Post COVID Care: How to care for someone who has recovered from COVID-19

We know that COVID-19 affects the lungs because the SARS-CoV-2 coronavirus that causes COVID-19 attaches to ACE2 receptors, which are mainly present on the lungs and blood vessel, as well as some other organs. (Read more: What are ACE2 receptors and why does COVID-19 affect the lungs?)

Shortness of breath is one of the more serious symptoms of COVID-19—the infection can reach the air sacs (alveoli) and cause inflammation and fluid build-up in the lungs (pneumonia).

Some of the breathing difficulties may persist in the post-treatment recovery phase of COVID-19 as well. The reason: COVID-19 may cause a pulmonary embolism (blockage in the tiny blood vessels of the lungs, by blood clots and debris that is left behind after a hyperactive immune response) and/or post-COVID lung fibrosis (scarring of lung tissue) in some patients.

There are at least two ways you can manage breathlessness after COVID-19:

• By assuming breathing positions
• By doing some breathing exercises

Let's look at them one by one.

Breathing positions

These aren't difficult or even challenging positions. The point is to make you comfortable, and help you get as much air into your lungs as possible. Try one of these positions anytime you feel breathless:

• Seated upright: Sit comfortably but upright in a chair or sofa. Relax your shoulder by lifting and dropping them once or twice—or simply try to increase the distance between your ears and shoulders. Place your hands in your lap. Keep your eyes open, gaze soft and look forward. Try to breathe slowly. Sitting straight helps to remove obstructions in the airways. Relaxing the shoulders can reduce anxiety and improve breathing.
• Seated, bent forward: Sit comfortably in a chair. You can put your forearms on the armrests of the chair or your thighs and lean slightly forward. Don't do this if you feel dizzy, though. Leaning forward improves "ventilatory capacity" or the ability of your lungs to take in more air.
• Seated with head laid down: If you are sitting in front of a desk, make a pillow with your arms and lay your head down. Look to one side—rest one of your cheeks on the arms rather than the forehead. You can also keep a chair cushion or pillow under your cheek.
• Standing with back support: Lean your back against a wall. Bring your feet slightly forward, away from the wall. Focus on relaxing your shoulders.
• Standing, forward bend: Face a wall or window sill. Lean forward slightly and rest your palms on the wall or your elbows on the window sill (make sure the window is secure and there is no risk of you falling out).
• High side-lying: Place four or five soft pillows on your bed and lay down on one side with your head resting on the pillows. This position is also good to sleep if nasal congestion (blocked nose) is giving you sleepless nights.

Breathing exercises

It can be quite scary when you can't breathe properly. It is also completely understandable if this brings up bad memories of your stay in the hospital or the sickbed at home.

However, your immediate goal when you are out of breath should be to regularise your breathing. Try not to panic and focus on doing one of these exercises:

• Belly breathing: Sit comfortably in a chair. You back should be upright but supported. Now place one hand on your chest and the other on your tummy. As you breathe in through the nose, feel the hand on your tummy rising. Breathe out through your mouth and observe the hand on your tummy returning to its original spot. Breathe comfortably.
  Research has shown that when we breathe in through the nose, there's a natural injection of nitric oxide into the body. This helps the lungs to take up more oxygen with each breath. (Read more: Does nitric oxide kill coronavirus?)
• Trace a rectangle: This exercise can help you regularise your breathing by getting into an easy rhythm. Start by finding a small rectangle in your room: a computer monitor, television screen or window frame will do. Breathe in as you move your gaze from one end of the shorter side of the rectangle to the other end. Breathe out as you look down the long side of the rectangle. Do this for one or two minutes or until your breathing becomes more rhythmic.
• Paced breathing: Climbing stairs and walking longer distances may leave some recovered patients winded. Rest assured this will get better little by little. You can gradually increase the distances you walk and stairs you climb by following this rhythm of breathing:
  • Breathe in before you take a step up.
  • Breathe out as you step up one stair.
  • Rest and breathe in before climbing again.

Pulmonologists warn that supplemental oxygen will not ease breathlessness in these circumstances. It is much better to focus your attention on one of the exercises described above. Feeling breathless can also cause anxiety, which can make breathing even more difficult. It's not easy, but it is important to try and stay calm (see below for relaxation techniques for anxiety).

Read more: Deep breathing exercises

Fatigue is a common sign of viral infection. This is because the body diverts a lot of energy from the normal body processes to fight the infection. Some patients with COVID-19, however, report feeling extremely fatigued—a symptom that can continue for a little while after they beat the disease.

If you have just recovered from COVID-19, it's important to be realistic about your symptoms after recovery too. Recovered patients who find it difficult to resume regular activities can also reach out to occupational therapists, who would be able to advise them on ways and equipment to resume day-to-day life.

You can try these six tips to deal with fatigue after COVID-19:

1. Make a new timetable with your current energy levels in mind. Plan meticulously.

Remember you still need to rest and regain your strength. You should factor this into your work calendar over the next few weeks as well:

• Try to keep deadlines as flexible as possible for a little while
• Budget more breaks into your day than normal
• Delegate as much as possible: assign tasks that you feel can be done by other people to your team/family/friends/house help
• Try to delay or cancel non-essential tasks or tasks that are not time-sensitive
• Figure out when you are most active in the day and take up the most energy-consuming tasks at that time. For example, if you feel most energised after a nap in the afternoon, take up the most difficult tasks immediately afterwards.

2. Reorganise your space/office/desk to reduce energy consumption.

• If you need to make trips to the copier or supplies cupboard several times in the day, see if you can shift closer to these temporarily.
• If you can keep most of the things you need at your desk, for now, that could save you a lot of extra movement.
• Remember that walking, climbing stairs, talking on the phone can be more tiring while you recover fully. So be patient with yourself.
• You could take the help of an occupational therapist to come up with a plan for organising your workspace and workload to make it more manageable.

3. Be honest about how much you can take, and the things that need your input. Assign a priority to the tasks you set for yourself.

Call it good planning or pruning, but you need to be absolutely clear about which tasks need your inputs, where your inputs would be nice-to-have and where other people can take over for a while as you regain your strength.

4. Go slow: pace yourself

Your memory and concentration could take some time to come back to their normal strength. Trying to rush back into the flow of work could be frustrating and tire you out more. So take a graded approach—try to do a little bit more each day and each week.

Your strength and stamina will also improve little by little. Eating a healthy, protein-rich diet and taking up light exercises will help, too.

5. Don't overlook how you are feeling

You have been through a lot lately. If you feel sad or frustrated or anxious about your health sometimes, don't ignore these feelings. Talk to a friend or doctor about these feelings, to come up with an appropriate response to them. Feelings of anxiety can drain your energy and add to the fatigue or tiredness.

6. Eat energy-boosting foods

Bananas, apples, oranges (or freshly squeezed orange juice), goji berries and sweet potato are great for getting energy quickly. You can also add a little bit of honey to warm lemon water and drink that for a quick pick-me-up. When you are feeling really low on energy, sipping on water can be surprisingly helpful. Try it.

A persistent cough is one of the symptoms of COVID-19. Some patients report feeling pukish because of continuous cough. After the infection is over, some patients may still experience cough and excessive phlegm production. This is nothing to worry about if your doctor says you are infection-free now.

There are some simple tips for managing your cough, depending on whether you have a dry cough or wet (productive) cough with phlegm.

How to manage a dry cough

• Drink lots of fluids. This should include warm drinks like an infusion of tulsi leaves in boiled water or honey and lemon in warm water. Try to avoid alcohol, sugary drinks and coffee for some time, as these can cause dehydration. Sip on water throughout the day—don't gulp several glasses at a time, sip slowly and frequently.
• If you don't have water or anything else to drink nearby, try swallowing your saliva a few times. This can help if you need to cough or your throat is very dry.
• Inhale steam for 10-15 minutes, two to three times a day. You can also keep a humidifier in your room if the weather is dry and/or cold.

Read more: Home remedies for dry cough

How to manage a productive cough or cough with sputum

• Steam inhalation can loosen the phlegm and help it to come out. Take steam twice or thrice a day, for about 15 minutes each time.
• Phlegm can cause congestion in the chest or nose. This may disrupt your sleep—which, in turn, could adversely affect your recovery. Try sleeping on one side rather than flat on your back. You could also sleep in the high side-lying position (on one side, with your head raised on multiple pillows).
• Drink lots of fluids, including high-protein and high-energy drinks like bone broth, and vegetables and lentil soup. You can also drink kadha made by boiling ginger, tulsi and black pepper in water for 5-7 minutes.

Read more: Home remedies to get rid of mucus

An excess of phlegm and post-viral cough can also cause chest congestion in some recovered patients. You can try the following exercise and position to ease this symptom.

Exercise to ease chest congestion

• Active cycle of breathing: This is a multi-step breathing exercise that may help some former COVID-19 patients to expel phlegm and chest congestion. Here's how to do it:
  • Sit comfortably in a chair. Relax your shoulder by pushing them down and away from your ears. Take two or three normal breaths to get comfortable.
  • Now, take three or four belly breaths: place one hand on your chest and the other on your tummy. Breathe in through the nose. Try to fill your stomach (rather than chest) with air.
  • Now expel your breath in two huffs: imagine you are trying to fog up a mirror to clean it. Use your chest and stomach muscles to breathe out slightly forcefully.

Position for congestion

You could try one of these positions for draining the lungs:

• Lie down on your right side with one or two pillows under your hips. You can also increase the number of pillows to three, to drain the lower lobes (sections) of the lungs.
• Lie down on your right side with two or three pillows under your head. Cross your left arm over your chest if this feels comfortable.

When you should not assume these positions:

• You are feeling nauseous
• There's blood in your phlegm
• You feel dizzy
• You have acid reflux or heartburn
• The position makes you breathless

Read more: Home remedies for chest congestion

There are many reasons why someone who has just recovered from COVID-19 might feel anxious. The most obvious ones are:

• The anxiety is a residue of neurological symptoms of COVID-19
• You worry about a relapse or reinfection or giving the infection to a family member or friend
• You worry about the post-COVID symptoms or you are concerned about the pace at which you resume your normal life
• If you are unable to sleep properly, then this could also add to your feeling of anxiousness
• You have bad memories of your convalescence. This could happen for a number of reasons such as:
  • Fear of organ damage and even death
  • Not always knowing what is happening to you
  • Being isolated and separated from family and friends for several days
  • Feeling out of breath makes you anxious

Whatever the reason, it is important to try and relax now. Stress and anxiety can exacerbate (or increase) some of the post-COVID symptoms like difficulty breathing and fatigue. You can try some of these tips:

• Stop watching the news about the pandemic if it makes you unhappy or anxious in any way. If this is not possible, limit your exposure to news to only a few minutes a day and only reliable channels, newspapers or news sites.
• Take up meditation or yoga to de-stress and jumpstart your physical recovery. (Read more: How to meditate—for beginners)
• Practise relaxation techniques such as:
  • Visualisation: Imagine you are in a place you really like. It could your mom's kitchen, a favourite holiday spot, your favourite library. Really think about the details of this place: what does it smell like, what can you see, is it cosy here or breezy.
  • Ground yourself: Engage all five senses, to really become present in the moment. List five things you can see, four you can hear, three you can touch, two you can feel and one you can taste.
• Stay connected with friends and family over the phone and video calls.