Rehabilitation after COVID-19

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Rehabilitation after COVID-19 is needed in individuals experiencing longer-term disabling illness at any stage of COVID-19 infection. [1] The rehabilitation of individuals with COVID-19 includes screening for the need for rehabilitation, participation of a multi-disciplinary team to evaluate and manage the individual's disabilities, use of four evidence based classes for rehabilitation (exercise, practice, psychosocial support and education), as well as individualised interventions for other problems. [1]

Contents

Scope

The range of problems suffered by individuals after COVID-19 have, as of January 2021, not yet been well described in scientific literature. [1] Individuals with COVID-19 have developed several complications, such as respiratory failure, renal failure, myocarditis, [2] encephalitis, impaired immunologic response and blood clotting disorders. [1] However, COVID-19 can affect any organ system, and can therefore have any symptoms and signs. Individuals with COVID-19 can also have psychological conditions such as anxiety or depression. [3] People who required mechanical ventilation while they had COVID-19 may have injury to the airways, weakened muscles, delirium [4] and post-traumatic stress disorder. [5] [6] Those with COVID-19 can have reduced ability to perform activities of daily living.

Approach

There is limited data regarding rehabilitation after COVID-19 due to the recent nature of the disease. [3] The general pulmonary rehabilitation method based on 4S principle (simple, safe, satisfy, save) has been proposed in China for pulmonary rehabilitation, particularly in individuals who were admitted to ICU. A recent study concluded that a six week respiratory rehabilitation program improves respiratory function and quality of life as well as decreases anxiety in older individuals with COVID-19. [7] Early active mobilization has been recommended by one study for improving muscle strength and mobility after discharge from hospital in individuals with COVID-19. [8]

Challenges

In the context of the pandemic, face-to-face interactions are likely to be minimised. Therefore, tele-rehabilitation systems could be used to address the difficulties associated with the ongoing pandemic. [3] The limitations of virtual care are technical malfunctions, lack of availability of equipment and limited scope for physical examination. [3] The pandemic situation has reduced the ability to meet the typical needs in rehabilitation such as social interaction and human contact among caregivers and family members, thereby limiting the available options for multidisciplinary rehabilitation. [3]

See also

Related Research Articles

Delirium, also known as acute confusional state, is an organically caused decline from a previous baseline mental functioning, that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in attention, consciousness, and cognition. It may also involve other neurological deficits, such as psychomotor disturbances, impaired sleep-wake cycle, emotional disturbances, and perceptual disturbances, although these features are not required for diagnosis.

Myocarditis Inflammation of the heart muscle

Myocarditis, also known as inflammatory cardiomyopathy, is inflammation of the heart muscle. Symptoms can include shortness of breath, chest pain, decreased ability to exercise, and an irregular heartbeat. The duration of problems can vary from hours to months. Complications may include heart failure due to dilated cardiomyopathy or cardiac arrest.

Exercise intolerance Medical condition

Exercise intolerance is a condition of inability or decreased ability to perform physical exercise at the normally expected level or duration for people of that age, size, sex, and muscle mass. It also includes experiences of unusually severe post-exercise pain, fatigue, nausea, vomiting or other negative effects. Exercise intolerance is not a disease or syndrome in and of itself, but can result from various disorders.

Angiotensin-converting enzyme 2 Exopeptidase enzyme that acts on angiotensin I and II

Angiotensin-converting enzyme 2 (ACE2) is an enzyme attached to the membrane of cells located in the intestines, kidney, testis, gallbladder, and heart. ACE2 lowers blood pressure by catalyzing the hydrolysis of angiotensin II into angiotensin (1–7). ACE2 counters the activity of the related angiotensin-converting enzyme (ACE) by reducing the amount of angiotensin-II and increasing Ang(1-7), making it a promising drug target for treating cardiovascular diseases.

Bronchoalveolar lavage (BAL) is a diagnostic method of the lower respiratory system in which a bronchoscope is passed through the mouth or nose into an appropriate airway in the lungs, with a measured amount of fluid introduced and then collected for examination. This method is typically performed to diagnose pathogenic infections of the lower respiratory airways, though it also has been shown to have utility in diagnosing interstitial lung disease. Bronchoalveolar lavage can be a more sensitive method of detection than nasal swabs in respiratory molecular diagnostics, as has been the case with SARS-CoV-2 where bronchoalveolar lavage samples detect copies of viral RNA after negative nasal swab testing.

Aspergillosis Medical condition

Aspergillosis is a fungal infection of usually the lungs, caused by the genus Aspergillus, a common mold that is breathed in frequently from the air around, but does not usually affect most people. It generally occurs in people with lung diseases such as asthma, cystic fibrosis or tuberculosis, or those who have had a stem cell or organ transplant, and those who cannot fight infection because of medications they take such as steroids and some cancer treatments. Rarely, it can affect skin.

Viral cardiomyopathy occurs when viral infections cause myocarditis with a resulting thickening of the myocardium and dilation of the ventricles. These viruses include Coxsackie B and adenovirus, echoviruses, influenza H1N1, Epstein-Barr virus, rubella, varicella, mumps, measles, parvoviruses, yellow fever, dengue fever, polio, rabies and the viruses that cause hepatitis A and C as well as COVID-19 where it has been seen to cause this in persons otherwise thought to be "low risk" of the virus's effects.

Vaping-associated pulmonary injury (VAPI) also known as vaping-associated lung injury (VALI) or e-cigarette, or vaping, product use associated lung injury (E/VALI), is an umbrella term, used to describe lung diseases associated with the use of vaping products that can be severe and life-threatening. Symptoms can initially mimic common pulmonary diagnoses pneumonia, but sufferers typically do not respond to antibiotic therapy. Differential diagnoses have overlapping features with VAPI, including COVID-19.

COVID-19 pandemic Ongoing pandemic of coronavirus disease 2019

The ongoing global pandemic of coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was first identified in Wuhan, China in December 2019. In January 2020, China implemented a nationwide lockdown in Wuhan, but this measure failed to contain the virus, with it spreading to other parts of mainland China and, eventually, around the world. The World Health Organization declared the virus a Public Health Emergency of International Concern on 30 January 2020, and later a pandemic on 11 March 2020. Since 2021, variants of the virus have resulted in further waves in several countries, with the Delta, Alpha and Beta variants being the most virulent. As of 20 July 2021, more than 191 million cases have been confirmed, with more than 4.1 million confirmed deaths attributed to COVID-19, making it one of the deadliest pandemics in history.

Severe acute respiratory syndrome coronavirus 2 Virus that causes COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is the virus that causes COVID-19, the respiratory illness responsible for the COVID-19 pandemic. Also colloquially known simply as the coronavirus, it was previously referred to by its provisional name, 2019 novel coronavirus (2019-nCoV), and has also been called human coronavirus 2019. First identified in the city of Wuhan, China, the World Health Organization declared the outbreak a Public Health Emergency of International Concern on 30 January 2020, and a pandemic on 11 March 2020. SARS‑CoV‑2 is a positive-sense single-stranded RNA virus that is contagious in humans. As described by the US National Institutes of Health, it is the successor to SARS-CoV-1, the virus that caused the 2002–2004 SARS outbreak.

COVID-19 Disease caused by severe acute respiratory syndrome coronavirus 2

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

COVID-19 vaccine Designed to provide acquired immunity against SARS-CoV-2

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19. The COVID‑19 vaccines are widely credited for their role in reducing the spread, severity, and death caused by COVID-19.

COVID-19 drug repurposing research Drug repurposing research related to COVID-19

Drug repositioning is the re-purposing of an approved drug for the treatment of a different disease or medical condition than that for which it was originally developed. This is one line of scientific research which is being pursued to develop safe and effective COVID-19 treatments. Other research directions include the development of a COVID-19 vaccine and convalescent plasma transfusion.

Mental health during the COVID-19 pandemic Psychological aspect of viral outbreak

The COVID-19 pandemic has impacted the mental health of people around the world. Similar to the past respiratory viral epidemics, such as the SARS-CoV, MERS-CoV, and the influenza epidemics, the COVID-19 pandemic has caused anxiety, depression, and post-traumatic stress disorder symptoms in different population groups, including the healthcare workers, general public, and the patients and quarantined individuals. The Guidelines on Mental Health and Psychosocial Support of the Inter-Agency Standing Committee of the United Nations recommends that the core principles of mental health support during an emergency are "do no harm, promote human rights and equality, use participatory approaches, build on existing resources and capacities, adopt multi-layered interventions and work with integrated support systems." COVID-19 is affecting people's social connectedness, their trust in people and institutions, their jobs and incomes, as well as imposing a huge toll in terms of anxiety and worry.

Symptoms of COVID-19 Overview of the symptoms of COVID-19

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and runny nose, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

Multisystem inflammatory syndrome in children Disease of children; pediatric comorbidity from COVID-19

Multisystem inflammatory syndrome in children (MIS-C), or paediatric inflammatory multisystem syndrome, is a rare systemic illness involving persistent fever and extreme inflammation following exposure to SARS-CoV-2, the virus responsible for COVID-19. It can rapidly lead to medical emergencies such as insufficient blood flow around the body. Failure of one or more organs can occur. A warning sign is unexplained persistent fever with severe symptoms following exposure to COVID-19. Prompt referral to paediatric specialists is essential, and families need to seek urgent medical assistance. Most affected children will need intensive care.

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

Impact of the COVID-19 pandemic on children Overview of the impact of the COVID-19 pandemic on children

A systematic review notes that children with COVID-19 have milder effects and better prognoses than adults. However, children are susceptible to "multisystem inflammatory syndrome in children" (MIS-C), a rare but life-threatening systemic illness involving persistent fever and extreme inflammation following exposure to the SARS-CoV-2 virus.

Long COVID Long-term symptoms of COVID-19

Long COVID, also known as post-COVID-19 syndrome, post-acute sequelae of COVID-19 (PASC), chronic COVID syndrome (CCS) and long-haul COVID, is a condition characterized by long-term sequelae—appearing or persisting after the typical convalescence period—of coronavirus disease 2019 (COVID-19). Long COVID can affect nearly every organ system with sequelae including respiratory system disorders, nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain, and anemia. A wide range of symptoms are commonly discussed, including fatigue, headaches, shortness of breath, anosmia, parosmia, muscle weakness, low fever and cognitive dysfunction.

Impact of COVID-19 on neurological, psychological and other mental health outcomes

While acute symptoms of COVID-19 act on the lungs, there is increasing evidence suggesting that COVID-19 causes both acute and chronic neurologicalor psychological symptoms. Caregivers of COVID-19 patients also show a higher than average prevalence of mental health concerns. These symptoms result from multiple different factors.

References

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