What exactly IS Covid-19
COVID-19 is a respiratory disease that developed from the Coronavirus family of viruses. The term “Coronavirus” is used to describe them because of the protein spikes that line each virus, and the crown-like appearance they have (Corona meaning crown in Latin) when viewed under a microscope.
People with COVID-19 often present with respiratory symptoms ranging from mild to severe, however, some will be asymptomatic, meaning they will not have any symptoms but may still carry the virus. Common symptoms include; fever, cough, fatigue, loss of taste or smell, shortness of breath, sore throat, and headaches. More severe and less common symptoms include pneumonia and septic shock, and people with these conditions may need to be hospitalised. According to Public Health England (PHE, 2021) data looking at symptom severity, 40% of people will have mild symptoms, 40% will have moderate symptoms and non-severe pneumonia, 15% will have significant symptoms including pneumonia, and 5% will have critical disease with life-threatening complications.
COVID-19 can infect people of all ages, but people over the age of 70 and those with serious chronic illness such as diabetes, cancer, chronic respiratory disease, and cardiovascular disease are at greater risk of developing severe COVID-19 symptoms.
The COVID-19 virus can enter the body through the nose, mouth, and eyes. Here it can enter and infect healthy cells and make new copies of itself. The new copies then go on to infect the surrounding healthy cells, and so the virus spreads. This can cause inflammation and irritation in the throat, triggering the development of the common symptom of coughing.
How does it affect the lungs?
The virus may continue to spread through the airways from the throat and into the lungs. The lungs can then become inflamed as the body’s immune system fights back. An infection called Pneumonia could result as the alveoli (the tiny air sacs in the lungs that take up the air breathed in) become inflamed. In severe cases the alveoli can become filled with mucus and fluid which can make it harder for the body to take in oxygen, leading to breathing difficulties and shortness of breath. In critical cases, the walls and linings of the alveoli can be damaged, making it even harder for the body to take up oxygen and expel carbon dioxide. Some may go on to develop Acute Respiratory Distress Syndrome (ARDS), which is a type of respiratory failure brought about by widespread inflammation of the lungs. Some people at this stage may require a ventilator to help them breath sufficiently as the lungs become increasingly inflamed and less able to do their job.
Covid differs from other lung illnesses like COPD and asthma in many ways
COVID-19 differs from respiratory conditions such as Chronic Obstructive Pulmonary Disease (COPD) and Asthma, firstly because it is a virus, and secondly because it is acute in onset. COPD and Asthma are chronic conditions, but people can suffer from acute exacerbations. COPD develops typically because of long-term exposure to irritants, such as cigarette smoke. COPD is characterised by inflammation of airways and increased mucus production, and/or the destruction of the alveoli. These contribute to the obstruction of airflow out of the airways and a build-up of CO2 in the lungs. COPD is also a progressive disease, meaning that symptoms generally worsen over time. People with COPD also generally have an increased amount of mucous production compared to those with mild to moderate COVID-19.
How physiotherapists treat people with Covid-19
The main role of a physiotherapist in the management of people with COVID-19 is to relieve symptoms and improve function, and to mitigate the adverse effects of prolonged bed rest and mechanical ventilation during critical illness.
Physiotherapists treat people with a range of symptoms in all age groups with anywhere from mild to severe COVID-19 symptoms.
In severe cases where people are mechanically ventilated, physiotherapists can implement regular turning of patients to prevent atelectasis, prevent pressure sores, and optimise ventilation.
In hospitals, physiotherapists use closed inline suctioning to remove secretions from ventilated patients. This involves a suction catheter being inserted into the endotracheal tube of the ventilated patient to remove secretions without disconnecting them from the ventilator. Patents with critical illness in the Intensive Care Unit (ICU) may be there for long periods of time, and can often be inactive in bed. This can lead to muscle deconditioning, amongst other problems. Physiotherapists therefore play a big part in the rehabilitation of patients as they recover from COVID-19 in ICU. Evidence suggests that early mobilisation whilst patients are still in the ICU can reduce length of hospital stay and minimise functional decline. To help with this, physiotherapists may prescribe range of motion exercises to improve muscle strength and joint integrity. Mobilisations such as bed mobility, sitting out of bed, sitting balance, and walking can be employed to maintain and gradually increase muscle strength and exercise tolerance.
While patients are recovering from infection, in order to help clear lung secretions, airway clearance techniques such as the Active Cycle of Breathing Technique (ACBT) may be used. ACBT is a combination of breathing exercises that loosens and moves secretions from the airways. Another airway clearance technique is Positive Expiratory Pressure. This utilises a small mouthpiece device to help open up the airways and to get air behind secretions to push them up and out towards the mouth.
Post-acute COVID-19, or “Long Covid”, can be described as the long-term symptoms associated with COVID-19 infection. It occurs for over three weeks after infection in around 10% of patients who have tested positive for COVID-19, and in some people can last for months. Long Covid is mostly associated with the symptoms of cough, low grade fever, and fatigue. Other symptoms include shortness of breath, chest pain, muscle pain and weakness, and depression. Physiotherapists can support the management of Long Covid symptoms through the prescription of breathing control exercises for breathlessness, possibly pulmonary rehabilitation for those who have had significant respiratory illness, and gentle gradual activity programmes for those with reduced exercise tolerance.
PHE. 2021 COVID-19: epidemiology, virology and clinical features. [online] Available at: <https://www.gov.uk/government/publications/wuhan-novel-coronavirus-background-information/wuhan-novel-coronavirus-epidemiology-virology-and-clinical-features#:~:text=Coronaviruses%20are%20a%20large%20family,such%20as%20the%20common%20cold> [Accessed 5 February 2021].