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]
The range of problems suffered by individuals after COVID-19 have, as of January 2021 [update] , 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.[ citation needed ]
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]
For individuals experiencing post-COVID fatigue, an approach based upon recommendations for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is recommended. [9] There is some early support for this approach. For example, a 7-week virtual rehabilitation course developed by Bradford District Care NHS Foundation Trust supported people to improve their sleep, manage energy levels (e.g. by striking a balance between rest and activity using pacing), optimise their breathing and manage stress. A study evaluating the service found that patients completing the course significantly improved their quality of life. [10] However, although quality of life was improved, it did not return to pre-COVID levels for the majority of patients. These findings suggest that post-COVID syndrome is likely to be a long-term condition that requires ongoing rehabilitation.
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]
Delirium is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or multiple causes, which usually develops over the course of hours to days. As a syndrome, delirium presents with disturbances in attention, awareness, and higher-order cognition. People with delirium may experience other neuropsychiatric disturbances, including changes in psychomotor activity, disrupted sleep-wake cycle, emotional disturbances, disturbances of consciousness, or, altered state of consciousness, as well as perceptual disturbances, although these features are not required for diagnosis.
Fatigue describes a state of tiredness, exhaustion or loss of energy.
Coxsackie B is a group of six serotypes of coxsackievirus (CVB1-CVB6), a pathogenic enterovirus, that trigger illness ranging from gastrointestinal distress to full-fledged pericarditis and myocarditis.
Fibromyalgia is a medical condition which causes chronic widespread pain, accompanied by fatigue, waking unrefreshed, and cognitive symptoms. Other symptoms include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and a general hypersensitivity.
Post-polio syndrome is a group of latent symptoms of poliomyelitis (polio), occurring at about a 25–40% rate. These symptoms are caused by the damaging effects of the viral infection on the nervous system. Symptoms typically occur 15 to 30 years after an initial acute paralytic attack. Symptoms include decreasing muscular function or acute weakness with pain and fatigue. The same symptoms may also occur years after a nonparalytic polio (NPP) infection.
Myocarditis, also known as inflammatory cardiomyopathy, is an acquired cardiomyopathy due to 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.
Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS is a disorder of the autonomic nervous system that can lead the individual to experience a variety of symptoms. Symptoms may include lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, chest pain and shortness of breath. Other conditions associated with POTS include migraine headaches, Ehlers–Danlos syndrome, asthma, autoimmune disease, vasovagal syncope and mast cell activation syndrome. POTS symptoms may be treated with lifestyle changes such as increasing fluid, electrolyte, and salt intake, wearing compression stockings, gentler and slow postural changes, avoiding prolonged bedrest, medication, and physical therapy.
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.
Anakinra, sold under the brand name Kineret, is a biopharmaceutical medication used to treat rheumatoid arthritis, cryopyrin-associated periodic syndromes, familial Mediterranean fever, and Still's disease. It is a slightly modified recombinant version of the human interleukin 1 receptor antagonist protein. It is marketed by Swedish Orphan Biovitrum. Anakinra is administered by subcutaneous injection.
Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. Typically, both sides of the body are involved, and the initial symptoms are changes in sensation or pain often in the back along with muscle weakness, beginning in the feet and hands, often spreading to the arms and upper body. The symptoms may develop over hours to a few weeks. During the acute phase, the disorder can be life-threatening, with about 15% of people developing weakness of the breathing muscles and, therefore, requiring mechanical ventilation. Some are affected by changes in the function of the autonomic nervous system, which can lead to dangerous abnormalities in heart rate and blood pressure.
Influenza-like illness (ILI), also known as flu-like syndrome or flu-like symptoms, is a medical diagnosis of possible influenza or other illness causing a set of common symptoms. These include fever, shivering, chills, malaise, dry cough, loss of appetite, body aches, nausea, and sneezing typically in connection with a sudden onset of illness. In most cases, the symptoms are caused by cytokines released by immune system activation, and are thus relatively non-specific.
Inosine pranobex is an antiviral drug that is a combination of inosine and dimepranol acedoben in a ratio of 1 to 3. It is used primarily in European countries, especially as a treatment for acute viral infections, such as the common cold.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating long-term medical condition. People with ME/CFS experience delayed worsening of the illness after minor physical or mental activity, which is the hallmark symptom of the illness. Other core symptoms are a greatly reduced ability to do tasks that were previously routine, severe fatigue that does not improve much with rest, and sleep disturbances. Further common symptoms include dizziness or nausea when sitting or standing, along with memory and concentration issues and pain.
Post-viral cerebellar ataxia also known as acute cerebellitis and acute cerebellar ataxia (ACA) is a disease characterized by the sudden onset of ataxia following a viral infection. The disease affects the function or structure of the cerebellum region in the brain.
Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the coronavirus SARS-CoV-2. The first known case was identified in Wuhan, China, in December 2019. The disease quickly spread worldwide, resulting in the COVID-19 pandemic.
Convalescent plasma is the blood plasma collected from a survivor of an infectious disease. This plasma contains antibodies specific to a pathogen and can be used therapeutically by providing passive immunity when transfusing it to a newly infected patient with the same condition. Convalescent plasma can be transfused as it has been collected or become the source material for hyperimmune serum or anti-pathogen monoclonal antibodies; the latter consists exclusively of IgG, while convalescent plasma also includes IgA and IgM. Collection is typically achieved by apheresis, but in low-to-middle income countries, the treatment can be administered as convalescent whole blood.
The symptoms of COVID-19 are variable depending on the type of variant contracted, ranging from mild symptoms to a potentially fatal illness. Common symptoms include coughing, fever, loss of smell (anosmia) and taste (ageusia), with less common ones including headaches, nasal congestion and runny nose, muscle pain, sore throat, diarrhea, eye irritation, and toes swelling or turning purple, and in moderate to severe cases, breathing difficulties. People with the COVID-19 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; and a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, or throat disorders, loss of taste combined with loss of smell is associated with COVID-19 and is reported in as many as 88% of symptomatic cases.
The treatment and management of COVID-19 combines both supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support as needed, and a growing list of approved medications. Highly effective vaccines have reduced mortality related to SARS-CoV-2; however, for those awaiting vaccination, as well as for the estimated millions of immunocompromised persons who are unlikely to respond robustly to vaccination, treatment remains important. Some people may experience persistent symptoms or disability after recovery from the infection, known as long COVID, but there is still limited information on the best management and rehabilitation for this condition.
Long COVID or long-haul COVID is a group of health problems persisting or developing after an initial period of COVID-19 infection. Symptoms can last weeks, months or years and are often debilitating. The World Health Organization defines long COVID as starting three months after the initial COVID-19 infection, but other agencies define it as starting at four weeks after the initial infection.
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.