COVID -19: I am positive for Covid-19, what should I do after being discharged from hospital?

Most people who are positive for covid-19 will recover within a few weeks with mild to moderate symptoms. If the symptoms are manageable at home, hospitalization is usually avoided. However, for those who have underlying medical conditions such as diabetes mellitus, hypertension and high cholesterol, it may take longer to recover with a higher risk of severe complications.

What are the complications?

These post-COVID conditions may also be known as long COVID, long-haul COVID, post-acute COVID-19, long-term effects of COVID, or chronic COVID. Many of these complications may be caused by a condition known as cytokine release syndrome or a cytokine storm. This is when an infection triggers your immune system to flood your bloodstream with inflammatory proteins called cytokines. They can kill tissue and damage your organs which are lungs, heart, and kidneys.

The common complications are:

· Fatigue

· Shortness of breath or difficulty breathing

· Cough

· Joint pain

· Chest pain

· Memory, concentration or sleep problems

· Muscle pain or headache

· Fast or pounding heartbeat

· Loss of smell or taste

· Depression or anxiety

· Fever

· Dizziness when you stand

· Worsened symptoms after physical or mental activities

Role of physiotherapy in post COVID- 19 rehabilitation

Acute care

Some patients may developed sever illnesses such as pneumonia, ARDS (Acute Respiratory Distress Syndrome), sepsis or septic shock. Physiotherapy management involves respiratory intervention in the hospital.

Post-acute care

This stage is defined as a presentation beyond 3 weeks from the symptom’s onset. Minority of patients who developed severe complications was found lower in transfer factor of the lung for carbon monoxide (TLco)3. Nevertheless, the forced vital capacity (FVC) and total lung capacity (TLC) are affected in those patients.

Hence the management of physiotherapy include:

1. Removing secretion retention

2. Management of breathlessness

3. Palliative care management

4. Management of dysfunctional breathing

5. Management of exercise tolerance

6. Management of complications of post intensive care unit (ICU) such as sarcopenia (muscle wasting)

Once you are discharged from the hospital, you may need to frequently check your oxygen saturation by using a pulse oximeter as silent or asymptomatic hypoxia is one of the complications of covid-19.

1. The target range for oxygen saturation is 94-98%.

2. A level of 92% or below may indicate the need of supplementary oxygen.

3. For patients with chronic lung disease and chronic CO2 retention, a range of 88-92% is considered acceptable.

Exertional desaturation test is an assessment to determine if a patient has exertional dyspnoea whose resting pulse oximeter reading is 96%.

The procedure of this assessment is to repeat the pulse oximeter reading:

1. After 40 steps on a flat surface (if self-testing remotely) or

2. After spending one minute doing sit-to-stand as fast as they can with supervision.

3. A fall of 3% in the saturation reading on mild exertion is abnormal and requires investigation.

In a nutshell, the role of physiotherapy is vital during the COVID -19 pandemic regardless of preventive management or post COVID rehabilitation. You may discuss with your physiotherapist for rehabilitation program in order to return to active daily living (ADL) and optimize independency level after discharge from hospital.

References:

1. Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020;370. doi:10.1136/bmj.m3026

2. George PM, Barratt SL, Condliffe R, et al. Respiratory follow-up of patients with COVID- 19 pneumonia. Thorax. 2020;75(11):1009-1016. doi:10.1136/thoraxjnl-2020-215314

3. Mo X, Jian W, Su Z, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55(6):2-5. doi:10.1183/13993003.01217-2020