.[2]
There’s Hope after Covid-19: A Physiotherapist’s Prospective
What Corona virus does to one’s lungs is very simple. Imagine a normal balloon which inflates and deflates very easily. Now, if some part of this balloon or all of it, is dipped into a sticky glue kind of solution, it will no longer be able to inflate or deflate as much as it would do earlier. It’s the same that happens to the lungs of an individual who contracts the virus.
This is where a physiotherapist comes into the picture to help you resolve this issue.
The symptoms that pop up post hospital discharge
Once a patient overcomes the acute symptoms of Covid-19 and is discharged from the hospital, they still have to cope with a few symptoms, underlined as below:
- Breathlessness
- Fatigue
- Chest congestion
- Inability to cough out mucus, restricting full expansion of the lungs or a Dry cough
As a physiotherapist, our main goal at this stage is to activate the whole alveolar chain for maximum air stacking followed by appropriate recoil at a proper ratio; so that the expanded lung can function to its maximum. In short, a physiotherapist tries to bring the balloon back to its normal self to nil out the extended or delayed symptoms.
As a matter of fact, the damage once done may not be fully repairable. However, with proper rehabilitation, a physiotherapist can ensure that there is no further deterioration of lung function and that maximum recovery happens in a timely fashion. Some patients have been seen to successfully restore lung function even upto 80-90% of their pre-disease level with a guided pulmonary rehabilitation program.
Bouncing Back to Normal after Covid-19
While trying to get back to normal, here are a few norms to be followed:
- Never exert yourself too much.
- Follow a strict exercise routine.
- Stick to your diet plan, at least for next 2-3 months.
- Follow all the advice given to you by your healthcare provider.
- Do not keep any doubts in mind, ask them right away.
- Be aware of the changes happening in your body (even minute ones) – good and bad; make a note of them.
Physiotherapist Dr Huda (PT) says, “If you are a long hauler, then this is where you could begin. We do strongly recommend you to take a guided rehabilitation programme to ensure maximum recovery in a timely manner.”
Dyspnea Relieving Postures
Activities should be discontinued after you experience breathlessness. So it is advised to:
- Rest
- Stay calm and
- Go into any of these two resting postures to reduce the work of breathing
- Forward lean (Position A)
- Side-lying and leaning towards the wall (Position B)
These postures help to reduce burden onto the primary muscle of ventilation ie. Diaphragm so that it can function optimally.
Practice Breathing Control
All the breath control techniques should be practiced under a physiotherapist’s supervision/ guidance. Not all techniques are suitable for everyone. Your therapist will prescribe the technique based on your current symptoms and capability.
Activity Pacing Techniques
The essence of Pacing is about ‘listening to your body’. Slow down if necessary or take short breaks if needed, to stay in control and manage breathlessness on a day-to-day basis.
Understand your current energy levels and plan your daily activities accordingly.
Practicing Lung Expansion Techniques
Your therapist will also teach you to do the lung expansion exercises for opening up the alveolar channels and getting rid of the mucus which is stuck by specialised expiratory techniques.
In order to reduce chest tightness thoracic expansion exercises, breath control techniques are encouraged that aids increasing the vital capacity of the lung thus reducing dyspnea and fatigue.
Practicing these techniques, we hope will help those “Long Haulers” to be turned into Long runners; helping them carry out activities at ease. Mastering the art of managing the symptoms will add to their overall well-being.
This post is based on the inputs from Dr Ashwini Sahasrabudhe (PT) and Dr Huda (PT). They are senior physiotherapists at ReLiva Physiotherapy & Rehab and are working relentlessly towards rehabilitation of Covid-19 patients in Pune, India during the pandemic outbreak in 2020.
References:
[1] https://www.ndtv.com/world-news/covid-19-causes-far-more-symptoms-than-first-suspected-2260587
[2] The Covid Symptom Study undertaken by King’s College London, https://covid19.joinzoe.com/
