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The Multifaceted Road to Recovery for COVID-19 Patients | By Dr. Ayman Al Haj Zen

At the time of writing, more than one million people across the world have recovered from COVID-19. Other statistics suggest that approximately 85% of patients with mild symptoms recover within two weeks and without the need for hospitalization. That said, no two journeys back to full health are the same, particularly when it comes to those who unfortunately require intensive treatment for this novel coronavirus.

Clinical reports coming out of China and Italy suggest that 50% of patients admitted to hospital with COVID-19 require no further action upon recovery. Of the rest, 45% will receive low-level medical or social intervention, with a further 5% requiring more focused rehabilitation. Generally, the longer an individual experiences the symptoms of COVID-19, the longer it will take to recover.

COVID-19 patients that experience severe pneumonia and/or have spent time in Intensive Care Units (ICU) are a case in point. Clinical evidence shows that this infection sometimes progresses into acute respiratory distress syndrome in which the air sacs of the lungs fill with fluid. Moreover, while the majority of patients will recover, some develop lung fibrosis (scarring) causing long-term breathing abnormalities. Upon discharge, patients are advised to refrain from strenuous exercise due to damage to their lungs and respiratory muscles. As part of their recovery, pneumonia patients are encouraged to perform breathing exercises, while smoking cessation is highly recommended for some.

Both such cases offer a glimpse of what the journey back to full health looks like for patients that suffer the worst effects of COVID-19. Rehabilitation typically begins in hospital and focuses on relieving rapid weight loss and subsequent weakness caused by muscle wastage as the body would have gone into crisis state during ventilation. In most cases, recovery is measured in months and punctuated by episodes of fatigue, shortness of breath and reduced activity.

Currently, there is no clinical data showing the longer-term recovery status from COVID-19. Until then, previous studies concerning Severe Acute Respiratory Syndrome-coronavirus (SARS-CoV) could be used for comparative purposes. These suggest that although patients regained normal lung function within one year, their ability to exercise remained lower than the general population, which could be attributed to non-respiratory causes such as muscle deconditioning. Accordingly, we can extrapolate that patients recovering from severe cases of COVID-19 require graded exercise and physiotherapy programs.
When it comes to nutritional support, there is no diet particularly recommended for COVID-19 patients to follow. To assist recuperation, individuals must nevertheless ensure that they consume at least five portions of fruit and vegetables per day and increase their intake of protein to improve health, wellbeing, and body healing properties. In the case of the latter, protein provides valuable resources for the repair of muscles weakened by COVID-19 symptoms or forced ventilation periods.

Despite the lack of convincing scientific evidence, some COVID-19 patients have been treated with high doses of intravenous vitamin C in the hope that it will accelerate recovery. Doing so is nevertheless consistent with previous research studies into the benefits of vitamin C supplementation for treating acute respiratory tract infections. This also extends to the vitamin C deficiency caused by scurvy, a disease that often leaves patients susceptible to pneumonia.

A proper randomized clinical study to determine whether high doses of vitamin C are useful for treating severe COVID-19 has been initiated by Zhi Yong Peng, a professor of critical care medicine at China’s Zhongnan Hospital. Its results are expected in September 2020.

The SARS-CoV outbreak also provides an insight into the mental health problems potentially awaiting COVID-19 patients. Prior research indicates that two-thirds of SARS-CoV patients experienced symptoms of depression, anxiety and post-traumatic stress disorder in the year after recovery. When it comes to COVID-19, patients that have spent extended periods of time on mechanical ventilators are thought to be susceptible to delirium and other psychological disorders. Neurological injury and excessive use of benzodiazepines and other sedatives to suppress coughing during ventilation have been identified as possible triggers.

Accordingly, access to mental health services will be an essential feature of many patient’s recovery from COVID-19. Treatment options include medication and cognitive therapy, as well as mobile technologies. The latter includes an app being tested by Professor Catherine Hough, a pulmonary critical care physician, and her colleagues at the University of Washington, USA. Once up and running, the app will provide COVID-19 patients with tips on mindfulness and other coping skills for life after hospital.

A COVID-19 patient’s journey from hospitalization to full recovery will most likely be long and multifaceted. The same rule also applies to treatment provided by health services. Healthcare providers will typically focus on how best to manage patients in the post-acute phase and on discharge from hospital. The ideal treatment ‘mix’ for COVID-19 patients recuperating at home includes respiratory rehabilitation, physiotherapy and nutritional advice, as well as mental health support as they regain physical health.

Dr. Ayman Al Haj Zen is an assistant professor at the College of Health and Life Sciences (CHLS) at Hamad Bin Khalifa University (HBKU).

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