May 25

Post COVID-19 Syndrome

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Over the past year and a half the world has been dealing with the effects of the COVID-19 pandemic. It has led to a global healthcare crisis and resulted in strained health care resources. Now with vaccination rates on the rise an end seems to be in sight. However, data shows that a number of people experience persisting symptoms following their initial infection. These individuals are often referred to as the COVID “long haulers”.

What is Post Covid-19 Syndrome?

"Long COVID," otherwise known as Post COVID-19 Syndrome, is defined as having signs and symptoms that develop during or after a COVID-19 infection, present for more than 12 weeks and are not attributable to any other diagnoses. The most common symptoms associated with Long COVID are fatigue, shortness of breath, muscle and joint pain and chest pain. Recently some individuals have described their most debilitating symptom to be impaired memory and concentration. This “brain fog” is often associated with extreme fatigue.

How common is it?

It is estimated that roughly 10% of patients who test positive for COVID-19 will go on to experience prolonged symptoms.

In Canada that would equate to over 100,000 people. Development of post COVID-19 syndrome does not seem to be associated with the severity of the initial COVID-19 infection. Most individuals who experience Long COVID type issues were not hospitalized due to a severe acute illness. In fact, some individuals may not have tested positive for COVID-19 at all (they may have been asymptomatic or had minor symptoms that did not lead them to be tested). Thus a lab confirmed positive test is not a prerequisite for diagnosing post COVID-19 syndrome. 

Why does it occur?

Prolonged viraemia (condition where a virus enters the bloodstream and thus gains access to the rest of the body) may be due to a decreased or absent immune response, relapse or reinfection, inflammatory reactions, deconditioning and/or mental factors (such as post-traumatic stress). This sustained COVID-19 infection may then trigger long lasting changes in both the immune and nervous system. Symptoms such as increased heart rate and significant fatigue may be attributed to the autonomic nervous system (the section of our nervous system that controls most of our vital functions) becoming “unregulated”.

How is it managed?

If someone is experiencing any of the symptoms outlined above following a COVID-19 infection they should consult a health professional. Once other potential contributors and/or complications are ruled out, they may be ready to begin treatment. Management should be multifactorial and include attention to general health, rest and relaxation, advice on self pacing and setting realistic and measurable goals. If tolerated a supervised graded exercise program can be commenced. Specific pulmonary rehabilitation such as breathing exercises may be warranted if persistent breathlessness is a concern.

Can physiotherapy help?

Due to the relative short history of post COVID-19 syndrome research on outcomes is limited. Thankfully more and more evidence is becoming available with each passing day. A recent study conducted in the UK recommended individuals with persisting symptoms of COVID-19 should be offered a comprehensive recovery programme. This program involved a twice per week supervised rehabilitation programme consisting of aerobic exercise, strength training and education. After 6 weeks participants demonstrated significant improvements in exercise capacity, respiratory symptoms, fatigue and cognition. Also important to note that no serious adverse effects were reported!

Should you have any queries or would like further information on treatment options please contact REP Physio. Our physiotherapists have received further training in managing post COVID-19 syndrome and we want to help! We look forward to hearing from you.

References

Daynes, E, et al. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition – A cohort study. Chronic Respiratory Disease. (2021).

Greenhalgh, T, et al. Management of post-acute covid-19 in primary care. BMJ. (2020).

Rubin, R. As Their Numbers Grow, COVID-19 “Long Haulers” Stump Experts. JAMA. (2020).

Shah, W, et al. Managing the long term effects of covid-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ. (2021).


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