What is Covid 19?

COVID-19 is a highly contagious virus that mainly attacks the lungs. It is transmitted through droplets created from sneezing and coughing from those infected. The virus enters the body via the nose, mouth and eyes.

The most commonly reported symptoms of COVID-19 are:

  • A new continuous cough
  • A fever
  • Fatigue
  • Muscle aches
  • Shortness of breath when moving around
  • Sputum production
  • Loss of appetite/taste/smell

Some people may require hospitalisation to treat these symptoms. The severity and duration of symptoms for people who have COVID-19 can vary. For most people, symptoms last 7-14 days and will be very mild. To manage mild symptoms:

  • Stay hydrated
  • Take paracetamol if you have a temperature
  • Rest
  • Get up and move about at regular intervals

If you need additional advice, visit the NHS 111 online service or telephone 111 to speak to someone.

What do I do if my symptoms get worse?

Monitor your symptoms regularly. If you get one of the following:

  • Worsening shortness of breath
  • A new or returning fever
  • Worsening ability to concentrate
  • Chest pain

Please call 111 for more advice or for a medical emergency, dial 999 immediately.

How might I feel after having Covid-19

You may find that your symptoms last for weeks or possibly months, especially if you have been in hospital or had severe COVID-19 symptoms. This might make it more difficult to do the things you are normally able to do, such as housework, having a wash, getting dressed or walking up and down the stairs.

This pack contains information on how to manage the following symptoms:

  • Severe fatigue
  • Ongoing breathlessness
  • Muscle weakness
  • Post viral cough
  • Difficulties with memory/confusion

How are you feeling?

As well as the physical symptoms listed above, it is very common to experience feelings of anxiety and low mood. Some people who have had treatment in hospital may also experience anxiety or unpleasant memories about their stay. There is guidance on managing anxiety in this booklet.

Positions to manage breathlessness

Following COVID-19 you may find you have continued breathlessness.

You should monitor this and if it gets worse seek further review from your GP or 111.

These positions can help ease your breathlessness and can be used when resting or when walking.

Managing breathlessness

When you develop a chest infection such as COVID 19, changes in the pattern, rate and depth of breathing are needed to help your body fight the infection. This response is essential, as your body is under stress and it is part of the fight or flight response. During the acute phase of a severe infection breathing patterns may change to ensure that the body gets all the oxygen it needs. The most common changes are:

  • breathing faster than normal
  • breathing more deeply than normal
  • breathing in and out through your mouth rather than your nose

As the infection improves and your lungs recover, your breathing should return to normal. However, for some, switching off that fight or flight mode can be challenging. The changes in your breathing pattern become habitual, leaving you with a fast and erratic breathing pattern.

This may result in you feeling exhausted and breathless and slows down the body’s ability to recover. Re-setting your breathing pattern back to normal can take time, concentration and requires you to become more aware of your breathing, but should result in you starting to feel better

Effects of an altered breathing pattern vary greatly but can include:

  • Breathlessness (at rest, moving around or even when you are talking)
  • Fatigue and low energy levels
  • Tired muscles
  • Tense muscles or twitchy muscles
  • Unable to exercise
  • Chest pain and palpitations
  • Tingling in hands, feet or tip of nose
  • Headaches

These symptoms will continue to make you feel unwell and can be very worrying. A few people who have had COVID 19 have developed long-term effects in their lungs and the heart, but even if this is the case, ensuring that you are breathing properly will not make any of these changes any worse and may help to relieve some of your symptoms.

Check your own breathing

Look at how you are breathing- is it through the nose or the mouth? Do your shoulders, arms and hands feel tense? Can you feel or see your upper chest rising or does your tummy rise and fall as you breathe in and out? Can you hear yourself breathing? Do you sigh or yawn a lot?

Breathing well at rest means breathing quietly in and out though your nose, at between 8- 16 breaths per minute. Try to relax your neck, shoulders and upper chest.

Breathing with your nose ensures that the air is warmed, humidified and cleaned before it reaches your lungs. It also slows down the breath which helps the air go down in to the lower part of the lungs. Breathing in this way helps you to breathe using your diaphragm, the big muscle underneath your lungs.

Diaphragmatic breathing, also known as relaxed breathing or tummy breathing, is how we are meant to breathe when at rest. As the diaphragm moves down it pulls air into your lungs, and pushes your tummy forward. As it relaxes, the air passes out of your lungs and your tummy sinks back down. Breathing with your diaphragm ensures you use the bottom part of our lungs, which allows the body to move more oxygen in to the blood and uses less energy per breath.

Breathe a rectangle

  • Find a comfortable position.
  • Look for a rectangle shape in the room e.g. a window, door or TV screen.
  •  Move around the sides of the rectangle with your eyes, breathing in on the short sides and out on the long sides.

Exercises to help manage your breathing

Breathing exercises can help you manage your breathlessness and reduce its impact on your everyday activities.

Breathing control

  • Take a slow breath in through your nose
  • Try to relax your shoulders and neck
  • Allow the air to fill up from the bottom of your lungs to the top of your chest
  •  Breathe gently out through pursed lips (as if you were going to blow out a candle) to create space for the next breath in

Breathing well while walking

This will help you walk on the flat, climb stairs and negotiate slopes. Try to keep your shoulders and upper chest relaxed and use your breathing control. Time your breathing with your stepping.

  • Breathe in – 1 step
  • Breathe out – 1 or 2 steps

Keep cool

Make sure you have good air circulation in the room by opening a window or door.

Try holding a hand held battery operated fan to the side of your face if you are feeling particularly breathless

Use a wet flannel to cool the area around your nose and mouth this can help reduced the sensation of breathlessness.

Managing your cough

A dry cough is one of the most commonly reported symptoms for COVID-19 however in some cases it may be productive of phlegm.

Strategies to manage a dry cough:

  • Stay well hydrated
  • Sipping a soft drink – take small sips, one after the other, avoid taking large sips
  • Steam inhalation – pour hot water into a bowl and put your head over the bowl. If comfortable, cover your head and bowl with a towel
  • Drink warm honey and lemon or another warm drink, this can help to soothe the throat
  • If you do not have a drink to hand, but need to cough, try swallowing repeatedly. This can work in a similar way to sipping water

Strategies to manage a productive cough

  • Keep well hydrated
  • Steam inhalation
  • Try lying on either side, as flat as you can. This can help drain the phlegm
  • Try moving around or just changing position; this will help to move the phlegm so that you can cough it out

Exercises to help clear your chest

Following COVID-19 you may find that you have a productive cough and mucus on your chest.

These exercises and positions can help you clear your chest. These may be recommended by your physiotherapist or nurse following COVID-19.

Active Cycle of Breathing Technique (ACBT) exercise consists of three breathing exercises that together help to clear the mucus off your chest.

Breathing control

  • Gentle, relaxed breathing with l your shoulders relaxed

Deep breaths

  • Breathe in slowly and deeply
  • Gently breath out without forcing it
  • Repeat 3-4 times only (too many can make you feel dizzy)

Forced expiration techniques

  • Take a medium sized breath in
  • Breathe out forcefully for a short time
  • Keep your mouth open and use your stomach and chest muscles
  • Think ‘huffing’ a mirror to polish it
  • Repeat 1-2 times
  • Always finish on a cough or huff
  • Stop when your huff is dry on two consecutive cycles

How often and how long?

  • Continue to do until you feel your chest is clearer
  • Clear as much mucus as you can without becoming exhausted
  • Perform for at least 10 minutes, but no longer than 30 minutes
  • If productive 2-3 times per day

Positions to help keep your chest clear

Use the following positions, along with ACBT to help clear your chest. However:

  • Don’t use immediately before or after a meal
  • Stop if you have any side effects
  • Choose the position below that you feel would best drain your lungs, you can do this in discussion with a health care professional

Do not do this if you have:

  • Nausea
  • Acid Reflux
  • Become significantly breathless
  • Have blood in your phlegm
  • Have a recent chest, spine or rib injury
  • Feel wheezy

If you have any of the above, please speak with a health care professional before doing this.

Fatigue management

Initially you are likely to find that your energy levels fluctuate from day to day.

Walking around your home might be difficult, including managing the stairs, accessing toileting facilities and managing your daily routine.

This may result in you needing to adapt the activities that you do to enable you to conserve your energy.

If you find your activities of daily living difficult, you may need a referral to the occupational therapist to complete an assessment.

Whilst you recover, you may need:

  • To consider a different set up such as single level living either downstairs or upstairs whilst you recover

  • Specialist equipment to make things easier

Understanding your energy levels

  • Imagine you had 10 bags of beans to fuel your day.
  • When you are feeling well, it may feel like getting up from bed uses up half a bag of beans.
  • Whilst you are recovering, this may now feel like it uses up 4 bags of beans meaning you only have 6 bags left to use for the
  • rest of the day.

With this analogy in mind it may be useful to keep a note of how tiring different activities are for you in order to help you understand the pattern of your fatigue and enable you to manage and adapt to this better.

Conserving your energy using the four ‘P’s

Planning

Planning includes organising daily routines to allow completion of essential activities when you have the most energy.

E.g. many find it more helpful to perform strenuous tasks such as dressing early in the day when strength and stamina are often at their peak.

It is important to think about the task prior to performing the task and expending physical energy.

Consider the following:

  • Think about the steps that need to be completed and items required for the task.
  • Prepare the required items ahead of time.
  • Keep frequently used items in easily accessible places.
  • Have duplicate items available to limit unnecessary trips between the bathroom, bedroom, or kitchen.
  • Consider using a bag, basket, or rolling trolley to carry tools or supplies in one trip.
  • Consider your weekly routine. It will be beneficial to schedule strenuous activities, such as going to the hairdresser, attending religious services, and shopping, evenly throughout the week instead of all in one day.

Once activities are planned, pacing allows individuals to sustain an energy level until the task is completed.

Consider the following:

  • Allow plenty of time to complete activities and incorporate frequent rests.
  • Perform tasks at a moderate rate and avoid rushing. Although a task may be completed in less time, rushing utilises more energy and leaves less ‘in the bank’ for later activities.
  • Allow plenty of time for rest and relaxation. Take a morning or afternoon nap prior to activities or outings to build up energy.
  • Breathe easily and properly during activities. Using these techniques helps decrease shortness of breath
  • Rethink activities with rest in mind. For example, sit instead of stand while folding clothes or preparing food. Instead of writing 25 holiday cards in one day consider writing five cards per day over five days.

Prioritising

The third strategy is often the most challenging. When faced with limited energy reserves individuals must look critically at work, family, and social roles and keep only those roles that are necessary and pleasurable.

Consider the following:

  • Can a friend or family member assist with chores e.g. emptying the rubbish, vacuuming so you have more energy for necessary and pleasurable tasks?
  • Eliminate unnecessary tasks, chores or steps of an activity. Look for shortcuts and loosen the rules.
  • Be flexible in daily routines enables you to enjoy activities you would like otherwise miss because of fatigue.

Positioning

Positioning is extremely effective, but not often considered when addressing energy conservation. Current methods of performing tasks may be using more energy than required.

Consider the following:

  • Storing items at a convenient height to avoid excessive and prolonged stooping and stretching.
  • Make sure all work surfaces are at the correct height. If a counter is too short, slouching and bending can occur which results in more energy expenditure.
  • Use long-handled devices such as reachers or telescopic cleaning tools to avoid unnecessary bending and reaching.
  • Facilitate bathing - use a shower seat and a hand-held shower head.

The emotional impact

The experience of having COVID-19 can be very frightening. It is very understandable that the experience can have an emotional impact.

Whether you have had mild or more severe symptoms, these are some common difficulties that you may be having:

  • Feeling anxious when breathless
  • Worries about health or about family or friends getting ill
  • Feeling low in mood
  • Poor sleep

If you were treated in hospital, you may also experience:

  • Unpleasant images from your stay, that might seem to come ‘out of the blue’
  • Nightmares
  • Feelings of panic with any reminders of hospital

What can help?

  • Avoid watching too much news or social media if it is making you feel anxious, try limiting yourself to looking at the news once a day
  • Speak to family and friends
  • Try to do activities that you find enjoyable and relaxing
  • Don’t be too hard on yourself if there are some things that you are finding harder to do, remind yourself that recovery takes time
  • Focus on what is in your control like eating well
  • If you continue to feel overwhelmed by your symptoms, speak to your GP

Relaxation techniques

Relaxation is an important part of energy conservation.

It can also help you to control your anxiety, improve the quality of your life and reduce pain and discomfort. Below are two relaxation techniques you can use to manage anxiety and help you relax.

Grounding technique for when you feel anxious

Take a few slow breaths and ask yourself:

  • What are five things I can see?
  • What are four things I can feel?
  • What are three things I can hear?
  • What are two things that I can smell?
  • What is one thing I can taste?

Think of these answers to yourself slowly, one sense at a time spending at least 10 seconds focusing on each sense.

Picture yourself somewhere calm

Think of somewhere relaxing and peaceful. It could be a memory of somewhere you’ve been or a made up place.

Close your eyes, and think about the details of this place. What does it look like?

  • What colours and shapes can you see?
  • Can you hear any sounds?
  • Is it warm or cool?
  • What does the ground feel like?

Spend some time imagining each of these.

Managing your diet post COVID-19

You may find your taste changes during and for a period of time following COVID-19. However it is important to eat and remain well hydrated.

What makes food and drink important?

When our body is fighting an infection it needs more energy and more fluids to help; so we need to eat and drink more than we usually would if we were well.

When our body is recovering from an infection it needs more building blocks (from protein foods) to repair and enough vitamins and minerals help the process along.

What can you do to make the most of your food and drink?

Continuing to choose foods higher in protein together with gradually getting back to normal activity levels will help to rebuild your strength...

  • Aim to have three hand size items from this Protein group daily
  • Aim to have three thumb size items from this Dairy* group daily 

How can you get enough vitamins and minerals?

Aim to have five handfuls from this fruit and vegetable group each day.

If you need more help and support your GP can refer you to the community dietitian

Community Support Hubs

You will be able to get help from get support from Lancashire County Council’s Community Hubs. If you need help with shopping or food parcels, collecting prescriptions, financial or debt advice, housing advice or tackling loneliness.

If you have access to the internet you can access their website: www.lancashire.gov.uk or email support@preston.gov.uk

Or for Preston Together Community Hub, telephone 01772 906777

For South Ribble Together Community Hub, telephone 01772 625625

For Chorley Together Community Hub, telephone the Council on 01257 51515

Physical activity following COVID-19

Spending time in hospital or being ill at home with COVID-19 can result in a significant reduction in muscle strength, particularly in your legs. This can be for a number of reasons, but mainly due to inactivity.

It’s not harmful to get out of breath when doing physical activity, this is a normal response.

However if you are too breathless to speak, slow down until your breathing improves. Try not to not get so breathless that you have to stop immediately, remember to pace your activities.

You might have been given some exercises to do in hospital or in the community by a physiotherapist.

Make sure you keep doing these regularly however if you are unsure, contact the prescribing therapist.

Do not overdo it, try to increase your activity levels slowly.

Social life and hobbies

When you’ve been seriously ill, you may feel differently about things and you may not want to do things you used to enjoy. You may:

  • Not feel like seeing lots of people at once

  • Find it difficult to concentrate

  • Find it hard to follow a TV programme

Your concentration will get better and your memory will usually improve.

Physical exercise - how hard should it be?

  • Smoking tobacco products increase your risk of infection due to the harm caused to your immune system and lungs.

  • Smoking is linked with poorer outcomes in COVID-19.

  • It’s never too late to stop.

  • By stopping you can see benefits within 24 hours.

For help to stop smoking you can access NHS stop smoking services via the internet or you can telephone 0800 328 6297.

What to do if my symptoms do not improve

The length of time that it takes to recover from COVID-19 varies from person to person, for some it will be days, others weeks or months.

The more severe your symptoms, the longer it might take for you to return to what is normal for you.

If however after 6-8 weeks, you are still experiencing symptoms, please contact your GP for further review.

Getting psychological support

Feeling anxious or low in mood is very normal when recovering from COVID-19. You can discuss this with your family and friends or GP if you feel able too.

However, if it feels like it is going on too long or you are finding it hard to cope, you can refer yourself for talking therapy with a trained professional by visiting our Talking Therapies self referral page.

Or you can telephone your local Talking Therapies Service on:

If you would just like to talk to someone we have a Wellbeing Helpline and Texting Service that offers emotional support. If you want to chat about your mental health or are lonely telephone 0800 915 4640 or text Hello to 07860 022846

If you need urgent help, LSCft has a crisis helpline that remains open 24 hours a day. If you are worried that you might harm yourself or someone else telephone 0800 953 0110.

This help is also available for your family or carers, who may experience anxiety, depression or acute stress reactions following your diagnosis and recovery of COVID-19

Getting back to work

Employers have a duty under the requirements of the Equality Act 2010, to not directly or indirectly, discriminate against an employee because of long term health condition/disability. The Equality Act 2010 provides protection for those with a disability for the following areas;

  • application forms
  • interview arrangements
  • aptitude or proficiency tests
  • job offers
  • terms of employment, including pay
  • promotion, transfer and training opportunities
  • dismissal or redundancy
  • discipline and grievances

Types of discrimination are listed below.

  • Direct discrimination relates to the unfair treatment of an individual because of a disability.
  • Indirection discrimination may involve imposing rules or policies that apply to all employees, but puts an individual living with a disability at an unfair disadvantage.
  • Harassment is the unwanted behaviour which may cause you to feel offended, humiliated or intimidated.
  • Victimisation may relate to the unfair treatment of someone who has raised a complaint about discrimination or harassment.

Reasonable Adjustments in the Workplace

Employers have a duty to make reasonable adjustments in the workplace to support you to remain in employment, by preventing you from being put at an unfair disadvantage. Under the Equality Act 2010 there is legal requirement to make adjustments to the working environment, policies and procedures to promote accessibility for all employees.

Good communication between employers and employees can support an individual to return to or remain in employment. This may also involve communication with an occupational health department or human resources to identify support that can be put in place. When considering what support may be useful, it may be helpful to consider the following discussion points;

  • How your condition affects you?
  • How the symptoms of your condition may impact your job performance, or what tasks may be challenging.
  • Strengths at limitations
  • What adjustments are available?
  • Regular review discussions to ensure adjustments are effective and to identify if any further adjustments are required.

Some examples of reasonable adjustments are listed below.

  • Making adjustments to the working environment
  • Altering your job role to enable you to take on lighter or less demanding work. This may involve allocating some working duties to another person.
  • Completing an ergonomic workplace assessment in order to provide assistive equipment, to support you to do your job.
  • Adjusting working hours, allowing flexible hours or time working from home if possible.
  • Allowing you to take time off from work for medical appointments.
  • Adjusting performance targets. Considering reducing the workload to reduce unnecessary pressure.
  • Taking regular breaks during the working day. A full lunch break away from the working environment might be helpful. Short and frequent breaks e.g. to make a hot drink, may be useful to support you to reposition. This may also increase work productivity.
  • Training in other working roles and regular support.
  • Offering opportunities for you to engage a variety of tasks to ensure you are able to change position and pace yourself to balance your energy levels.
  • Graded return to work following a period of sickness absence, which may involve reduced working hours building to fulltime.

Support via the Internet

Asthma UK and The British Lung Foundation - have set up a support hub to provide information and dedicated support for people who have been diagnosed with COVID-19 and their family members.

More information is available on the post covid org website.

Your Covid Recovery is an on-line NHS resource to help you manage your recovery. It has information on managing a range of symptoms, including breathlessness, fatigue, anxiety, low mood, cough, musculoskeletal pain, problems with taste, smell, voice, swallowing, insomnia, memory and concentration. It also has information for family, friends and carers, and provides advice about supporting your wellbeing, managing daily activities, returning to work and when to seek help.

More information is available on the your covid recovery online NHS resource website.

Lancashire Community Roots

Lancashire Community Roots offers a wide range of free courses about mental health, wellbeing and recovery that are available to anyone over the age of 16 (regardless of where you live). The courses are co-designed by people with lived experience and professionals, and cover a variety of topics linked to the 5 ways to wellbeing. Visit the Lancashire Recovery College website, or follow them on Twitter

Visit Community Roots website for more information about current courses, and how to book on them.

Coffee and Chat for People with Post Covid

Our Community Prevention and Engagement Team hold a fortnightly on-line session. For more information and a log in for the group email: cad@lscft.nhs.uk

Most public libraries now have computers linked up to the Internet. Check with your local library if you don’t have a computer at home and want to access the resources on line. Be sure to only access trusted sites for advice and guidance.

Acknowledgments:

Homerton University Hospital NHS Foundation Trust

Higginson LJ, Maddocks M, Bayly J, Brighton LJ, Hutchinson A, Booth S, Ogden M, Farquhar M. on behalf of the NIHR Applied Research Collaborative Palliative and End of Life Care Theme. April 3rd2020. Managing your breathlessness at home during the corona virus (COVID-19) outbreak.

St George’s University Hospitals NHS Foundation Trust (2020) COVID-19 Managing Breathlessness.