“The healers come in wheelchairs, they come out on their own feet”. What does rehabilitation after COVID-19 look like?

«Some people come in wheelchairs, and after their stay they go out on their own feet. Others are addicted to an oxygen concentrator that after a week or two turns out to be unnecessary for them ”. I talk to the ward nurse Anna Murawska and psychologist Anna Kozłowska from the Grupa Zdrowie Medical Center in Kraszewo Czubaki about what the “return to form” looks like as part of rehabilitation after COVID-19.

1. There are over 5 million convalescents in Poland. Not everyone struggles with the long-term effects of coronavirus infection, but many patients complain of persistent symptoms
2. As part of rehabilitation after COVID-19, patients can take advantage of special stays. They use breathing exercises, trainings and consultations with doctors of various specialties
3. Psychological support is an important element of recovering from illness. Patients after covid often experience anxiety, stress, depression and insomnia
4. Experts from the Grupa Zdrowie Medical Center in Kraszewo Czubaki tell what the day of a patient during a rehabilitation stay looks like
5. Check your health. Just answer these questions
6. More information can be found on the Onet homepage

Zuzanna Opolska, Medonet: It is said that “long covid”, or “long tail”, is an umbrella term for all the long-term effects of COVID-19. What symptoms do patients most often deal with?

Anna Murawska: Our Medical Center Center Grupa Zdrowie in Kraszewo Czubaki mainly includes patients with complications after COVID-19 in the field of the respiratory or circulatory system, as well as disorders of the nervous system. They tire quickly, have a lower exercise tolerance, and reduced muscle strength, which makes it difficult for them to function in everyday life, and to be physically and professionally active. Thanks to rehabilitation, convalescents will significantly improve their respiratory fitness and recover faster. Additionally, as they openly say, rehabilitation has a positive effect on their mental condition.

Is “long covid” treated in Poland as a disease entity?

Anna Murawska: In connection with the encoding of COVID-19, additional categories have been introduced in ICD-10A to assist with documentation. Patients who are referred for rehabilitation have the following designation in the diagnosis: U09.9, i.e. Patient’s health after undergoing COVID-19, undefined.

Further part below the video.

Apparently, the “long tail” can also apply to patients who have passed the coronavirus infection asymptomatically, is it really so?

Anna Murawska: The observations so far confirm this, but the pass to the rehabilitation program is the one issued to the patient immediately after hospital treatment or from the general practitioner, after the end of treatment related to COVID-19 disease.

1. Find out more: Free COVID-19 rehabilitation is not for everyone. There is a condition

The deadline for patients to appear for rehabilitation is counted from the end of quarantine or the day of discharge from the hospital, if the patient required hospitalization. Therefore, convalescents who meet clinical criteria are referred to our center: complications in the respiratory system, cardiovascular system, nervous system or locomotor system, decrease in muscle strength or the occurrence of dyspnea assessed according to appropriate scales.

Are seniors dominating among your pupils?

Anna Murawska: No, we have both people in their twenties and eighty. Although younger patients usually recover faster, it really depends on the percentage of their lungs involved. The more, the more inflammatory changes, which translates into the patient’s condition after the end of treatment.

Then let’s talk about what COVID-19 recovery looks like? Is possible?

Anna Murawska

Absolutely, as evidenced by the stories of our patients. Some come in wheelchairs, and after their stay they go out on their own legs. Others are addicted to an oxygen concentrator that turns out to be unnecessary after a week or two.

Sometimes it happens that despite the correct saturation, the patient is simply afraid to give up oxygen therapy. That is why, apart from medical care, it is very important to provide support that allows you to feel more confident and believe in your own strength. The improvement can be seen especially in the spirometric test, which allows for an objective assessment of lung function, which is performed on admission to the center and at the end of the stay.

Which lasts…?

Anna Murawska: Maximum six weeks.

Can the program be used several times?

Anna Murawska: Not only once, but later the patient is referred to a convalescent clinic (pulmonology, neurology or directly to a primary health care physician). If they feel the need to do so, they use it, but most do not have to.

What are the components of the rehabilitation program after COVID-19?

Anna Murawska: Our pupils are dealt with by a medical rehabilitation specialist, who qualifies them for the type of treatments and determines their number depending on what is wrong with the patient. In addition, the program includes consultations with doctors of other specializations: neurologist, pulmonologist, cardiologist, internist, dietician, psychologist, and, if necessary, also a psychiatrist.

1. The editorial board recommends: They have nightmares, they cannot sleep. A psychiatrist about the problems of convalescents

Let’s follow the day of the long covid who qualified for the program – he gets out of bed and …

Anna Murawska: We start with gymnastics, including breathing exercises that relax the chest. Already upon admission to our center, the patient receives a spirometer, a breathing apparatus (three balls), a tool for breathing training, on which we recommend exercising several times a day, depending on the patient’s condition and fitness. I admit that they really train reliably and have results. It happens that when they start, they only lift one ball during a deep breath, with time it becomes two or three.

After morning exercises, it’s time for breakfast, and then physical activity determined by physiotherapists. Sometimes it is endurance training in the gym, sometimes interval training on a bicycle ergometer. As part of the exercises, the patients also have classes at the swimming pool two / three times a week.

Even before dinner, our pupils meet a dietitian, usually cook together, and learn what healthy eating is, what a wholesome diet should look like.

After the meal, a walk is always planned, especially as our center is situated in a beautiful place, in the middle of a forest where a “health path” has been created. Since last year, we also have a graduation tower.

Every day, patients also have classes with a psychologist, both individual and group. However, after dinner, there is free time. We have qualified staff who can always react at the right moment when the patient’s condition deteriorates or when patients simply need contact and conversation, especially after isolation in hospital wards. I think that for your mental health, the need to be heard or heard is very important.

You said about classes with a psychologist. What role do they play in post-COVID-19 rehabilitation? After all, so much is said about the mental health problems of convalescents: anxiety, insomnia, depression …

Anna Murawska: From my own experience, I can say that patients go through the isolation they experience very badly in covid wards. They tell about the fact that they collided with a wall: doctors in masks and coveralls, no contact with the family, terrifying loneliness in an unknown disease.

Anna Kozłowska: Many convalescents referred for COVID-19 rehabilitation report feelings of tension or anxiety, nervousness, panic attacks, feeling overwhelmed, insomnia, and chronic fatigue. Therefore, part of the program at our facility is cooperation with a psychologist who conducts individual and group therapies.

Psychological care at our ward consists of two stages. First of all, I conduct an extensive interview with the patient, in which I learn about his needs, problems and experiences with which he comes to us. We conduct research on the cognitive sphere, ie memory, attention, concentration, understanding, logical thinking, etc. The research also covers the emotional sphere. The collected information allows us to develop a diagnosis and together with the patient we set the goals of individual therapy.

The next stage is participation in group activities. During joint meetings in the field of psychoeducation, the patient’s awareness of their own disease and the long-term consequences of COVID-19 increases. We also discuss prophylactic pro-health behaviors – we must not forget that some survivors suffer from other diseases: diabetes, hypertension, ischemic heart disease, obesity or various neurological diseases. During individual therapy and group classes, the patient can benefit from additional supportive therapy at any time. In addition, we have the opportunity to consult our psychiatric wards. The next activities offered to our patients are relaxation classes aimed at familiarizing themselves with techniques that reduce tension and stress from the body.

I wonder what determines mental health disorders in long covid patients?

Anna Kozłowska: I think the links between the virus and mental health are complex. On the one hand, patients face a new, unknown disease that the whole world is talking about. They are naturally afraid of many things: will they survive, how COVID-19 will affect their lives and daily functioning. In addition, we still have isolation, that is, being sick in loneliness, without the possibility of contact with loved ones. It must be overwhelming …

Apparently, a complication after COVID-19 may be PTSD, i.e. post-traumatic stress disorder. Are there such patients in your facility?

Anna Kozłowska: I haven’t seen it myself. Obviously, patients exhibit symptoms of long-term stress, medication, and trauma associated with difficult disease experiences, but a few selected symptoms do not make a full post-traumatic stress disorder diagnosis. Currently, the psychological community is investigating the possibility of introducing a new, more adequate, disease entity called “popandemic stress disorder”.

Healers also struggle with neurological complications, including the so-called brain fog, i.e. cognitive disorders, concentration and fresh memory disorders, a sense of alienation – how is it treated?

Anna KozłowskaFirst of all, it should be emphasized that brain fog is a complex of cognitive dysfunctions of various origins, which include apathy, memory problems, poor concentration, mental fatigue and sleep problems. The most common dysfunction we observe in COVID-19 patients is memory loss, difficulty concentrating, and insomnia.

In accordance with the procedure carried out in our ward, the patient is first and foremost thoroughly examined and we check the degree of cognitive impairment. Then, we adjust the training to the individual situation of the patient, which may consist of several elements. Sometimes they are simple logical exercises, and sometimes we support ourselves with applications and information systems that help train memory and concentration. In our center, we also have the C-eye, a modern solution that helps people with neurological dysfunctions and more.

What effects can patients expect? Do they really see an improvement after six weeks of rehabilitation?

Anna Kozłowska: Yes, patients feel better. It all depends on several factors: the patient’s condition, his deficits, predispositions, but also commitment. We do everything to give our patients the tools and opportunities to improve their health, of course, the best results are achieved by patients who are determined and consistently implement the assumptions of the therapy.

We encourage you to listen to the latest episode of the RESET podcast. This time we are talking about the war in Ukraine and the drama of our eastern neighbors. We help as much as we can, but we ourselves are full of fears. Is it possible to get rid of them? How to help, but also how to take care of yourself? You will hear about this and many others below.

This may interest you:

1. What is it like to live after COVID-19 without smell? “Perfumes stank, coffee and chocolate rejected”
2. Are we going to take off our masks in April? Expert: It’s very unwise
3. This could be the coronavirus’s next move. What awaits us? Four options