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Advice to help you manage your symptoms during and following COVID-19.
Information for patients
This information has been created to give you a framework that you can use with your team of health care professionals and your family to support your recovery following COVID-19.
Life after illness can be challenging and it can feel like a series of stepping stones to feel “normal” again. This process will take time, effort and energy for you and your family. Remember to give yourself time to adapt, recharge and support yourself or your loved ones through this process.
This information has been designed to incorporate advice and specific exercises to enhance your recovery while in hospital and could potentially speed up your recovery at home.
Your therapy team will have advised you on everything you need to help further your recovery while in hospital. It is expected that you will experience breathlessness on minimal activities once home initially, this will improve over time.
COVID-19 is a virus which predominantly affects the airways. It can cause shortness of breath, coughing and at times low oxygen levels. Breathlessness at rest and during activities are also typical symptoms of COVID-19.
All staff treating you will be wearing protective equipment. During some treatments you may be asked to wear a mask to minimise the risk of spreading the virus. To further minimise the risk, we may phone you to talk, rather than enter the room.
Individuals are likely to have different problems due to the impact of COVID-19. Some people recover quickly and do not require much support. However, some will require more time and help with their recovery.
Remember, on average it can take between 6-8 weeks to recover from COVID-19. In some cases, it can take longer especially if you are in hospital for an extended period of time The longer your stay in hospital, generally the longer it will take you to recover.
Once home it is important to slowly build yourself back up to your “normal” daily routine over time. The following information can help you achieve this. Going home and remaining inactive will not help; remember being short of breath on activity is not a reason to not participate in activities.
At the end of this information are many resources and contacts to support you through your recovery.
Listed below are some common physical and psychological symptoms that you may have following a respiratory illness.
Most people cough and clear phlegm from their throat throughout the day without noticing. With COVID-19 you may have a dry cough, but some people develop phlegm as the course of their illness progresses. This can depend on your underlying health conditions, or it may just be how you are being affected by the virus. Clearing this phlegm is important as it will improve your oxygen levels and help make breathing easier. Please refer to the secretion clearance section for advice.
Breathlessness is a key feature for many people with this condition. If you have been admitted to hospital it is likely that you may become short of breath as your lungs work harder to provide oxygen to your body. This may mean that you breathe faster and shallower. Being breathless with simple daily tasks can make you feel anxious or frightened, this is a normal response. This booklet has a section to help with this.
Being unwell often means you’re resting more, either in bed or sat out in a chair. This can lead to muscle weakness which can put you at risk of deconditioning and or further muscle weakness, if you continue with a sedentary lifestyle.
All of the problems listed above can have an impact on; your daily activities, the distance you are able to walk and the amount you can achieve each day.
Being unwell and recovering from this illness may leave you feeling very tired. You may feel you need to sleep more or feel completely exhausted after only taking a short walk, or during minimal activity.
Delirium is a sign that someone is physically unwell. People may feel suddenly ‘confused’ at times and then seem their normal selves at other times. People who are delirious may not know where they are or believe they are somewhere else, e.g. on holiday. Sometimes people see things that other people can’t see, or believe things that aren’t true.
Some people who have been very confused with delirium may feel very frightened or embarrassed afterwards. It may help to talk to a member of staff or one of your friends/family to help you make sense of why you feel like this.
Some people after being unwell have problems with memory and attention. You might find yourself forgetting things that previously you would have remembered. This is common and will often get better over time.
Active cycle of breathing technique (ACBT) is a breathing technique that helps to loosen and clear mucus from the lungs, improve ventilation in the lungs and improve the efficiency of your cough.
In a relaxed position:
This is gentle normal breathing using your stomach. Put your hands on your stomach. As you breathe in you should feel your hands rise and as you breathe out your hands should fall. Your breathing should be slow and steady.
Focus is on taking a deep breath in, slowly through your nose, hold your breath for 1-3seconds, followed by a gentle relaxed breath out through your mouth.
Take a big breath in, keep your mouth open imagine steaming up a mirror with force and huff all the air out of your lungs. (Use breathing control between huffs to avoid getting breathless.)
Try a big strong cough if you think you have phlegm on your chest to clear. If this is painful, try hugging a pillow tightly when coughing.
If you don’t have any phlegm to cough up, then concentrate on cycles of breathing control and deep breathing.
Stopping smoking could help your lungs recover much quicker from a respiratory illness and reduce your risk of susceptibility to further infections. If you, or a relative, would like to stop smoking please contact Get Healthy Rotherham.
It is very easy to avoid activity if you are feeling unwell and breathless, however this can lead to a vicious cycle of inactivity.
Avoiding the inactivity cycle is vital to your recovery and progression. Adopting a positive cycle of activity, along with the advice in the leaflet could help enhance your recovery, both physically and mentally.
To help you improve and control your breathlessness, you will find below some activities that you can do at rest. You may also progress to using them when you are exercising. This will enable you to improve your physical activity levels and will help to manage any anxiety surrounding your breathlessness.
People with lung problems or those recovering from illness can often feel short of breath. Many daily tasks can make you breathless, such as walking or getting dressed. Being breathless can also make you feel anxious or frightened. It is important not to hold your breath when this happens as it will make you feel more short of breath. The following breathing activities and positions of ease can help you to manage and control your breathlessness.
The positions below can help you to control and settle your breathing. Remember to take rests and use one of these positions before you get too short of breath.
Relaxed breathing with minimum effort. The aim is to move from fast, upper chest breathing to relaxed, slow tummy breathing.
Try counting "in, 2, out 2,3,4" or "Square Breathing": Look at a square picture window or screen. Focus on the corner as you breathe in, then breathe out as your
eye moves along the square to the next corner
This exercise can be used at any time to help control your breathlessness, either at rest or while you are moving.
Breathe in gently through your nose, then purse your lips, as if you were blowing out a candle or whistling, and breathe out through your lips.
Try to blow out for as long as is comfortable for you; do not force your lungs to empty.
This is a useful technique to use when you are active to pace your breathing to the activity that you are doing. You can use it at the same time as ‘blow-as-you-go’ or
‘pursed lip breathing’.
For example, count the length of your breath when you are walking or climbing stairs. Count for 1 as you breathe in and for 2 or 3 as you breathe out. You can count for longer when you breathe in or out if that feels better for you. This may change depending on the stage of your recovery and may change day to day.
This is useful when you are doing activity e.g. lifting a heavy bag. Breathe in before you make the effort, then breathe out when making the effort for the task you are doing. You can use this technique alongside pursed lip breathing when you are breathing out.
It is important to practise these exercises often so that you learn them and your lungs get used to them. You will find it easier to begin with to learn these exercises at rest before you use them when doing activity or when you are already short of breath. See the resources section for further information and advice.
The best thing you can do for your recovery is to start moving. You may feel tired but even some basic exercises will be beneficial to your recovery.
While in hospital you may become short of breath easily on very little activity. This will improve as you continue your recovery in hospital and then at home. The following exercises can help you to begin improving your strength and physical ability. They will also help to improve your mental health and lung function.
You can use the scale below to help measure how your breathing feels during an activity.
0 = Nothing at all
0.5 = Very, Very Slight
1 = Very Slight
2 = Slight
3 = Moderate
4 = Somewhat Severe
5/6 = Severe
7/8 = Very Severe
9 = Very, Very Severe
10 = Maximal
When exercising at home you should be aiming to become moderately to somewhat severely breathless (Borg 3-4). Exercising at this level will help improve endurance and lung function. This may be different if you are in hospital and the therapy team will guide you with this.
Sit towards the middle or front of your chair so that you are utilising your tummy muscles to keep you strong and stable. Start with feet flat on the floor, sat upright with your back straight. Bring one knee up as high as possible and then slowly back down. Continue to alternate legs until the set is complete. To advance this, carry it out standing so you are marching on the spot.
Start with feet flat on the floor, either sat or stood upright with back straight and arms by your body. Keeping your elbows tucked into your body slowly bend your elbow so that your hands finish near your shoulders and slowly back down again. You should do one arm at a time. Use small weights for progression.
Start with feet flat on the floor, sat upright with back straight. Straighten one leg out as much as possible then bring your toes towards your body. Repeat with each leg.
Start with feet flat on the floor, sat or stood with back straight and arms by your side. Using both arms bring them up towards your chin while keeping your elbows out wide, then slowly take them back down to your start position. You can use small weights to make the exercise more challenging.
Sit towards the front of a chair, making sure you keep your back and shoulders straight, knees bent and feet flat on the floor. Aim to use your hands as little as possible (or not at all, if you can) and keep your back straight as you stand; make sure you don’t lean forward with your shoulders as you rise. Hold the stand for 2 seconds before returning to sitting.
Start with feet flat on the floor, stood upright with back straight and arms by your side.
When walking, initially make a note of how long you are able to comfortably walk for i.e. distance or time. Walk outdoors, indoors or on the spot at a comfortable pace, so that you become moderately short of breath. Focus on building up your stamina as you progress.
The aim is to become moderately to fairly breathless doing these exercises (Borg Breathlessness Scale points 3-4). If you become severely breathless you should stop
or slow down until you’ve recovered enough to carry on. If needed, we will then work with you to set further goals to improve your endurance.
The role of the Occupational Therapist in the acute hospital setting has two main aims.
This booklet explains some of the common problems that people who have been admitted to hospital due to COVID-19 may experience, either on the ward or after
Everyone is different and you may experience some of the common problems already listed in this booklet. An Occupational Therapist (OT) can help you with your rehabilitation, treatments, advice and tips to help you manage and recover.
Understanding your home circumstances and how you previously managed to do the things in your everyday life is really important. This helps identify any additional
support and equipment you may or may not require when leaving hospital.
These are snapshots of activities assessed before discharge, to ensure you are able to manage once you have left hospital with your normal activities of daily living. Depending on your circumstances you may be asked to do some or all of them.
Even if you are able to physically carry out the activity you need to do; you may find that you become tired very quickly. Your OT can advise you on how to break down any activity into manageable chunks. Energy levels fluctuate from day to day and hour to hour. This may result in you needing to adapt the activities that you do to enable you to conserve your energy.
With this analogy in mind it may be useful to keep a note of how tiring different activities are for you in order to help you understand the pattern of your fatigue and enable you to manage and adapt to this better.
Planning includes organising daily routines to allow completion of essential activities when you have the most energy. E.g. many find it more helpful to perform strenuous tasks such as dressing early in the day when strength and stamina are often at their peak.
Consider the following:
Once activities are planned, pacing will allow you to split the task into manageable smaller tasks, thus allowing you to sustain an energy level until the task is completed.
Consider the following:
Prioritising your tasks is key to conserving energy. When faced with limited energy reserves, prioritise tasks that are necessary first.
Consider the following:
Positioning can be extremely effective to help you conserve energy and manage fatigue levels.
Consider the following:
You may be medically ready to leave hospital before you can easily manage all your necessary tasks. Prior to leaving hospital your safety and place of discharge or rehabilitation will already have been considered, and where appropriate will be commenced on discharge. If you require any further support at home, referrals can and will have been made to the correct community services who will contact you accordingly.
Please see the resources section for additional local support.
Having good nutrition and hydration is very important in the treatment for a respiratory disease because your body needs extra energy and protein to help fight off the illness and recover. Without enough nutrients, particularly protein, energy, vitamins and minerals, your body will start to break down muscle tissues in order to provide an alternative energy source.
Carbohydrates are the body’s main source of energy and should be included at each meal time. Good sources include: cereals and porridge, bread, rice, pasta, noodles, potatoes. Most of these foods are easy to fortify which will be discussed later in this section.
Protein is needed for growth and repair of the body’s tissues and cells. Good sources include: red meat, poultry, fish, eggs, nuts, beans and dairy products. Try and select full fat dairy foods to help increase energy intake.
Dairy products are a good source of calcium which is important for bone health. Particularly, if you are taking steroids to help reduce inflammation as these can increase your risk of osteoporosis (thinning of the bones). Dairy products include: full fat milk, cream, cheese, yoghurt.
Meals and snacks can be fortified to help increase the energy and protein content. This can be achieved by adding small amounts of high calorie ingredients, without increasing the portion size of the meal/snack.
If you are struggling with eating or finding it hard to manage large portions, having nourishing drinks is a good way to increase protein and energy intake. Drinking plenty is important to prevent dehydration and constipation. Aim for 8-10 glasses of fluid per day (about 2 litres). Adequate hydration can help clear mucus. There is no evidence to suggest that high intake of milky drinks increases mucus production or thickness.
Some people find that during times of increased breathlessness, eating can become more difficult and tiring. These tips can help to make eating a little bit easier.
If you need any extra advice or are particularly concerned about your eating, you can ask your GP for a referral to a Dietitian. Or you can contact us on 01709 424297 or send an email to email@example.com for a full nformation pack on how to help improve your nutrition.
It is likely that the muscles you use for eating/drinking will be weaker at the moment. This is because your body will have used energy from its stores in your muscles while you were unwell and you might have used them less (for example, if you were fed through a tube). You might also be more short of breath than usual and easily fatigued. This will all affect your eating and drinking. You might need to do things a bit differently at the moment to make it easier while you are building your strength back.
Food preparation can be tiring. Prepare food when you are feeling the least tired and save it in the fridge for when you are ready to eat it.
Softer moist foods need less chewing and are easier to swallow.
Meal ideas include shepherd’s pie, fish pie, cauliflower cheese, scrambled eggs, baked potato without the skin, cake/crumble with custard etc.
Avoid foods that cause bloating (e.g. beans, cabbage, broccoli and salty, fried and greasy food). These can increase pressure and make it harder to eat and breathe.
You might need to cough and clear phlegm before you start eating.
It can be useful to begin a meal feeling calm. Notice if your shoulders need relaxing down. Take a few slow, gentle breaths. Practise thinking helpful thoughts to yourself (such as “I’ve got plenty of time”, “I can do this”, “I’m ok” or “everything’s ok”).
If you become breathless during a meal:
You can self-refer to Speech and Language Therapy if you are concerned about your swallowing or contact your GP for advice.
It is really important to look after your mouth well - this will help make your eating and drinking easier and will prevent infections. Your mouth might be dry due to receiving oxygen via a mask and needing to breathe through your mouth while you are short of breath.
There are things you can do to help:
It is important to manage any reflux symptoms as well as you can. Unmanaged reflux can affect your swallowing by making your throat sore or causing infection if it is breathed into your lungs.
Make sure you are taking any reflux medication as directed by your doctor. This includes ‘PPIs’ (e.g. Lansoprazole or Pantoprazole) and/or Gaviscon Advance. If you are on medication and still feeling reflux symptoms, arrange for a medication review.
Contact your GP if you notice new reflux symptoms and aren’t on medication - these include heartburn/ indigestion, having a taste of acid in your mouth, a dry/irritable cough at night/in the morning, feeling a lump in your throat, feeling you need to clear your throat a lot and having a hoarse voice.
You can also improve reflux symptoms with changes to your lifestyle:
Be aware of:
You might find it more difficult to communicate at the moment. Talking can be hard work if you are breathless. Your voice might sound weak, quiet, rough or hoarse. You may have a sore or swollen throat if you have been coughing a lot or if you needed a breathing tube in hospital. Your communication should improve as your symptoms resolve, there are strategies which might make things easier for now.
Top tips for making communicating easier
Contact us or your GP if you are concerned that your voice is not improving with time.
Sometimes your larynx or voice box can become hypersensitive and you may experience the following:
This can sometimes be called Inducible Laryngeal Obstruction (ILO) where your vocal cords come together when they shouldn’t, particularly when you breathe in.
It can be helped by:
A specialist Speech and Language Therapist can help if your symptoms don’t improve. Contact our department to refer yourself or see your GP. See resources for contact information on this page.
While regular exercise is important, you should also take some time to relax both your mind and body. Stress and anxiety is not uncommon after illness which can:
Your body has been through a lot so it is important you make time for yourself regularly. It does not take very much time and regular practice can dramatically reduce your stress levels. Some good examples of mindfulness can be found on ‘Every Mind Matters’ on YouTube, Headspace from the app store and Be Mindful is an online course. See resources section for more information.
Doing things that you enjoy is a great way to relax. This may include:
If you find that you feel low, anxious, or worried either when in hospital or once you get home please speak to someone you trust. There are some useful contacts in the resources section.
Some people experience changes in their mood such as, feeling low, irritable or lethargic. They may also have feelings of anxiety and worry, or helplessness. This is very common after being critically ill; you need time to recover physically and emotionally. Anxiety can have both psychological and physical symptoms. When you’re feeling anxious or stressed, your body releases stress hormones.
Common psychological symptoms can include:
Common physical symptoms can include:
These are normal symptoms of anxiety; they are not dangerous and will pass. Your Occupational Therapist can support you with this by helping you to set goals so you can see your progress, help you take part in activities you enjoy and assist you with strategies to help you cope with your feelings.
PTSD is an anxiety disorder caused by very stressful, frightening or distressing events. Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt. They may also have problems sleeping, such as insomnia, and find concentrating difficult. The symptoms of PTSD can have a significant impact on your day-to-day life and can vary widely between individuals, but generally fall into the categories described below.
This is the most typical symptom of PTSD. This is when a person involuntarily and vividly relives the traumatic event in the form of:
Some people have constant negative thoughts about their experience, repeatedly asking themselves questions that prevent them coming to terms with the event.
For example, they may wonder why the event happened to them and if they could have done anything to stop it, which can lead to feelings of guilt or shame.
Trying to avoid being reminded of the traumatic event is another key symptom of PTSD. This usually means avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience.
Many people with PTSD try to push memories of the event out of their mind, often distracting themselves with work or hobbies. Some people attempt to deal with their feelings by trying not to feel anything at all. This is known as emotional numbing. This can lead to the person becoming isolated and withdrawn.
Someone with PTSD may be very anxious and find it difficult to relax. They may be constantly aware of threats and easily startled. This state of mind is known as hyper arousal and often leads to:
It is important that if you think you are suffering from PTSD that you talk to someone that you trust or seek advice from a medical professional. You can utilise the simple STOP strategy below to help.
It is common for people to experience confusion during an illness and this may still be present when you are discharged from hospital. This may involve problems with remembering, paying attention, solving problems, thinking problems, difficulty talking, as well as organising and working on complex tasks.
Mild confusion and feeling “muddled” is perfectly normal following an illness and can be caused by many factors, including; lack of sleep, loss of routine, dehydration, poor appetite and infection. It is important that you continue to rest, drink well, and eat well. Severe confusion, known as delirium, is usually temporary and resolves as the illness improves. However, it can take a while to completely clear and can feel very scary for the person experiencing it and their families or carers.
Occasionally, people can continue to feel distressed by their experiences for longer periods of time. They may notice an increase in anxiety, concentration and memory problems and they may be bothered by distressing images or dreams of delirious experiences.
When you’ve been seriously ill, you may feel differently about things and you may not want to do things you used to enjoy, like seeing lots of people all at once, or find it hard to follow a TV programme.
Your concentration will get better and your memory will usually improve. Your Occupational Therapist can assess your cognitive needs and provide treatment and practical tools to help you to recover.
Avoid watching too much news or social media if it is making you feel anxious, try limiting yourself to looking at the news once a day.
Try to focus on what is in your control, what you can do and what you are able to achieve. The more we ‘worry’ about the thoughts we are having and the feelings we’re experiencing, the worse they are likely to get.
Mindfulness and relaxation exercises can help to reduce the physical symptoms of anxiety and the intensity of our thoughts. It is understandable to dwell on what might have been or what might happen in the future. This is natural but not necessarily useful or helpful.
Here are two relaxation techniques you can try to manage anxiety and help you relax.
Take a few slow breaths and ask yourself:
Think of these answers to yourself slowly, one sense at a time spending at least 10 seconds focusing on each sense.
Think of somewhere relaxing and peaceful. It could be a memory of somewhere you’ve been or a made up place.
Close your eyes, and think about the details of this place.
If you continue to feel overwhelmed by your symptoms, speak to your Occupational Therapist or GP. Also see the useful contact numbers on this page.
It is important to keep active whilst you are at home. Set yourself a challenge to get up and move about a least every hour.
Keep in touch with friends and family by phone and video calling regularly. Make a date when you are going to contact people. Try sharing photos or join an online quiz session with your friends/family.
Give time to yourself. Have a bath, read a book, listen to a podcast, or maybe start to learn a new skill that you’ve wanted to try. Make cards for people, play board games, do a jigsaw, make a scrap book, share with friends. Give your time to other people - call people who might be living alone. Give yourself a good night’s sleep.
Learning builds self-esteem, increases confidence, encourages social interaction and generally leads to having a more active life. Learn something new, try a new recipe, dig out that musical instrument or learn a new language.
Try and have a daily routine. Get up at the same time and try to have some structure. Try to distinguish between weekdays and weekends. You’ll feel less tired; more refreshed, and find it easier to concentrate throughout the day. Get ready, washed, and dressed.
You will be advised of the latest isolation guidance upon discharge from hospital.
Please discuss your particular case with the Doctor discharging you before you leave the hospital.
Up to date government advice, visit www.gov.uk/coronavirus
If you are in a crisis and require immediate help:
Rotherham Community Hub
Telephone: 01709 807319
The Rotherham Heroes Volunteer Programme is a borough-wide volunteer programme, to help vulnerable people across Rotherham during the COVID-19 outbreak:
For guidance on mental health and wellbeing aspects of coronavirus is available at www.gov.uk
Get Healthy Rotherham - Telephone: 01709 718720
Trained therapy team who can support with any mental health needs.
Telephone: 01709 447755
Monday to Friday, 9am to 4pm
Telephone 01709 835214
A listening and advice service
Telephone 116 123
For concerns about caring for someone with dementia through the coronavirus pandemic.
Specialist Admiral Nurses on Helpline
Telephone 0800 888 6678
Monday to Friday, 9am to 9pm
Weekends 9am to 5pm
Supporting individuals and families with support for children, men and women.
Telephone 0330 2020571
National Domestic Abuse Helpline
Telephone 0808 2000 247 (run by Refuge)
Freephone 24 hour
Men’s Advice Line
Telephone 0808 801 0327
Telephone 0808 802 4040
BreathingSpace has a team of specialist respiratory nurses, who can offer advice and support post discharge.
Telephone: 01709 421700 (Monday to Friday, 9am to 5pm)
Mobile: 07596255598 (Saturday and Sunday, 9am to 5pm)
The NHS have a series of downloadable leaflets of exercises to help flexibility, strength, and balance.
PsychologyTools offer advice for living with worry and anxiety amongst global uncertainty.
MIND offer support for psychological wellbeing during coronavirus.
ICU Delirium help you understand the problems that critically ill patients experience.
Breathing Anxiety provides videos demonstrating breathing exercises for anxiety.
The Mental Health Foundation offer their top ten tips for getting a good night's sleep.
Every Mind Matters can offer guidance, advice and tips on how to maintain your mental wellbeing. Simple things you can do to maintain your mental wellbeing and deal with anxiety about coronavirus.
The Psychology team at TRFT produced a mindfulness video. Although it was made with stroke patients in mind, it can be used by anyone.
You can self-refer to the Speech Therapy team for help with swallowing and communication problems.
Telephone: 01709 427015
For discussion and advice
Telephone: 01709 424297 firstname.lastname@example.org
The NHS provide advice for gaining weight.
Telephone: 01709 421700
COVID-19 Rehabilitation: Advice to help you manage your symptoms during and following COVID-19 - patient information leaflet
Produced by M.Peters, C.Bates, May 2020 Reviewed March 2021
Version:1.0. Next revision due March 2023.
©The Rotherham NHS Foundation Trust 2021. All rights reserved