Health & WellnessLifestyles

Physiotherapist: Awareness is first step in tackling long COVID

If you have recovered from COVID-19 but continue to notice symptoms such as shortness of breath, fatigue, and cognitive impairment (brain fog), you may have a condition called long COVID, as identified by the World Health Organization (WHO) and the National Institute of Health and Care Excellence (NICE), according to Dr. DeVonnia Bonimy-Lee, Bahamas Association of Physiotherapists (BAPT) president.

Bonimy-Lee said the first step in tackling long COVID is awareness.

“By understanding that there is a population of survivors who are undergoing more than six months of symptoms which impact quality of life, their return to work and recreation, and impair cognitive performance, we can start the process of safe recovery,” said Bonimy-Lee.

With October recognized as national physiotherapy month, Bonimy-Lee said physiotherapists have been woven into the healthcare front lines during the COVID-19 pandemic.

She said rehabilitation specialists such as physiotherapists are aware of strategies to promote function, cardiorespiratory performance and safety during physical activity.

“There are several tools which physiotherapists can use to screen patients for post-exertional fatigue, reducing the risk of exacerbating symptoms in at-risk patients.”

Bonimy-Lee referenced the post-COVID-19 functional status assessment (PCFS), SF-36 questionnaire and DePaul symptom questionnaire, which she said are part of a longer list of useful tests and measures to identify at-risk patients.

“A second consideration would include the avoidance of repetitive, structured and intentional movement to improve or maintain physical fitness. A thorough assessment is indicated in any scenario before specific exercise prescription is instructed to any patient.”

According to Bonimy-Lee, signs and symptoms are defined over a timeline – acute symptoms last for up to four weeks; ongoing symptoms for four to 12 weeks; and long-term signs and symptoms are reported and observed for 12 weeks or more (and which cannot be explained by an alternative diagnosis), would then be identified as long COVID.

“The most reported symptoms are fatigue – described as by some as a ‘crash’ or ‘total body shutdown’; shortness of breath or breathlessness; and brain fog. There are hundreds of other symptoms which are being reported as well – these include, but are not limited to: chest pain, skin rashes, tinnitus, dizziness, joint pain, diarrhea, abdominal pain and palpitations.”

Bonimy-Lee said there are several theoretical reasons for long COVID, such as viral persistence, continued hyperactive immune responses, cellular metabolic dysfunction, challenges with auto-antibody production and organ impairment.

“Those who have been hospitalized with COVID may have undergone long-term ICU care, have post-viral fatigue, may have experienced permanent organ damage, and are suffering with the effects of long COVID.

“The long-term effects of these experiences influence the time it takes for recovery and it would be detrimental to recovery to treat this as just ordinary muscle weakness or as one would a typical pneumonia.

“The inability of the heart to function optimally, as a result of long COVID, may mean that a commonly-reported symptom such as fatigue or post-exertional malaise, can become much worse with exercise, and can also trigger a relapse of symptoms. This exacerbation can extend the recovery period and make everyday tasks such as getting out of bed, dressing oneself, and simple chores even more challenging.”

Bonimy-Lee said people with long COVID-related fatigue should be considerate of their level of exhaustion, and exercise caution with graded or progressive exercise as a form of treatment or recovery.

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