Treatment options are currently limited as there is insufficient understanding of the mechanisms that underpin long Covid. As a result, treatment is highly individualised and depends on the main symptoms a patient is experiencing.
Patients may require multidisciplinary care involving the long-term monitoring of ongoing symptoms, identification of potential complications for clinical intervention, physical rehabilitation, mental health support and social services support.
Patients with long Covid who are managed in intensive care units may develop muscle weakness, deconditioning, myopathies (muscle disease) and neuropathies (nerves damage or dysfunction), which are the physical domains of post-intensive care syndrome. It is recommended that appropriate rehabilitation to prevent this syndrome should start in intensive care units as soon as sedation and clinical stability permit. Pulmonary rehabilitation, including oxygen supplementation, may help improve patients’ breathing, exercise capacity, muscle strength, quality of life and functional outcome. Early mobilisation would help to improve functional, cognitive and respiratory conditions in these patients and may shorten hospital stay.
Non-hospitalised patients with long Covid may also require physical rehabilitation, especially those with cardiopulmonary problems who may need significant rehabilitation, in order to improve their ability to engage in activities of daily living. However, identifying this group of patients may be challenging due to under-recognition and under-investigation of symptoms. There is also a risk that non-hospitalised patients with long Covid with mild-to-moderate symptoms, who are likely to represent a significant proportion of long Covid sufferers, may not be prioritised for follow-up care.
Early research has highlighted the utility of prescribed exercise programs in the treatment of long Covid. Aerobic exercises may boost immunity and respiratory functions as well as increased functional capacity of people with long Covid-19 in their self-care or return to work.
Management of Pre-existing Comorbidities
A significant proportion of patients who experience long Covid have underlying comorbidities. It is therefore essential that these are adequately managed to avoid clinical deterioration and the need for readmission in these patients.
Mental Health Support
Psychological and mental health issues such as anxiety, depression, PTSD and suicidal ideation can be long-term consequences of long Covid. There is a need to ensure that appropriate mental health support is available and accessible to those patients who require such services. Patients may be screened as part of their follow-up care and those identified as requiring extra support referred for specialist management. However, care should be taken not to pathologise patients as physical manifestations of COVID-19 may distort responses to assessment tools.
The utility of steroids, anticoagulants and other medications is currently being explored as treatment modalities for long Covid-19. Special care must be taken when prescribing steroids to avoid secondary fungal infections like aspergillosis, mucormycosis and pneumocystis pneumonia especially in diabetic and immunocompromised patients.
Social Services Support
Due to persistent symptoms, a significant number of patients with long Covid are unable to return to work and may require long-term governmental financial support. Some patients may be unable to cope with day-to-day living especially if they also suffer significant social isolation and or stigmatisation. These groups of patients would benefit from social services support.
Allied Health Services
Aside from physical rehabilitation and mental health support services, education to patients with long Covid-19 regarding self-management techniques and additional supports available may increase independence in activities of daily living. Education regarding energy conservation and pacing techniques may also be beneficial to improve outcomes and capacities. Assistance with developing return to work plans that are based around gradually upgrading capacity has not been widely discussed in relation to long Covid-19 however, is expected to be an emerging field as ‘societal long Covid’ impacts become more prevalent.
Rehab Management has been working closely with our customers to research the ongoing impacts of long Covid, particularly from a return to work perspective. We will continue to share our research with our clients.
Learn more about long Covid symptoms.