So, you got Covid-19…now what?

Fortunately, about 80% of people who get Covid-19 will experience only mild symptoms. However, the other 20% can experience more severe symptoms and 5% may experience critical illness as a result. Recovery from moderate to severe Covid-19 can take weeks, months or longer. Generally, the longer you were in the hospital, ICU or on a mechanical ventilator, the longer you may experience residual effects, and the more protracted your recovery may be. The APTA has provided physical therapists with a wonderful resource, the PACER series (Post-Acute Covid-19 Exercise and Rehabilitation project) to help us best prepare to care for patients as they recover from Covid-10 and I have pulled together some of the most relevant information I learned from this course here for you. If you contracted Covid-19, and still don’t feel yourself despite the ‘all-clear’ of a negative test, here are some things you may be experiencing, and some information on how Physical Therapy can help you continue along the recovery process.

WHAT TO EXPECT DURING COVID-19 RECOVERY:

• Fatigue and Decreased Endurance: You will likely find you are more tired than normal from moving around, walking, and performing activities of daily living. This can be due to deconditioning from the bed rest and hospital stay, due to dehydration, because of decreased blood volume, or related to impaired use gas exchange and ventilation (your ability to pull oxygen out of the air and into your lungs). Anemia is also possible after Covid-19 and should be assessed for by your doctor if you are experiencing these types of symptoms.

• Muscle Weakness: You may feel like your body is weaker than it was before or it is harder to carry heavy items. Muscle weakness can develop from prolonged bedrest or decreased activity, but it can also be more significant if you have been diagnosed with Critical Illness Myopathy (CIM) or Critical Illness Polyneuropathy (CIP) related to your Covid-19 illness.

• Shortness of Breath or Difficulty Breathing: As Covid-19 causes damage to the lungs, you may find you continue to be short of breath at rest or with activity while you recover. You may notice you have to lean forward to support yourself to breathe deep or find yourself taking shallow breaths or breathing more rapidly when you feel out of breath. This may be due to damage to the alveoli, in the lungs, where the oxygen is extracted from the air and drawn into the blood stream, or it may be due to scarring and fibrosis that has occurred within the lungs during their healing process.

• Signs of Cardiovascular Impairment: If you already had Cardiovascular disease prior to developing Covid-19, you may find your symptoms are now worse. If you suffered any cardiovascular damage during your illness, you may experience periods of angina (chest pain), a higher than normal resting heart rate, feelings of irregular heart rate or arrythmia or swelling in your legs or your feet. If you are experiencing any of these symptoms, it is important to report these to your doctor, so they can assess your need for further care. You also may experience lightheadedness when you stand up. Orthostatic hypotension is common after spending time in the hospital, and can be improved by drinking plenty of fluids, and taking extra time to come to standing, especially first thing in the morning or when you get out of bed.

• Difficulty with your Balance: Whether due to impact on your neurological system or simply due to weakness and deconditioning, it is possible you may feel more off balance or unsteady when you walk. If are having falls, or even feeling like you may fall, it is worth seeking physical therapy to improve your balance and keep you from sustaining any falls-related injuries that could further set you back.

• Increased Confusion, Memory Loss, Anxiety or Depression: Lastly, it is common to feel anxious or depressed after a hospital stay and especially after a hospital stay for Covid-19. If these feelings become overwhelming or are distressing, it is important to bring these to the attention of your doctor. It is also possible to have some degree of delirium or new onset memory loss after an ICU stay. This can take some time to improve, and you may benefit also from seeing a Speech Language Pathologist to help you learn recovery or compensatory strategies to address issues you may be having.

HOW PHYSICAL THERAPY CAN HELP YOU RECOVER AFTER COVID-19:

As a skilled Physical Therapist, I can help you work to get stronger after Covid-19. These are some things I would likely work with you on as part of your rehabilitation.

• Functional Mobility: I will help you improve the things you may be struggling to do at home. This may include the ability to get in and out of bed, transfer on and off various surfaces around your home and in and out of your car. We will also practice walking in your home, outdoors and in more complex environments to get you safer at home and more comfortable walking within your community.

• Strength and Flexibility: I will teach you exercises to improve the muscles that have become weaker. Most of these exercises will incorporate whole body functional movements that will also help make your mobility and activities of daily living feel easier. I will also teach you safe stretching exercises to address any impairments in flexibility you may have developed during your hospital stay or as a result of prolonged bedrest.

• Breathing, Pacing and Energy Conservation: To improve your ability to breathe comfortably, I will teach you specific exercises that will strengthen the muscles involved with the breath cycle like the diaphragm and the intercostals. I will also teach you ways you can pace yourself when performing self-care and household activities and coach you in ways you can save your energy for things you really need it for. If you have come home using oxygen, I will work with you to wean off, if approved by your doctor, and if not, can teach you how to manage your oxygen equipment and oxygen needs ongoing.

• Fall Prevention and Safety Awareness: By working on your balance and ability to use your balance reactions, I will help you prevent losses of balance, and teach you how to respond quickly if you do experience any. We will talk also about safety awareness; I will make recommendations to improve your safety at home and when you go out and about in the community.

• Aerobic Capacity and Activity Tolerance: While keeping a careful eye on your vital signs and response to activity, I will help you improve your endurance in safe and comfortable ways. It may start as small as laps around the house, but I will help you progress over time, with a goal of getting you back to doing everything you were doing before.

• Home Exercise Program and Discharge Planning: While we will work together on these areas during your Physical Therapy sessions, I will also be giving you work to do on your own. This will likely be a mix of walking, strengthening, stretching and balance activities and will be scaled to what you can do right now, then progressed as you can do more. When we finish with our course of therapy, I will make sure you have a program you can continue with on your own, or we can continue to work together on a Wellness basis ongoing.

Click here to learn more about our HAE/PT Covid-19 Action plan for infection control and patient safety.

If you have experienced Covid-19, but still don’t feel back to normal, please call or email to set up a phone consult or in-person evaluation so I can help you get better.

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