Durban - There could be long-term health complications for Covid-19 survivors, including UK research showing post-viral fatigue syndrome as well as post-traumatic stress syndrome.
Physiotherapy can improve the outcome from the moment a patient has been diagnosed with the virus to post-Covid rehabilitation.
Physiotherapist Nerusha Perumaul, who was treating patients at the Busamed Gateway Hospital in uMhlanga at the height of the pandemic a couple of weeks ago, is a specialist in cardiorespiratory treatment. She has a private practice and works with pulmonologists at the medical centre next to the hospital.
“The patient would have difficulty breathing, a dry cough and in some instances, be unable to move.
“If a patient was on a ventilator, we would physically turn a patient to try to prevent post-Covid damage. For a patient in intensive care, the physiotherapy required is about positioning to improve oxygenation and prevent pressure sores, breathing and passive movement of limbs. That is where the physio starts, in the acute stage.
“Once the patient moves to a general ward, we would do more breathing exercises and positioning.
“Our patients would also have a lot of fear and part of our job was to reassure and pacify them. There were no visiting hours and you become the family, you are the support,” said Perumaul, adding that patients admitted to the ICU were at risk of developing neuromuscular weakness (limbs) and respiratory muscle weakness as a ventilator helps the mechanics of breathing.
She said that because post-Covid damage could become apparent in different areas of the body, each patient had to be treated individually.
With South Africa just emerging from the peak, long-term effects were still becoming apparent.
“Research coming out of the UK has indicated that post-viral fatigue syndrome can happen,” said Perumaul, adding that the coronavirus had not only respiratory, but also vascular effects, with different organs being affected in different patients.
“There has to be a multi-disciplinary approach, which would include many different specialists and it is very patient specific. I think we are going to see far more post-Covid complications, it’s still to come,” she said, adding post-Covid symptoms include shortness of breath, fatigue, muscle weakness, limited movement, decrease in daily living activities and neurological conditions.
“As a country, we have really done well and the early lockdown was needed, we must not become complacent.”
Perumal added that South African medical professionals continued to take part in many national and international Zoom meetings to gather as much information as possible.
Another Durban physiotherapist, Sugantha Moodley, based at Life Mount Edgecombe Hospital, has also been at the front line of the pandemic.
Apart from physiotherapy such as regulating breathing and positioning, she helped Covid-19 patients in the general ward with high levels of fear and anxiety, which also included playing calming music.
“Each patient has to have a thorough and complex assessment. PostCovid, fatigue has been one of the most prevalent symptoms after discharge with patients trying to cope with daily living. Some experience headaches or general muscular pain. We work with them on respiratory education, as well as improving muscle strength and mobility.
“It’s also important for the patient to be able to take responsibility for their health at home and empowering patients is important,” she said.
President of the SA Society of Physiotherapists, Rogier van Bever Donker, said: “With extensive experience and research in rehabilitation, physiotherapists can help with many debilitating long-haul symptoms; breathing exercises to help the lungs recover, counsel on managing pain and other symptoms like dizziness.
“Because they are first-line practitioners, they can also refer the patient to the right specialist for each of the 90-plus symptoms that have been shown to afflict long-term Covid-19 patients,” he said.
British epidemiologist Professor Tim Spector found that 12% of patients have symptoms longer than 30 days and one in 200 for more than 90 days.
More than 10% of Covid-19 patients may have symptoms affecting their quality of life or ability to perform daily activities for more than 60 days.
University of Leeds clinical professor, Dr Manoj Sivan, said: “The emerging evidence is that, for some, the road to recovery may take months and it is vital specialist rehabilitation is on hand to support them.”
The Independent on Saturday