Recovery after Coronavirus (Covid-19)

Managing physical symptoms of breathlessness, fatigue and anxiety

Introduction

During and after your stay in hospital you may experience some of the following physical symptoms – fatigue (tiredness), shortness of breath, body aches, loss of taste or smell, sore throat, cough, headache and fever.

Recovery from COVID-19 will take time. The length of time needed will vary from person to person and it is important not to compare yourself to others. If you have had a stay on Critical Care (Intensive Care Unit or High Dependency Unit) you may also notice problems with your memory, difficulty sleeping and nightmares.  These are all very common problems.

This leaflet gives some helpful ways to manage some of your symptoms during and after your stay in hospital.  Symptoms of coronavirus are different for each person, so not all the techniques shown here may help you.  Please use the ones that apply to you.

If you have any questions, please ask your allocated nurse to contact one of the therapists on your ward before your discharge from hospital.  Alternatively, there is further contact information at the end of this leaflet if you have been discharged.

Breathlessness

The information given below is to help you manage your breathlessness.  If you feel your breathing is getting worse, or you experience new breathlessness, it is important to get medical advice.

General advice

• Avoid breath-holding during activities, for example, climbing stairs or bending. Try to ‘blow as you go’. This means breathing out on effort, such as when bending, lifting, reaching or standing up from a chair or when walking.

• Try to avoid rushing.

• Try matching the rhythm of your breathing to your steps, for example, take a breath in and out on each step when climbing the stairs.

• Sometimes a fan directed towards your mouth and nose can help reduce feelings of breathlessness.

Breathing Control

Breathing control is breathing gently, using as little effort as possible:

• Breathe in and out gently through your nose if you can.  If you cannot, breathe through your mouth instead.

• If you breathe out through your mouth you can use breathing control with ‘pursed lips breathing’ (see below).

• Try to let go of any tension in your body with each breath out.

• Gradually try to make the breaths slower.

• Try closing your eyes to help you to focus on your breathing and to relax.

Breathing control can also help you when you are short of breath or feeling fearful, anxious or in a panic.

Pursed-lips breathing

Some people find breathing in through the nose and out through narrowed lips helps to ease their breathlessness.  This technique tends to help people who have breathlessness with conditions such as COPD.  People who find this helpful often use it without realising they are doing it.

Pursed-lips breathing helps to keep the airways open, allowing the air to leave the lungs more easily. This creates more room for the next breath in.

Positions to ease breathlessness

These positions may help to ease your breathlessness at rest and after activity. Experiment with and adapt different positions until you find what works best for you.

The positions in this leaflet place the arms so that the breathing accessory muscles are in a better position to help with breathing. Leaning forward may also improve the movement of your breathing muscles.

• Make sure you are fully over on your side. Resting your upper arm on a pillow may also help.
• Relax down onto the pillows as much as possible. Having your legs apart may also help.

Positions to ease breathlessness immediately after activity

The following positions may help to ease breathlessness after you have been active.  With all positions, try to relax the hands, wrists, shoulders, neck and jaw as much as possible. Experiment with your arm position. Does your breathing feel easier with your hands behind your head or back?

Fatigue Management

Tiredness is a common symptom in coronavirus. It makes you feel less motivated to keep active, which means that often you avoid activities. This can lead to you having even less energy, which can make you more tired. If this behaviour becomes a habit, the cycle can often be difficult to break.

We cannot take away your tiredness completely, but there are a number of ways you can manage it. These might help you to do some of the things that you would like to do. Think about how much energy you have to use each day. Some people imagine having a ‘jug of energy’ or liken their energy levels to a battery. Consider what you would like to use your energy for, but always leave something in the jug so that it is never completely empty. Even when you make plans, something unexpected might happen that uses more energy, so it is always good to keep some energy in reserve.

If you imagine your energy in terms of having a ‘jug of energy’, some activities will top up the energy and other activities will use up the energy in your jug. What would you like you to use your energy on? Try to keep your ‘jug’ at least a quarter full all times.

Here are some ideas to help you manage your fatigue.

Pacing

• Slow down your activities, as they will take less energy.

• Slow down when you talk, eat or cough. These actions can affect your breathing pattern.

• Break down your activities into smaller tasks that are more manageable.

• Allow yourself some time each day to try to relax. Remember it is better to take a little extra time to complete a task and be able to continue, than to finish the task quickly and feel too tired to continue.

Positioning

• Try to avoid too much bending and twisting, which can be tiring.

• Don’t sit or stand for too long without changing your position.

• Think about trying to organise your home so that things are where you need them (for example in the kitchen, have frequently used items nearby).

• It takes less effort to push, pull or slide objects, so try to avoid carrying heavy things.

Expectations

If you are placing high expectations on yourself, it is worth having a think about allowing yourself to do things in a different way that helps with your energy levels.

• Try to be patient with yourself and give yourself time to do things.

• Try to recognise the things that you are achieving.

• Try not to feel disappointed if your recovery seems to be slow. We expect a range of time frames for the symptoms you are experiencing to improve.

You may find it helpful to write down in a diary your symptoms and your achievements as you recover. This can help remind you that you are moving forwards even if progress feels slow.

Activity

It is important to stay as active as you can. A little regular, gentle exercise each day can make a big difference. This can be a walk, run or gentle resistance training. It is also important to graduate your return to exercise, slowly and steadily increasing how much exercise you do. Simple mobilisation around the house will also help with the clearance of secretions from your lungs and simply sitting in an upright position will help you to have more effective coughs.

Sleeping Even if you are not sleeping at night, try not to sleep during the day. If you do need to sleep during the day, try to keep this down to a short nap rather than a prolonged sleep. Remember these symptoms will likely improve as you recover from coronavirus.

Anxiety (stress) management

Breathlessness can often cause anxiety and feelings of panic. Anxiety tends to make the feeling of breathlessness stronger, which leads to more anxiety. It is important to remember that breathlessness in itself is not harmful, and you will recover your breathing when you rest. It is also possible to try to control the level of anxiety you are feeling, and relaxation is one way of doing this.

Relaxation is a useful skill that you can learn.

Preparing for relaxation

Relaxation is not always easy, but the more you practice, the easier and more effective you will find it.  Try to allow yourself some time each day to practice your relaxation exercise.  Tell the people you live with that you will need at least 20 minutes undisturbed, every day to practice relaxation.  Make sure the light and temperature of the room is at a comfortable level.

Relaxation exercises

These might be something that you can try with a friend or relative. It might be helpful to have someone read these out to you the first few times you do the exercises, until they become familiar.

Visualisation

Visualising a relaxing scene with your imagination can often help you feel more relaxed.  It could be your favourite place, a walk that you know, a garden or the beach.  It could also be somewhere from your imagination.  Somewhere that makes you feel happy and secure, but not a place that evokes bad or sad memories. Sometimes visualising colours, and images associated with these colours, can also be relaxing.

Here are some examples that you might like to try.

Letting go of thoughts

• Spend a few moments thinking about the pace of your breathing.

• Close your eyes and imagine that you are sitting on the bank of a river.

• You are warm and relaxed, and able to breathe freely.

• You see many leaves slowly drifting downstream.

• When a thought or feeling comes into your mind, try to see this as a leaf and let it drift away from you, then disappear.

• When it is gone, return to gazing at the river, waiting for the next leaf to float by with a new thought.

• Try not to think about the contents of each leaf. Just observe it and then let it go.

• Do not allow yourself to be concerned with these thoughts. Just watch them pass in front of you.

Body scan

Begin by focusing your attention on your feet, trying to release the tension in your muscles.

• First think of your toes, then work up through your ankles to your calves and shins, over your knees and along your thighs.

• Notice how loose your legs feel now.

• Become aware of your tummy and then your chest. Feel the tension releasing in your body.

• Now think of your shoulders, travel down to your elbows, through your forearms, and into your wrists, hands and fingers.

• Become aware even of your fingertips.

• Notice how loose your arms feel now.

• Next, focus your attention on your lower back and pelvis. Try to release any tension you are feeling here.

• Allow this feeling of looseness to rise up your back, to the back of your chest and shoulder blades.

• Continuing up into your neck and scalp, to the crown of your head.
• Slowly begin to focus on your forehead and move down to your jaw.

• Imagine that you have a giant paint brush sweeping over your body, following the same route and creating a feeling of calm and relaxation.

• Feel that every part of your body is relaxed.

• When you finish your relaxation exercise, become aware of your real surroundings by listening to the sounds around you.

• Be aware of how relaxed you feel.

• Start to move very gently by stretching your arms and legs, before you move from your position.

More information and courses around mental wellbeing is available at: www.recoverycollegeonline.co.uk

Eating and drinking during and after Coronavirus infection

healthy body weight. Foods and fluids contain essential nutrients to help prevent infections and help with your recovery. A well-balanced diet includes five key food groups:

• Fruit and vegetables have vitamins and minerals that boost your immune system to help you fight off infections.

• Starchy carbohydrates give your body energy for breathing and other tasks. Choose high fibre or wholegrain versions, such as brown pasta and rice or wholemeal bread. They will make you feel fuller for longer, protect your heart and keep your bowels moving.

• Protein helps to keep your muscles strong, including your chest muscles that help your ribs expand as you breathe. It’s also important for your immune system.

• Dairy foods are a good source of proteins, vitamins and minerals – including calcium for healthy bones.

• Oils contain a range of vitamins, such as vitamins A and E which are important for fighting infections.

If you have a pre-existing condition such as COPD or diabetes, you may require dietary advice specific to your condition so you can ask your GP to refer you to a local dietician for personal advice.

Are there any things I should avoid?

• Alcohol

• Cigarettes and vaping

• Caffeinated drinks

• Spicy foods that may cause acid reflux (acid that comes up from your stomach and irritates your throat)

Stay Hydrated

Make sure you drink plenty water whilst you are in hospital and when you get home you should aim to drink at least 2 litres of non-alcoholic and decaffeinated fluid per day.  Staying hydrated can help with many things such as making it easier for you to cough up your phlegm and preventing water infections.

More information about nutrition is available at: www.nhs.uk/goodfood

Acknowledgment

With thanks to our colleagues at Guys and St Thomas’ NHS Foundation Trust for sharing their current patient advice and information with us.

Support and Further Help

The following is an interactive online support application for patients and carers who have had a diagnosis of COVID-19 (coronavirus) https://covidpatientsupport.lthtr.nhs.uk. It contains advice on helping improve your recovery with videos and further advice for you and your family/carers/friends.

Critical Care

If you have had a stay in Intensive Care please refer to your Critical Care Rehabilitation Manual. There is also a support service in the Teesside Area called ICU Steps Tees for patients or relatives of patients who have spent time in Critical Care and you can contact for more information on 01642 624328 or visit www.icusteps.org/support/tees .

Involving your GP

Your GP should be up to date with your progress because information about your recent illness and treatment will have been sent from the hospital. It is very important that you involve your GP in your care, especially if you have any concerns about any of the issues in this leaflet, as they are now your primary contact for your care.

If the problem is urgent and you require immediate attention, contact 111 or 999 (in an emergency) for advice or medical assistance.

Contact numbers

The following are telephone numbers and contact information for services that you may find helpful following discharge from hospital.

University Hospital of North Tees

Telephone: 01642 617617

Integrated Single Point of Access

For information on district nursing, community occupational therapy and physiotherapy. Stockton and Hartlepool 01429 522500, Durham 03000 267979.

Chaplaincy Team Telephone: 01642 383138

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]