Covid-19’s ‘long tail’ for recovery may challenge occupational health

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While many make a relatively swift recovery from Covid-19, for others, especially those who have been hospitalised, it is increasingly clear there can be “long tail” of symptoms, sometimes lasting for months. This will mean the need for flexible and nuanced occupational health support, argue Dr David Poots and Fiona McGill.

According to John Hopkins University, more than two million people globally have now recovered from coronavirus. However, the journey back to full health may not be the same for everyone. Some people can shrug off the illness quickly but for others, especially those who are admitted to hospital, recovery may take longer.

In fact, while our understanding of Covid-19 is still at a very early stage, it is increasingly clear that, for many, there may be “long tail” to recovery, sometimes lasting months.

Issues such as breathlessness, chronic fatigue and weakness; recurring fevers, headaches and pains; heart and blood problems; nausea and other symptoms are all being reported, often for many weeks after patients have nominally “recovered” from the virus.

Individual needs

For occupational health, this mean these can be no standard approach when it comes to managing the return to work of people who have had Covid-19. The key will be individualised assessments of physical and psychological needs, in the context of both home and work life.

After recovering from infection, the body may not be operating 100%, especially if the person was severely ill. The World Health Organization, for example, has said it can take up to six weeks to fully recover if patients have been in a critical condition.

Spending a long time in hospital can lead to muscle mass loss that may need time to rebuild. Some people may need physiotherapy to walk again. Therefore, to maximise recovery from Covid-19, we recommend working on arm and leg muscle strength-breathing exercises.

When you’ve had an illness like Covid-19, your lungs may have lost some of their spring; they may not take oxygen in or let waste gases out as effectively. Regular breathing exercises can help improve the function of the diaphragm, get more air to the bases of the lungs and help to improve the supply of oxygen to the body.

In the same way that you should progress slowly with breathing exercises, OH should advise people to take it easy with general exercise. Walking is the best form of exercise, to begin with, on a level surface, and for no more than five minutes.

Wait until the next day to do more, and increase the time or distance you walk gradually, by 10% a day. Once a patient can walk comfortably for 30 minutes, they may want to increase the challenge by walking more quickly or adding in hills and stairs.

Bear in mind too those who have been used to being fairly active before may find this lower level of activity frustrating. But the key – and the message – is slow, steady and sustained increases in activity level, not boom and bust.

Oximeters and spirometers

Some patients may have been given a pulse oximeter to monitor their heart rate and oxygen levels upon discharge from hospital. It is important people in recovery recognise they should check their heart rate and oxygen levels before, during and after exercise.

Normal oxygen saturation is between 96 and 100%. It should not go below 88% during exercise. If a patient’s levels have fallen under 88%, they need to be advised to consult a doctor immediately.

People may have also received a spirometer upon discharge to help them take long, slow and deep breaths. The advice here needs to be they should be used for 15 minutes throughout the day, which can be broken into three sessions. Spirometers help strengthen breathing muscles and open up airspace in the lungs.

Mental health

Finally, it is vital to be recognising the mental as well as physical health support that a discharged patient may need to get back to “normality”. We’re living through a situation that has touched everyone. Some patients may be struggling with how mentally to process everything their body has been put through.

They may even develop signs and symptoms of an acute stress reaction, or post-traumatic stress disorder (PTSD). Symptoms can include flashbacks, persistent negative emotions or trouble with concentration.

People should be encouraged to engage in regular communication for social purposes with family and friends or perhaps to meditate before bedtime. But it may also mean signposting to mental health professionals or other mental health support tools.

It goes without saying that, for a person experiencing symptoms of stress or PTSD, the sooner they can get help, the better generally the outcome.

References
Covid-19 Map, John Hopkins Coronavirus Resource Center, https://coronavirus.jhu.edu/map.html

“Coronavirus recovery: how long does it take, and am I immune after having Covid-19?”, Daily Telegraph, June 2020, https://www.telegraph.co.uk/health-fitness/body/coronavirus-recovery-qa-long-does-take-immune-having-covid-19/

Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19, February 2020, https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

“Revealed: the long-term severe effects of Covid-19 that could go on for months”, The Daily Telegraph, May 2020, https://www.telegraph.co.uk/global-health/science-and-disease/revealed-long-term-severe-effects-covid-19-can-go-months/