How is post-COVID condition treated ?
There is currently no medication to treat persistent symptoms following SARS-COV-2 infection. The various symptoms should be evaluated, and interdisciplinary care is recommended. As a general rule, once other causes have been ruled out, rehabilitation within a person’s energy limits, and while avoiding post-exertional malaise, is recommended for most symptoms. You will find treatments organized by symptom on this website.
Regular follow-up is recommended for individuals suffering from post-Covid fatigue. You should keep an energy diary to track how your symptoms evolve when following the four Ps: plan, pace, prioritize and position. You should also adjust their routine to focus on everyday activities and avoid exhausting your daily energy reserves. If physical therapy is put in place, the exercises and your daily activities must not cause you to exceed your energy limits so as to avoid post-exertional malaise, which would require a prolonged subsequent recovery period. It is therefore a question of “pacing yourself” or returning to activities in a measured way by finding a balance between active and rest periods.
Depending on the symptoms, rehabilitation can be physical, pulmonary or neurological or take the form of olfactory training or speech therapy.
Complementary therapies such as hypnosis, meditation, acupuncture and vitamins are recommended for certain symptoms (for example, vitamin B2 for headaches). More information about specific treatments is available on the web page for each symptom.
Psychotherapy and psychological and psychiatric support are important for symptoms such as anxiety, post-traumatic stress and depression.
If treatment is ineffective or you need interdisciplinary follow-up, visit the next page for more information about the post-COVID clinic at the Geneva University Hospitals (HUG).
Online resources containing pacing, breathing, mindfulness, hypnosis and tai chi exercises can improve well-being and manage post-COVID symptoms.
Rehabilitation
Rehabilitation has an important part to play in care for patients with post-COVID symptoms, especially given the lack of pharmaceutical treatment to date.
Post-COVID patients undergoing outpatient or hospital treatment can benefit from rehabilitation programmes tailored according to the primary damage and severity of infection. This page is focused on rehabilitation for people undergoing outpatient treatment who have post-COVID symptoms such as fatigue, breathlessness or difficulty concentrating.
Physical rehabilitation while respecting energy levels and avoiding post-exertional malaise (pacing) is one of the treatments for post-COVID fatigue.
Before starting any physiotherapy treatment, the individual should undergo an assessment by a health professional. In cases of post-COVID fatigue, the patient should be assessed for potential post-exertional malaise before starting the rehabilitation programme. Cardiopulmonary exercise testing can provide information on the cause of the complaint(s) and make it possible to develop a personalized training programme.
Physical physiotherapy treatment of rehabilitation for orthostatic conditions (symptoms when standing up) or heart palpitations after exertion. In such cases, exercises may begin in the horizontal position to avoid dysautonomia (malfunction of the autonomic nervous system) and extra effort when standing up. The treatment also involves working on muscle strengthening, doing isometric exercises and restoring joint range of motion. The main aim is to enable you to carry out day-to-day activities while not exceeding your energy limits and avoiding post-exertional malaise. Physiotherapy should help you find the right balance between activity and rest. Patients should never be pushed beyond their capabilities, which could lead to a longer recovery time. The aim should always be to keep your heart rate below 60 per cent of the maximum. To calculate this: (220 – your age) x 0.6 = 60 per cent of maximum heart rate. Therapeutic patient education (learning how to understand your illness, safety precautions, etc.) and group therapy can be helpful, providing comprehensive patient care.
Respiratory rehabilitation using physiotherapy is a treatment for post-COVID shortness of breath. Respiratory physiotherapy is recommended in cases of post-COVID pulmonary sequelae (following a moderate-to-severe acute phase of the infection with or without hospitalization) and in cases of hyperventilation syndrome. A pulmonologist will diagnose hyperventilation syndrome, once structural lung damage has been ruled out, using specific tools including the Nijmegen questionnaire and a hyperventilation test. In these cases, the aim is to work on breathing control and improve ventilation under the supervision of specially trained physiotherapists.
Cognitive rehabilitation can help people who have difficulty concentrating, with tips and tricks for organization, monotasking, etc. Resources are not always available or reimbursed for cognitive rehabilitation, but you can do it as part of your everyday life by focusing on some cognitive tasks without exhausting your daily energy reserves. This may include reading two or three pages of a book, holding conversations for increasingly long periods of time or playing games (crossword puzzles, sudoku, board games) that require coordination or concentration. There is no need to start something new; rather focus on activities they already are familiar with.
For more information, you can read this leaflet published by the World Health Organization (WHO) : Rehabilitation : self-management of long COVID for adolescents.
