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Long COVID and rehabilitation – a World Physical Therapy day opinion piece

Today, as most of Aotearoa changes COVID-19 Alert levels it’s easy to forget how fortunate we have been to have limited COVID-19’s reach into our population. And at a time when so few of us have first-hand experience of this disease and its impacts, the benefit of lockdown can seem more abstract than its inconvenience and cost.

As we learn more about COVID-19 it’s becoming increasingly clear that for many people, being infected with COVID isn’t a short-term proposition. In fact, for up to one in ten people the fight with COVID-19 extends into weeks and months, and potentially ongoing health issues.

The ongoing symptoms that can follow acute COVID-19 are known as “Long COVID” – and that list of symptoms is long and life-affecting. These symptoms are wide ranging but commonly include fatigue and exhaustion, post exertional malaise, chest tightness and pain, shortness of breath, headache, sweats, brain fog and cognitive impairment.

At a physiological level, long COVID can damage the body in many areas including the cardiac, respiratory, renal, endocrine, and neurological systems. This has ramifications for healthcare providers and patients affected by COVID-19 and the provision of services over a sustained period of time.

While it’s not clear what the long-term impacts may be, some studies have shown up to three quarters of COVID patients still report symptoms after six months. Concerningly, many who have ongoing issues haven’t had a severe case of the virus to begin with.

Today is not only the day that those of us outside of Auckland shift alert levels – it’s also International Physiotherapy Day. This is significant as the physiotherapy profession is critical to long COVID rehabilitation.

While the first thing that many New Zealanders think of when they think of physiotherapy is sports physiotherapy, practitioners work in many different contexts including ICU, cardiac rehabilitation and breathing retraining. Treatment of breathing dysfunction is not new- many of the physiotherapy techniques used today were pioneered in the treatment of soldiers poisoned by mustard gas during the first world war.

If you ask any physiotherapist who has dealt with long COVID about its management and the first thing they will tell you is each patient has a different set of needs that requires a personalised treatment approach.

The second thing they’ll point out is that unlike many other rehabilitation programmes, the use of gently increasing exercise over time – known as “graded exercise” – can do more harm than good for those who experience long COVID symptoms.

That’s because long COVID has such diverse effects on the body including ongoing or late damage of one or more of our organs. A “push through it” approach to fatigue caused by long COVID, can make day to day functioning harder for the patient. Appropriate treatment relies on identifying what damage has been done by COVID during the assessment and adapting the therapeutic response accordingly.

Physiotherapists understand complex presentations – it’s what we do. Sometimes that will take time and require the patient to keep a diary of symptoms to assist the diagnosis and management. Once that’s done, we can appropriately pace and apply techniques to relieve patient’s symptoms. But first the patient needs to know that this help is available.

In Aotearoa we expect around 300 people to suffer from long COVID from the last outbreak and more from the one from which we are currently emerging. Unlike other nations who have seen far more substantial proportions of their population infected with COVID-19, long COVID does not loom as a major healthcare crisis for us unless our containment and elimination plan goes awry.

But for those few hundred people suffering with long COVID in Aotearoa, the effects can be life changing. We know that many patients who have had COVID -19 identify as Māori and Pasifika, and these groups already have inequitable healthcare outcomes. Aotearoa’s response to long COVID will need to take our unique cultural context and current health inequities into account as we see patients with long COVID symptoms.

Anyone with long COVID symptoms, needs to know that they can access rehabilitation for this including physiotherapy. As for the rest of us? Prevention remains the best option. Wear your mask, get vaccinated, use contact tracing, wash your hands, and stay safe.

Janice Mueller
Physiotherapy Board