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The total number of patients with COVID-19 being treated at home and in hospitals as of May 21 is almost 300 thousand people throughout our country. What doctors recommend for rehabilitation after coronavirus
About 80% of people recover from coronavirus without the need for special treatment and rehabilitation. But with massive pneumonia, a person suffers not only an infection, but also hypoxia (the supply of oxygen to the lungs and, accordingly, to other organs and tissues is disrupted). Doctors most often note a violation of the lungs and the cardiovascular system. Complications and consequences can persist for several months, so those who have been ill definitely need at least minimal rehabilitation.
The experience of doctors at the Mariinsky City Hospital in St. Petersburg shows that almost all people who have had a new coronavirus infection need to restore their bodies. The most common consequences of COVID-19:
- general weakness, shortness of breath at the slightest physical exertion, sweating;
- insomnia, anxiety, decreased mood background, depression;
- complications are heart attack and stroke.
Medical experts of SMK RESO-Med LLC told Trends that rehabilitation begins during the course of treatment and continues after discharge – in the clinic or at home. Rehabilitation has contraindications, therefore, the attending physician (or medical commission) determines the specific measures for each patient and gives a referral in the form 057 / y to the hospital inpatient or to the day hospital of the polyclinic.
The experts of SMK RESO-Med LLC explained who is entitled to free rehabilitation under compulsory medical insurance in accordance with the methodological recommendations for the prevention and treatment of coronavirus infection of the Ministry of Health of our country:
- patients with COVID-19 who have undergone prolonged artificial ventilation of the lungs – within two to five weeks;
- in some cases, patients who underwent extracorporeal membrane oxygenation;
- other patients – based on clinical indications, the results of instrumental and laboratory studies.
People who have had a mild to moderate coronavirus are undergoing rehabilitation treatment at home.
When a person recovered: criteria
Coronavirus survives in the body in severe forms of the disease for up to 28 days. Therefore, to resolve the issue of recovery, they take a set of tests:
- immunoglobulins A, M, G – only immunoglobulins G should remain in the blood, immunoglobulin A should disappear, and immunoglobulin M should show a clear downward trend;
- a nasopharyngeal swab for SARS-CoV-2 RNA should be negative.
Rehabilitation of patients who have undergone a severe form of the course of coronavirus infection according to compulsory medical insurance is carried out in three stages:
During the first two stages, patients are dealt with directly in the intensive care unit, and then in the therapeutic departments of the hospital. The third stage in the context of the ongoing pandemic can be carried out at home – the decision on this is made by the attending physician.
Natalia Krasnenkova, Director of the Department for work with insurance companies and corporate clients of Medsi Group JSC:
Rehabilitation after a coronavirus infection is not included in standard VHI programs. Patients can purchase rehabilitation programs after COVID-19 for cash in Moscow, where the main monitoring program costs 16,5 thousand rubles. Telemedicine rehabilitation services are available to residents of any region of our country (via the SMARTMED application). Ten individual lessons with a remote consultation of a doctor on exercise therapy cost 12 thousand rubles.
Some people with COVID-19 lose their sense of smell because the virus damages nerve endings in olfactory receptors or olfactory cells in the nose. Experts at the University College London Hospital NHS Trust (UCLH) say recovery could take up to 18 months. They encountered patients who partially recovered their sense of smell and taste, but at the same time, patients described distorted smells and tastes.
Rhinologist Peter Andrews from UCLH said that olfactory receptors are the only part of the central nervous system that can regenerate. Normally, the receptors in the nose regenerate every six weeks to replace cells damaged by pollution and toxic fumes. But after COVID-19, the ability to regenerate is sometimes lost, so these patients are referred for olfactory therapy – they are advised to sniff everyday objects with distinct aromas, including coffee, mint, rose essence and chocolate.
neurologists confirm that the number of complaints about problems with memory, orientation in time and space after suffering COVID-19 is growing. The work of weakened lungs worsens, reducing the enrichment of the cerebral cortex with oxygen.
Evgeny Seredkin, head of the neurology department of the Central Clinical Hospital No. 1 of Russian Railways, told Trends that in addition to problems with orientation in time and space, even after a mild form of coronavirus, neuromyalgia can be observed – severe muscle pain.
Foreign doctors call frequent neurological complications “coronavirus brain fog” – this is how cognitive symptoms are described, which may include memory loss, confusion, difficulty focusing, dizziness.
Dr. Andrew Budson, head of cognitive and behavioral neuroscience at the Boston Veterans Health Center and lecturer in neuroscience at Harvard Medical School, says one-third of ICU survivors have cognitive impairment so severe that neuropsychological testing scores are comparable to those of patients. with traumatic brain injury of moderate severity. In everyday life, this cognitive impact on memory, attention, and performance can lead to difficulty taking medication, managing finances, understanding printed texts, and even communicating with family.
Robert Stevens, professor and head of the intensive care unit at Johns Hopkins Medicine in the United States, warns of a wide range of neurological complications – the acute development of delirium (a mental disorder that occurs with clouding of consciousness, impaired attention, perception and thinking) or encephalopathy affects 40-50% of patients with moderate and severe COVID-19. Ischemic stroke occurs in 3-5% of people hospitalized with COVID-19.
Foreign experts recommend working with memory during illness and rehabilitation – engage in puzzles and activities that make you think more.
As for the psychological state, even the first results of Chinese studies showed the presence of anxiety, depression, sleep problems. Regardless of whether a person has experienced COVID-19, the weakening of social contacts, financial losses, a sedentary lifestyle, sleep disturbance during self-isolation have become the main factors of mental disorders.
Ekaterina Artemenko, community director, Yasno video consultation service with psychotherapists:
From the point of view of psychological assistance, you need to work as with a crisis or trauma, as with some event that “knocked you off your feet”. Coronavirus infection negatively affects cognitive processes – memory worsens, the speed of information processing decreases. The emotional sphere also suffers – often people with coronavirus show subdepressive symptoms and describe their condition as a loss of strength and a lack of desire to do anything. This is also not some kind of unique phenomenon – after a difficult struggle, there is often no strength left for the joy of victory. In my experience with clients who went through a fairly severe illness at home and continued online psychotherapy, the mere presence of another person nearby, maintaining regular contact and getting a response to difficult emotions gave a good relief effect.
Asymptomatic strokes
A group of Chinese doctors studied 29 people who were thought to have recovered and found a persistent impairment in attention span — the ability to pay attention to important information as long as it is relevant. Chinese doctors believe that cognitive impairment may be associated not only with inflammatory processes, but also with asymptomatic stroke and lack of oxygen, which damaged the brain. Asymptomatic strokes usually affect the white matter, the connection between brain cells that allows different parts of the brain to communicate with each other. When this connection is damaged, concentration is impaired.
Alexander Ruzhinskikh, psychotherapist, St. Petersburg:
Studies by foreign colleagues point to complications that can occur in severe cases of the disease. These studies only confirm the fact that SARS-CoV-2, affecting the vascular endothelium or through the ethmoid bone, contributes to the disruption of metabolic processes in the brain, which in turn contributes to the appearance of the described neurological complications.
But it is important to note that the design of these studies is not entirely clear: what contingent, age, and comorbidities did patients have before coronavirus. The answers to these questions would help to better understand what is happening in specific groups of patients, which in turn would help to identify risk groups and plan the therapy appropriate for them in an intensive care unit.
According to a study published in the journal JAMA Cardiology, which analyzed MRI of the hearts of 100 people who recovered from COVID-19, heart abnormalities were found in 78% of recovered patients, and “ongoing myocardial inflammation” in 60%. In the same study, 76% of patients examined had high blood levels of the enzyme troponin, an indicator of heart damage. Most patients in the study did not require hospitalization.
American cardiologists—Gregg Fonarow, head of the Department of Cardiology at UCLA, and Mina Chang, cardiologist and professor of medicine at the Cleveland Clinic, Lerner Medical College—advise those recovering from COVID-19 to watch for the following symptoms:
- severe shortness of breath, inability to lie flat without shortness of breath and waking up at night with shortness of breath;
- ankle swelling;
- bouts of dizziness.
Galina Semenova, Candidate of Medical Sciences, Head of the 11th Neurological Department of the Pokrovskaya Hospital, St. Petersburg:
The number of patients with strokes has increased, and the strokes themselves have become more severe. This is primarily due to the fact that coronavirus increases blood clotting and promotes thrombosis. As a result, all vascular problems are exacerbated in patients. There were more strokes and heart attacks, more vascular thrombosis, regardless of where these vessels are located (in the brain, myocardium, liver, kidneys, intestines, spleen).
Treatment of patients with coronavirus is carried out in accordance with the 9th version of the Interim Guidelines of the Ministry of Health of the Russian Federation. It states that prophylactic doses of low molecular weight heparins (blood thinners) should be given to all hospitalized patients.
Prepared by specialists of the City Mariinsky Hospital of St. Petersburg.
- To avoid complications, take your doctor’s recommendations seriously. Monitor blood pressure and pulse.
- Do breathing exercises regularly. With COVID-19, it is different from gymnastics for other pneumonias. It must be performed for a long time – one to two months, even when it seems that you are completely healthy.
- Do a light set of exercises to support the body, devoting more time to the muscles of the back, chest, shoulder girdle, upper limbs.
- Give up bad habits. Smoking and alcohol contribute to increased thrombosis, which is one of the causes of complications – heart attack and stroke.
- Eat right.
- Take vitamins, but the specific drugs and doses should be obtained from your doctor. You can only take multivitamin complexes on your own.
- Useful long walks in the fresh air with a gradual increase in the pace of walking and distance. Walking in the forest has anti-inflammatory, antibacterial and antiviral effects.
“After pneumonia, if you got two negative smears for a new coronavirus infection, walking in the fresh air, in city parks, in a forested area, outside of crowded places is the best way to physical rehabilitation. In warm, comfortable clothes and shoes, in calm weather, walking, without undue effort, is very useful. Breathing exercises – deep breathing with a slow exhalation through compressed lips, also helps a lot in the fight against hypoxia. Increase the distance traveled every day,” recommends Ekaterina Markova, a pulmonologist at the City Mariinsky Hospital in St. Petersburg, Candidate of Medical Sciences.
- After a severe form of the disease, rehabilitation is best done in your region. Climate change is not recommended.
- The return to normal activities is gradual. This is especially true for sports activities. Even with good health in the first two or three weeks, you can not immediately return to the previous sports regimen. If there is a high tachycardia, a slow recovery of the pulse after exercise, the appearance of shortness of breath – consult a doctor.
- A positive attitude will speed up recovery. Do not read on the Internet about complications and sad consequences.
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