Covid-19, caused by the novel coronavirus named SARS-CoV-2, has led to a pandemic that is increasing the burden of mortality and morbidities throughout the world. It has brought many challenges including prevalence of disability and caused major disruption to healthcare services. About 12 million people around the globe have been infected by the virus so far, with a vast majority of them already recovered. However, half a million valuable lives have been lost due to this deadly disease. In addition, the virus may have a lasting effect on the body in general—as well as in major organs including lungs—for those who have survived the infection.
In the aftermath of a major disease outbreak, many patients require rehabilitation to help them get back to a normal life or adapt to living with disability. Patients who have required intensive care for more than a few days often have wider physical, cognitive and mental health support needs following their discharge from acute settings. As Covid-19 is a multi-system disease, we are increasingly recognising more subtle deficits in patients who are less severely affected, even in those who did not require hospital admission.
Although we are still at the early stage of tracking the long-term health effects of the coronavirus on recovered individuals, the virus seems to be exerting damage even beyond the respiratory system. Some survivors have reported having shortness of breath, unusual fatigue and body aches months after the initial infection. Studies conducted in Asia also reported that some recovered patients had signs of impaired function of their lungs, heart and blood vessels, liver, kidneys, and intestines. In addition to the persisting effects of the virus, patients hospitalised with severe Covid-19 are likely to have to deal with a wide range of physical, cognitive, and mental health problems as a consequence of spending long time in the ICU, receiving emergency treatment as well as critical care support for survival. These conditions are supposed to be further complicated as body's immune system gets compromised through battling off the infection.
The most common physical challenge for recovered Covid-19 patients is shortness of breath. It means simple physical activities like walking or climbing stairs can become challenging for them, especially for those who are old. People have to be patient at this point, because it might take a long time to get past this symptom with or without medication, depending on the severity of the condition. They are also likely to be affected by the post-viral fatigue syndrome which is the next most common residual manifestation among the recovered people. Proper rest such as prioritising sleep and regulating energy, staying active, and eating micronutrient-rich diet would be helpful to fight with the post-Covid-19 exhaustion. Seeing a respiratory physiotherapist about how to exercise can also be helpful, if needed.
Most patients who survived on a ventilator are prone to having muscle weakness. Thus, regular movement of limbs, sit-ups, standing or walking with help might be needed to reduce that weakness. Some survivors might need to follow a basic exercise programme with the consultation of physiotherapists. Post Intensive Care Syndrome (PICS) was prevalent among many survivors who reported problems with thinking and judgment, concentration challenges, delirium or memory deficit. It is important to make sure that these survivors do not go through any kind of social stigma or discrimination and that they receive continuous support from their friends and family. Social and behavioural health scientists can help deal with cognitive dysfunction at a mass level.
Taking steps to boost immunity is absolutely necessary for patients who have already been affected by Covid-19 as well as for those who have not reflected any visible symptoms. Adequate and sound sleep is the single most important factor for everyone to boosting the immune system. In addition, since food and immune system are inextricably connected, consumption of vitamin C and vitamin D, nutrients such as iron, zinc, and selenium would be helpful to maintain a well-functioning immune system. Food containing probiotics, such as yogurt, is also recommended to add healthy bacteria in the gut environment and aid proper absorption of nutrients.
It's also important to remember that without a sound mental state, attaining a healthy body, fighting pandemics, or regaining lost energy are impossible. To ensure a strong mental state, having a stress-free relationship, ensuring consensual sexual behaviour, and meeting with a professional counsellor are all good initiatives. While getting stress under control can help, it is also important not to suffer in silence. Last but not least, please practice physical distancing, good hand hygiene, look after the vulnerable, and follow authentic social and behavioural health guidelines to be safe and healthy.
Shamim Ahmed is a doctoral researcher at the University of Toronto; Gias U Ahsan is Dean, School of Health and Life Sciences, North South University; Sharmin Majumder is a PhD student at the University of Toronto; and Salma Hasan is a GP registrar, National Health Service, England.