Post Covid-19 symptoms
Symptoms are generally determined by severity of the acute illness and the associated interventions such as medication and ventilation.
From the Gemelli Against COVID-19 Post-Acute Care Study Group:
Patients were assessed about 2 months after onset of the first COVID-19 symptom. At the time of the evaluation:
⦁ None of the patients had fever or any signs or symptoms of acute illness.
⦁ 12% were completely free of any COVID-19–related symptom
⦁ 32% had 1 or 2 symptoms
⦁ 55% had 3 or more symptoms.
⦁ Worsened quality of life was observed in over 40% of patients.
A high proportion of individuals still reported:
⦁ Fatigue (53.1%)
⦁ Shortness of breath (43.4%)
⦁ Joint pain (27.3%)
⦁ Chest pain (21.7%).
This study found that in patients who had recovered from COVID-19, 87.4% reported persistence of at least 1 symptom, particularly fatigue and shortness of breath at the 2 month post-symptom onset.
Limitations of the study include the lack of information on symptom history before acute COVID-19 illness and the lack of details on symptom severity. Furthermore, this is a single-centre study with a relatively small number of patients and without a control group of patients discharged for other reasons.
Patients with community-acquired pneumonia can also have persistent symptoms, suggesting that these findings may not be exclusive to COVID-19.6 Clinicians and researchers have focused on the acute phase of COVID-19, but continued monitoring after discharge for long lasting effects is needed.
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Recommendations on return to exercise
(Metzl, et al HSSJ DOI 10.1007/s11420-020-09777-1)
⦁ Patients should return to activity in a slow, gradual, stepwise manner using the “50/30/20/10 Rule” over 4 weeks after 7 to 14 days of being asymptomatic, if patient has no co-morbidities following a mild COVID-19 infection. That means for the first week, exercise to 50% of previous exercise level for one week, then if well tolerated, continue with 70% of previous exercise level for one week, the 80% and 90% in the 4th week. If well tolerated, return to full exercise level in 5th week.
⦁ Exercise should not resume if a patient with COVID-19 has persistent fever, shortness of breath at rest, cough, chest pain, or palpitations.
⦁ Any COVID-19 patient with an underlying cardiovascular or pulmonary condition should consult a physician prior to resumption of exercise, even if asymptomatic.
⦁ Consultation with a physician is recommended if patients who have had COVID-19 develop chest pain, fever, palpitations, or shortness of breath on the resumption of exercise.
English Institute of Sport Guideline