Corona virus also called Novel Corona Virus (COVID-19) is a newly identified virus in 2019 in Wuhan, China. Its infection soon declared as pandemic by WHO. It causes a wide variety of illness from common cold and respiratory problems to severe diseases like ARDS and ADEM (Acute Disseminated Encephalomyelitis).
Keywords: Covid-19; Rehabilitation; Long haul syndrome; Persistent complication; Telehealth; Telerehabilitation; Hospice; Comorbidity; Psychosocial; Quality of life; Physiotherapy
Abbreviations: WHO: World Health Organization; ADEM: Acute Disseminated Encephalomyelitis; NGO: Non-Government Organization; FES: Functional Electrical Stimulation
By the term ‘Long Covid’ Also called Long Haul Syndrome, we mean that the patients who have suffered from covid, and the symptoms are still persistent after the acute phase usually 3-4 weeks and it has become chronic illness usually beyond 12 weeks of infection. A study suggests that 6.7% of patient died due
to covid while 15.1% patients required re-admission and 32.6% reported persistent symptoms. The term Rehabilitation depicts that the group of interventions made by the therapist or the family and community members, by which a patient can gain his lost skills and achieve self-sufficiency.
As the Covid -19 disease is not associated with a single organ
or organ system and is linked with almost all the organ systems
of the body, the need for rehabilitation increases because, it is
still unknown when and which intensity a patient may develop
persistent complications. Apart from the inclusion of respiratory
system, it is seen that the musculoskeletal (sarcopenia),
cardiovascular, CNS, along with renal system (Figure 1) is also
involved. So, the specific method of rehabilitation for covid-19 is
unknown, but a combined design can be made to rehabilitate the
patients suffering from Long Haul Syndrome.
As we have seen in past 1 and half years, the changes
implemented in the health care system have not fitted so well
because the disease was not known. So, [1,2] in this crisis time,
apart from the general medical services, the local services like the
PHC’s, ASHA workers and the social workers have proved helpful
themselves. The disease was so devastating that it was impossible
for the health care system to monitor patient’s progress over time
along with history taking and assessment. In this era of persistent
covid we need more Hospices, in which the team of doctors, nurses,
Physiotherapists, allied health professionals along with the family
members of the patient will be there to support the patient.
We have seen that the disease has reached every corner of the
world, and most of the patients who are suffering from long haul
syndrome have never been hospitalised and tested for covid-19.
We can reach them through Community Based Rehabilitation. It
can be modulated by both government as well as the NGO’s. We
can aware the population (Figure 2) through the telehealth rehab,
and by this we can reach the maximum population. We can use the
caller tune service as done by the Indian Government along with
social media like Facebook, Instagram and twitter, also we can use
mass communication like TV, Newspaper, FM Radio etc and for
general local awareness we can use folk media.
Stepping in with the rehabilitation we must follow the basic
process along with planning, assessment and formulation of the
patient’s condition coupled with knowledge of the prognosis and
consequences. Concerning the whole body and body systems, we
can execute the rehabilitation by giving general exercise training
for strengthening of respiratory muscles, upper and upper
and lower body (Table 1) strengthening along with stretching,
balance awareness, energy conservation techniques, various
advanced techniques like chest physiotherapy, PNF breathing,
deep diaphragmatic breathing [3-5] and functional electrical
Stimulation (FES). We can educate the patient for lifestyle
modification and improvement in quality of life. We can enforce
cognizance of self-management, execution of psychosocial
therapies should be done with breathing control training, body
positioning training and screening of psychosocial comorbidities
that frequently coincide with fatigue symptoms.