What is SARS?

It is an atypical severe pneumonia caused by SARS-Cov coronavirus (unknown at the time), a virus capable of surviving about three hours outside the host organism.

Coronaviruses are generally the main cause of mild to moderate respiratory illnesses such as the common cold, but which can worsen into pneumonia and acute respiratory syndromes, sometimes fatal.

Symptoms of SARS

The incubation period of SARS is rather short: between 2 and 7 days.

The first symptoms are very similar to those of influenza:

  • high fever (>38°C)
  • joint and muscle pain
  • dry throat
  • headaches
  • chills
  • cough
  • difficulty breathing.

In some cases, respiratory symptoms occur from the first onset of the disease and may worsen leading to hypoxia and pneumonia.

After about 7 days, the disease progresses with a dry cough that may lead to a poor oxygen supply to the blood and in 10-20% of cases may worsen to the point where supportive therapies such as assisted breathing, oxygen therapy or, in extreme cases, resuscitation are required. The mortality rate is around 9% (source: World Health Organisation).

SARS transmission, diagnosis and treatment

SARS is mainly spread by direct contact with infected patients, through their respiratory secretions (droplets of saliva expelled with coughs or sneezes) or their body fluids.

Diagnosis is made through the observation of symptoms and the results of a series of tests: chest X-ray, blood cell count (thrombocytopenia and leucopenia have been found in many patients), Gram culture and a search for respiratory viruses.

SARS is treated like any severe atypical pneumonia, i.e. mainly with antibiotics for bacterial and antiviral agents.

Oral or intravenous steroids may also be administered in combination with antimicrobials.

Preventive measures against SARS

As SARS is still being researched and therefore there is no vaccine or specific treatment, prevention still remains the only effective weapon to prevent the spread of the disease.

First and foremost, it is important to take some simple hygiene measures:

  • wash your hands often
  • cover your nose and mouth when coughing or sneezing;
  • avoid sharing towels, glasses and cutlery.

Like all infectious diseases, SARS is more easily transmitted in crowded and poorly ventilated places, where the concentration of pathogens can be noticeably high. Wearing a face mask can be a good way to protect yourself and others from the spread of SARS and other respiratory diseases.

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Editor's note: Find the latest long COVID news and guidance in Medscape's Long COVID Resource Center.

Long COVID: The name says it all. It's an illness that, for many people, has not yet stopped.

Eric Roach became ill with COVID-19 in November 2020, and he's still sick. "I have brain fog, memory loss," says the 67-year-old Navy veteran from Spearfish, SD. "The fatigue has just been insane."

Long COVID, more formally known as post-acute sequelae of COVID (PASC), is the lay term to describe when people start to recover, or seem to recover, from a bout of COVID-19 but then continue to suffer from symptoms. For some, it's gone on for 2 years or longer. While the governments of the U.S. and several other countries formally recognize the existence of long COVID, the National Institutes of Health (NIH) has yet to formally define it. There's no approved treatment, and the causes are not understood.

Here's what is known: Long COVID is a post-viral condition affecting a large percentage of people who become infected with the coronavirus. It can be utterly debilitating or mildly annoying, and it is affecting enough people to cause concern for employers, health insurers, and governments.

First, the Many Symptoms

According to the CDC, long COVID symptoms may include:

  • Tiredness or fatigue that interferes with daily life

  • Symptoms that get worse after physical or mental effort (also known as "post-exertional malaise")

  • Fever

  • Difficulty breathing or shortness of breath

  • Cough

  • Chest pain

  • Fast-beating or pounding heart (heart palpitations)

  • Difficulty thinking or concentrating (sometimes referred to as "brain fog")

  • Headache

  • Sleep problems

  • Dizziness when standing

  • Pins-and-needles feelings

  • Change in smell or taste

  • Depression or anxiety

  • Diarrhea

  • Stomach pain

  • Joint or muscle pain

  • Rash

  • Changes in menstrual cycles

"People with post-COVID conditions may develop or continue to have symptoms that are hard to explain and manage," the CDC says on its website. "Clinical evaluations and results of routine blood tests, chest x-rays, and electrocardiograms may be normal. The symptoms are similar to those reported by people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other poorly understood chronic illnesses that may occur after other infections."

Doctors may not fully appreciate the subtle nature of some of the symptoms.

"People with these unexplained symptoms may be misunderstood by their health care providers, which can result in a long time for them to get a diagnosis and receive appropriate care or treatment," the CDC says.

Health professionals should recognize that long COVID can be disabling,the U.S. Department of Health and Human Services says. "Long COVID can substantially limit a major life activity," HHS says in civil rights guidance. One possible example: "A person with long COVID who has lung damage that causes shortness of breath, fatigue, and related effects is substantially limited in respiratory function, among other major life activities," HHS says.

How Many People Are Affected?

This has been difficult to judge because not everyone who has had COVID-19 gets tested for it and there are no formal diagnostic criteria yet for long COVID. The CDC estimates that 19% of patients in the U.S. who have ever had COVID-19 have long COVID symptoms.


Some estimates go higher. A University of Oxford study in September 2021 found more than a third of patients had symptoms of long COVID between 3 months and 6 months after a COVID-19 diagnosis. As many as 55% of COVID-19 patients in one Chinese study had one or more lingering symptoms 2 years later, Lixue Huang, MD, of the China-Japan Friendship Hospital in Beijing, and colleagues reported in the journal Lancet Respiratory Medicine in May.

According to the CDC, age is a factor. "Older adults are less likely to have long COVID than younger adults. Nearly three times as many adults ages 50-59 currently have long COVID than those age 80 and older," the CDC says. Women and racial and ethnic minorities are more likely to be affected.

Many people are experiencing neurological effects, such as the so-called brain fog, according to Ziyad Al-Aly, MD, of the Washington University School of Medicine and the VA St. Louis Health Care System, writing in the journal Nature Medicine in September. They estimated that 6.6 million Americans have brain impairments associated with COVID infection.

"Some of the neurologic disorders reported here are serious chronic conditions that will impact some people for a lifetime," they wrote. "Given the colossal scale of the pandemic, and even though the absolute numbers reported in this work are small, these may translate into a large number of affected individuals around the world — and this will likely contribute to a rise in the burden of neurologic diseases."

Causes

It's not clear what the underlying causes are, but most research points to a combination of factors.Suspects include ongoing inflammation, tiny blood clots, and reactivation of what are known as latent viruses, or those that linger quietly in your body without causing damage. In May, Brent Palmer, PhD, of the University of Colorado School of Medicine, and colleagues found people with long COVID had persistent activation of immune cells known as T-cells that were specific for SARS-CoV-2, the virus that causes COVID-19.

COVID-19 itself can damage organs, and long COVID might be caused by ongoing damage. In August, Alexandros Rovas, MD, of University Hospital Munster in Germany, and colleagues found patients with long COVID had evidence of damage to their capillaries. "Whether, to what extent, and when the observed damage might be reversible remains unclear," they wrote in the journal Angiogenesis.

People with long COVID have immune responses to other viruses, such as Epstein-Barr -- evidence that COVID-19 might reactivate latent viruses. "Our data suggest the involvement of persistent antigen, reactivation of latent herpesviruses, and chronic inflammation," immunobiologist Akiko Iwasaki, PhD, of the Yale University School of Medicine, and colleagues wrote in a study posted in August that had not yet been peer-reviewed for publication.

This might be causing an autoimmune response. "The infection may cause the immune system to start making autoantibodies that attack a person's own organs and tissues," the NIH says.

There could be other factors. A study by Harvard researchers found that people who felt stressed, depressed, or lonely before catching COVID-19 were more likely to develop long COVID afterward. "Distress was more strongly associated with developing long COVID than physical health risk factors such as obesity, asthma, and hypertension," Siwen Wang, MD, a research fellow with Harvard University'sT.H. Chan School of Public Health, said in a statement. Plus, nearly 44% of those in the study developed COVID-19 infections after having been assessed for stress, Wang and colleagues reported in the journal JAMA Psychiatry.

Vaccine Protection

There's evidence that vaccination protects against long COVID, both by preventing infection in the first place, but also even for people who have breakthrough infections.

A meta-analysis covering studies involving 17 million people found evidence vaccination might reduce the severity of COVID-19 or might help the body clear any lingering virus after an infection.

"Overall, vaccination was associated with reduced risks or odds of long COVID, with preliminary evidence suggesting that two doses are more effective than one dose," Cesar Fernandez de las Penas, PhD, of King Juan Carlos University in Madrid, Spain, and colleagues wrote.

A team in Milan, Italy, found unvaccinated people in their study were nearly three times as likely to have serious symptoms for longer than 4 weeks compared to vaccinated volunteers. Writing in July in The Journal of the American Medical Association, Elena Azzolini, MD, PhD, an assistant professor atthe Humanitas Research Hospital, said the team found two or three doses of vaccine reduced the risk of hospitalization from COVID to 16% or 17% compared to 42% for the unvaccinated.

Treatments

With no diagnostic criteria and no understanding of the causes, it's hard for doctors to determine treatments.

Most experts dealing with long COVID, even those at the specialty centers that have been set up at hospitals and health systems in the U.S.,recommend that patients start with their primary care doctor before moving on to specialists.

"The mainstay of management is supportive, holistic care, symptom control, and detection of treatable complications," Trish Greenhalgh, MD, professor of primary care health sciences at the University of Oxford, and colleagues wrote in the journal The BMJ in September. "Patients with long COVID greatly value input from their primary care clinician. Generalist clinicians can help patients considerably by hearing the patient's story and validating their experience … (and) making the diagnosis of long COVID (which does not have to be by exclusion) and excluding alternative diagnoses."

Evidence is building that long COVID closely resembles other post-viral conditions -- something that can provide clues for treatment. For example, several studies indicate that exercise doesn't help most patients.

But there are approaches that can work. Treatments may include pulmonary rehabilitation; autonomic conditioning therapy, which includes breathing therapy; and cognitive rehabilitation to relieve brain fog. Doctors are also trying the antidepressant amitriptyline to help with sleep disturbances and headaches; the antiseizure medication gabapentin to help pain, numbness, and other neurological symptoms; and drugs to relieve low blood pressure in patients experiencing postural orthostatic tachycardia syndrome (POTS).

The NIH is sponsoring studies that have recruited just over 8,200 adults. And more than two dozen researchers from Harvard; Stanford; the University of California, San Francisco; the J. Craig Venter Institute; Johns Hopkins University; the University of Pennsylvania; Mount Sinai Hospitals; Cardiff University; and Yale announced in September they were forming the Long COVID Research Initiative to speed up studies.

The group, with funding from private enterprise, plans to conduct tissue biopsy, imaging studies, and autopsies and will search for potential biomarkers in the blood of patients.

Sources

CDC: "Long COVID or Post-COVID Conditions."

CDC National Center for Health Statistics: "Nearly One in Five American Adults Who Have Had COVID-19 Still Have 'Long COVID.'"

National Institutes of Health: "Long COVID," "Long COVID symptoms linked to inflammation."

PLoS Medicine: "Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19."

The Lancet Respiratory Medicine: "Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study."

Angiogenesis: "Persistent capillary rarefication in long COVID syndrome."

PLoS Pathogens: "SARS-CoV-2-specific T cells associate with inflammation and reduced lung function in pulmonary post-acute sequalae of SARS-CoV-2."

Lancet eClinical Medicine: "Impact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: A systematic review."

JAMA Psychiatry: "Associations of Depression, Anxiety, Worry, Perceived Stress, and Loneliness Prior to Infection With Risk of Post–COVID-19 Conditions."

U.S. Department of Health and Human Services: "Guidance on 'Long COVID' as a Disability Under the ADA, Section 504, and Section 1557."

Long COVID Research Initiative:"Introducing LCRI."

Nature Medicine: "Long-term Neurologic Outcomes of COVID-19."

The BMJ: "Long covid—an update for primary care."



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Some health care providers in Arkansas are starting to offer services tailored to patients struggling to recover weeks or months after being diagnosed with covid-19.

An estimated one in five covid-19 survivors between 18 and 64 years old and one in four survivors 65 and older have a health condition related to their illness, according to a study released this year by the federal Centers for Disease Control and Prevention, which included 63.4 million individuals.

Another 2022 study published in the Journal of Infectious Diseases estimated millions of Americans -- about 1.7% to 3.8% of the U.S. population -- experienced new, long-term symptoms that limited daily activities one month or longer after covid-19 infection.

"Because the coronavirus can attack the lungs, heart, brain and other organs, there can be lasting internal damage," said Sheena CarlLee, director of the University of Arkansas for Medical Sciences' Long Covid Clinic, which opened Aug. 25 in Fayetteville.

Damage to vital organs can exacerbate long-term health problems such as heart disease, diabetes, kidney disease, blood disorders, neurological conditions and mental health disorders.

The new UAMS clinic brings together specialists in order to treat patients across the breadth of symptoms.

"We are seeing patients with a wide variety of symptoms that require a unique treatment regimen," CarlLee said. "Our long covid clinic offers extensive evaluation from a team of students and trained health care providers from the disciplines of medicine, pharmacy, nursing, physical therapy, occupational therapy and radiation sciences."

Some of the most successful long covid clinics in the country are team-based clinics, which can dive into a variety of symptoms and devise a detailed plan, according to CarlLee.

The clinic team also works closely with researchers at the UAMS campus in Little Rock, and patients may opt in to participate in that research, she said.

UAMS bills through insurance, and the cost for patients at the long covid clinic will be the same as a primary care clinic visit, according to CarlLee.

LONG COVID

CarlLee, a UAMS internal medicine doctor, and other doctors at various UAMS campuses have seen former covid-19 patients with prolonged symptoms related to the infection, she said.

Sometimes long covid symptoms develop for people who had little or no symptoms upon their initial positive test, but long covid tends to affect those who had a more complicated initial infection, she said.

Based on recent research, people who stayed in the ICU, were put on a ventilator, are unvaccinated or have underlying medical conditions all seem more likely to develop long covid, according to CarlLee. Women also may be disproportionately affected, she said.

Long covid is still being defined by the scientific community, according to health officials, but it generally signifies new or lingering symptoms of the virus occurring at least three or four weeks after a positive covid-19 test.

Because the term has yet to be precisely defined, data varies on the condition's prevalence, said Jennifer Dillaha, director of the Arkansas Department of Health.

The symptoms and conditions associated with long covid, which will likely affect many people in the coming years, are consistent throughout the scientific literature, Rachel Levine, U.S. assistant secretary for health, wrote last month in the Journal of the American Medical Association.

Symptoms such as shortness of breath, muscle aches, cough, fatigue, loss of taste or smell and problems with memory and concentration are among the more common symptoms. Heart palpitations, dizziness, diarrhea, stomach pain, rashes and joint or muscle pain have also been experienced post-covid, according to the federal Centers for Disease Control and Prevention.

Long covid isn't a singular case of long-term symptoms developing from viral infections, according to Dr. Marti Sharkey, Fayetteville's city health officer. Epstein-Barr virus is the cause of infectious mononucleosis, more commonly known as mono, she noted.

"It's not unusual to see prolonged systems. It's not surprising with a virus that has infected so many people," she said.

PATIENTS YOUNG AND OLD

In Central Arkansas, the Strong Hearts Rehabilitation Center by Arkansas Heart Hospital offers a rehab program for long covid patients at facilities in Little Rock, Russellville, Conway and Bryant.

The center enrolled its first post-covid patients in January shortly after the U.S. Centers for Medicare and Medicaid Services issued guidance allowing programs to treat lingering symptoms of the disease, said Amanda Xaysuda, director of the center.

"We had all of that planned before then but once Medicare was paying for that and more research was coming out that it was beneficial in this patient population, that's when we decided to go for it," she said.

Strong Hearts Rehabilitation Center's program focuses on pulmonary rehabilitation. Health care providers with the center help patients build their exercise tolerance and work on breathing exercises.

"Everything else we do is focused around the patient and what symptoms they are coming in with," said Xaysuda.

The program has helped post-covid patients dealing with postural orthostatic tachycardia syndrome, an abnormal spike in heart rate that occurs after sitting up or standing.

While the program's oldest patients have been in their 90s, the youngest was 16. Many patients are in their 30s and 40s, a demographic the Strong Hearts Rehabilitation Center isn't used to seeing.

"What we've always done is traditional cardiac rehab. Typically, our patients are Medicare age. They're 65 and older," said Xaysuda. "This is a whole new population of people."

Although Medicare and some private insurance companies cover pulmonary rehab for post-covid diagnoses, Xaysuda said Arkansas Blue Cross Blue Shield does not.

Other large Arkansas health care providers do not offer specialized clinics like the ones provided by UAMS and Arkansas Heart Hospital.

In a statement Thursday, spokesman Joshua Cook said CHI St. Vincent does not have a clinic dedicated to long covid treatment.

At Baptist Health, the prevalence of long covid is not high enough to warrant a specialty clinic, said Dr. Amanda Novack, medical director of infectious diseases in a statement Friday. Primary care physicians with Baptist Health nevertheless work with long covid patients to create personal care plans.

"These treatments might include specialized treatments such as physical therapy, nutritional support, cardiac or pulmonary rehabilitation," said Novack in the statement.

COMMUNITY RESPONSE

Sharkey, the Fayetteville city health officer, said preventing transmission should still be a goal of the community.

"Every time we get infected with this virus, there's another risk for long covid. Just because you haven't had long covid doesn't mean you won't," she said. "We have people who got covid on the first wave in winter of 2020 that are still suffering.

"We're definitely a lot better than where we were a year ago, but we're not at the end yet," she said.

Sharkey recommends people experiencing long-term covid symptoms visit a clinic with a team-based multidisciplinary approach, like the UAMS clinic.

"You need a team approach to assess multiple organ systems and have a very tailored approach to the symptoms of the person," she said.

Getting vaccinated will help fight transmission of the virus, Dillaha said.

"I'd encourage people to get primary vaccination doses, followed by at least one booster dose. Take reasonable steps to avoid getting infected. Especially if you're at high risk for severe illness," Dillaha said.

Dillaha worries people, especially parents, are not informed about long covid and do not consider the risks of infection when deciding whether to get themselves or their children vaccinated.

Even with mild symptoms, people should still get tested for covid-19, because they may be eligible for treatment with Pfizer's anti-viral drug Paxlovid and be able to minimize the risks of infection, according to Dillaha.

Arkansas' death toll from covid-19 topped 12,000 Tuesday. Nationally, more than 1 million people have died as a result of covid-19 infection, according to the centers.

Appointments

Residents can schedule an appointment at the UAMS clinic at 1125 N. College Avenue in Fayetteville by calling (479) 713-8701.

Source: University of Arkansas for Medical Sciences

 

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Some health care providers in Arkansas are starting to offer services tailored to patients struggling to recover weeks or months after being diagnosed with covid-19.

An estimated one in five covid-19 survivors between 18 and 64 years old and one in four survivors 65 and older have a health condition related to their illness, according to a study released this year by the federal Centers for Disease Control and Prevention, which included 63.4 million individuals.

Another 2022 study published in the Journal of Infectious Diseases estimated millions of Americans -- about 1.7% to 3.8% of the U.S. population -- experienced new, long-term symptoms that limited daily activities one month or longer after covid-19 infection.

"Because the coronavirus can attack the lungs, heart, brain and other organs, there can be lasting internal damage," said Sheena CarlLee, director of the University of Arkansas for Medical Sciences' Long Covid Clinic, which opened Aug. 25 in Fayetteville.

Damage to vital organs can exacerbate long-term health problems such as heart disease, diabetes, kidney disease, blood disorders, neurological conditions and mental health disorders.

The new UAMS clinic brings together specialists in order to treat patients across the breadth of symptoms.

"We are seeing patients with a wide variety of symptoms that require a unique treatment regimen," CarlLee said. "Our long covid clinic offers extensive evaluation from a team of students and trained health care providers from the disciplines of medicine, pharmacy, nursing, physical therapy, occupational therapy and radiation sciences."

Some of the most successful long covid clinics in the country are team-based clinics, which can dive into a variety of symptoms and devise a detailed plan, according to CarlLee.

The clinic team also works closely with researchers at the UAMS campus in Little Rock, and patients may opt in to participate in that research, she said.

UAMS bills through insurance, and the cost for patients at the long covid clinic will be the same as a primary care clinic visit, according to CarlLee.

LONG COVID

CarlLee, a UAMS internal medicine doctor, and other doctors at various UAMS campuses have seen former covid-19 patients with prolonged symptoms related to the infection, she said.

Sometimes long covid symptoms develop for people who had little or no symptoms upon their initial positive test, but long covid tends to affect those who had a more complicated initial infection, she said.

Based on recent research, people who stayed in the ICU, were put on a ventilator, are unvaccinated or have underlying medical conditions all seem more likely to develop long covid, according to CarlLee. Women also may be disproportionately affected, she said.

Long covid is still being defined by the scientific community, according to health officials, but it generally signifies new or lingering symptoms of the virus occurring at least three or four weeks after a positive covid-19 test.

Because the term has yet to be precisely defined, data varies on the condition's prevalence, said Jennifer Dillaha, director of the Arkansas Department of Health.

The symptoms and conditions associated with long covid, which will likely affect many people in the coming years, are consistent throughout the scientific literature, Rachel Levine, U.S. assistant secretary for health, wrote last month in the Journal of the American Medical Association.

Symptoms such as shortness of breath, muscle aches, cough, fatigue, loss of taste or smell and problems with memory and concentration are among the more common symptoms. Heart palpitations, dizziness, diarrhea, stomach pain, rashes and joint or muscle pain have also been experienced post-covid, according to the federal Centers for Disease Control and Prevention.

Long covid isn't a singular case of long-term symptoms developing from viral infections, according to Dr. Marti Sharkey, Fayetteville's city health officer. Epstein-Barr virus is the cause of infectious mononucleosis, more commonly known as mono, she noted.

"It's not unusual to see prolonged systems. It's not surprising with a virus that has infected so many people," she said.

PATIENTS YOUNG AND OLD

In Central Arkansas, the Strong Hearts Rehabilitation Center by Arkansas Heart Hospital offers a rehab program for long covid patients at facilities in Little Rock, Russellville, Conway and Bryant.

The center enrolled its first post-covid patients in January shortly after the U.S. Centers for Medicare and Medicaid Services issued guidance allowing programs to treat lingering symptoms of the disease, said Amanda Xaysuda, director of the center.

"We had all of that planned before then but once Medicare was paying for that and more research was coming out that it was beneficial in this patient population, that's when we decided to go for it," she said.

Strong Hearts Rehabilitation Center's program focuses on pulmonary rehabilitation. Health care providers with the center help patients build their exercise tolerance and work on breathing exercises.

"Everything else we do is focused around the patient and what symptoms they are coming in with," said Xaysuda.

The program has helped post-covid patients dealing with postural orthostatic tachycardia syndrome, an abnormal spike in heart rate that occurs after sitting up or standing.

While the program's oldest patients have been in their 90s, the youngest was 16. Many patients are in their 30s and 40s, a demographic the Strong Hearts Rehabilitation Center isn't used to seeing.

"What we've always done is traditional cardiac rehab. Typically, our patients are Medicare age. They're 65 and older," said Xaysuda. "This is a whole new population of people."

Although Medicare and some private insurance companies cover pulmonary rehab for post-covid diagnoses, Xaysuda said Arkansas Blue Cross Blue Shield does not.

Other large Arkansas health care providers do not offer specialized clinics like the ones provided by UAMS and Arkansas Heart Hospital.

In a statement Thursday, spokesman Joshua Cook said CHI St. Vincent does not have a clinic dedicated to long covid treatment.

At Baptist Health, the prevalence of long covid is not high enough to warrant a specialty clinic, said Dr. Amanda Novack, medical director of infectious diseases in a statement Friday. Primary care physicians with Baptist Health nevertheless work with long covid patients to create personal care plans.

"These treatments might include specialized treatments such as physical therapy, nutritional support, cardiac or pulmonary rehabilitation," said Novack in the statement.

COMMUNITY RESPONSE

Sharkey, the Fayetteville city health officer, said preventing transmission should still be a goal of the community.

"Every time we get infected with this virus, there's another risk for long covid. Just because you haven't had long covid doesn't mean you won't," she said. "We have people who got covid on the first wave in winter of 2020 that are still suffering.

"We're definitely a lot better than where we were a year ago, but we're not at the end yet," she said.

Sharkey recommends people experiencing long-term covid symptoms visit a clinic with a team-based multidisciplinary approach, like the UAMS clinic.

"You need a team approach to assess multiple organ systems and have a very tailored approach to the symptoms of the person," she said.

Getting vaccinated will help fight transmission of the virus, Dillaha said.

"I'd encourage people to get primary vaccination doses, followed by at least one booster dose. Take reasonable steps to avoid getting infected. Especially if you're at high risk for severe illness," Dillaha said.

Dillaha worries people, especially parents, are not informed about long covid and do not consider the risks of infection when deciding whether to get themselves or their children vaccinated.

Even with mild symptoms, people should still get tested for covid-19, because they may be eligible for treatment with Pfizer's anti-viral drug Paxlovid and be able to minimize the risks of infection, according to Dillaha.

Arkansas' death toll from covid-19 topped 12,000 Tuesday. Nationally, more than 1 million people have died as a result of covid-19 infection, according to the centers.

 

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The lungs are two of the most important organs that are affected by the coronavirus, which leads to Covid infection in the respiratory system. It has been noticed that while most patients recover completely after the infection, at least 5 per cent to 10 per cent experience prolonged symptoms that last for several months or even years. This is known as ‘long Covid‘.

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Dr Vishal Sehgal, the president of Portea Medical says “pulmonary rehabilitation” can improve a person’s lung function, their exercise performance, quality of life, and even counter any anxiety associated with the condition.

“Pulmonary rehabilitation is symptom-based; it requires a multi-pronged approach to deal with the various related complications. It is a holistic plan that comprises preliminary patient assessment followed by medicinal treatment, lifestyle modifications, physical exercise, nutritional support, self-awareness and psychological counselling,” he says.

According to the expert, some major aspects of a rehabilitation programme are as follows:

1. Physical activity

Physical activity can significantly improve the quality of daily living. From low-impact training for the chest and back muscles, to more intense forms of exercise, there is a range of activities that can help. Under the guidance of a trained specialist, these are done depending on individual progress and capacity, says Dr Sehgal.

2. Breathing techniques

Breathing techniques can help alleviate the pressure on the lungs. There are different types of breathing techniques including those that are part of yoga that can help in case the patient experiences symptoms of breathlessness, he adds. “For instance, pranayama — the ancient practice of breath control — helps in improving multiple aspects of physical health, including lung function.”

3. Diet and lifestyle

A balanced diet helps in boosting immunity and overall wellness. It can also help in alleviating certain symptoms of long Covid, the doctor states. “Those who are put under a pulmonary rehab programme are given a diet rich in complex carbohydrates and fibres, as well as other micronutrients. In case a patient lacks access to a proper rehabilitation facility at hospitals, it is possible to do this process at home.”

“People who survive Covid-19 can experience long-term consequences: respiratory, neuropsychiatric, cardiovascular, hematologic, gastrointestinal, renal, and endocrine. There is a rapid increase in the burden of long Covid which calls for strategies that can help improve outcomes over time,” says Dr Sehgal, adding that on World Lung Day, it is important to understand and discuss these strategies as well as take precautions and prevent the spread of the virus further.

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Definitions:

Healthcare Personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, dental healthcare personnel, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).

Healthcare settings refers to places where healthcare is delivered and includes, but is not limited to, acute care facilities, long-term acute-care facilities, nursing homes, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, dental offices, and others.

Source control: Use of respirators, well-fitting facemasks, or well-fitting cloth masks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing. Source control devices should not be placed on children under age 2, anyone who cannot wear one safely, such as someone who has a disability or an underlying medical condition that precludes wearing one safely, or anyone who is unconscious, incapacitated, or otherwise unable to remove their source control device without assistance. Face shields alone are not recommended for source control. At a minimum, source control devices should be changed if they become visibly soiled, damaged, or hard to breathe through.  Further information about source control options is available at:  Masks and Respirators (cdc.gov)

Cloth mask: Textile (cloth) covers that are intended primarily for source control in the community. They are not personal protective equipment (PPE) appropriate for use by healthcare personnel. Guidance on design, use, and maintenance of cloth masks is available.

Facemask: OSHA defines facemasks as “a surgical, medical procedure, dental, or isolation mask that is FDA-cleared, authorized by an FDA EUA, or offered or distributed as described in an FDA enforcement policy. Facemasks may also be referred to as ‘medical procedure masks’.”  Facemasks should be used according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures. Other facemasks, such as some procedure masks, which are typically used for isolation purposes, may not provide protection against splashes and sprays.

Respirator: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by CDC/NIOSH, including those intended for use in healthcare.

Airborne Infection Isolation Rooms (AIIRs):

  • AIIRs are single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 12 ACH (6 ACH are allowed for AIIRs last renovated or constructed prior to 1997).
  • Air from these rooms should be exhausted directly to the outside or be filtered through a HEPA filter directly before recirculation.
  • Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
  • Facilities should monitor and document the proper negative-pressure function of these rooms.

Immunocompromised:  For the purposes of this guidance, moderate to severely immunocompromising conditions include, but might not be limited to, those defined in the Interim Clinical Considerations for Use of COVID-19 Vaccines

  • Other factors, such as end-stage renal disease, may pose a lower degree of immunocompromise. However, people in this category should still consider continuing to use of source control while in a healthcare facility.
  • Ultimately, the degree of immunocompromise for the patient is determined by the treating provider, and preventive actions are tailored to each individual and situation.

Close contact: Being within 6 feet for a cumulative total of 15 minutes or more over a 24-hour period with someone with SARS-CoV-2 infection.

SARS-CoV-2 Illness Severity Criteria (adapted from the NIH COVID-19 Treatment Guidelines)

The studies used to inform this guidance did not clearly define “severe” or “critical” illness. This guidance has taken a conservative approach to define these categories. Although not developed to inform decisions about duration of Transmission-Based Precautions, the definitions in the National Institutes of Health (NIH) COVID-19 Treatment Guidelines are one option for defining severity of illness categories. The highest level of illness severity experienced by the patient at any point in their clinical course should be used when determining the duration of Transmission-Based Precautions. Clinical judgement regarding the contribution of SARS-CoV-2 to clinical severity might also be necessary when applying these criteria to inform infection control decisions.

Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.

Moderate Illness: Individuals who have evidence of lower respiratory disease by clinical assessment or imaging, and a saturation of oxygen (SpO2) ≥94% on room air at sea level.

Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.

Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.

In pediatric patients, radiographic abnormalities are common and, for the most part, should not be used as the sole criteria to define COVID-19 illness category. Normal values for respiratory rate also vary with age in children, thus hypoxia should be the primary criterion to define severe illness, especially in younger children.

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Background

This interim guidance is intended to assist with the following:

  1. Determining the duration of restriction from the workplace for HCP with SARS-CoV-2 infection.
  2. Assessment of risk and application of workplace restrictions for asymptomatic HCP with exposure to SARS-CoV-2.

Guidance addressing recommended infection prevention and control practices including use of source control by HCP is available in Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Employers should be aware that other local, territorial, tribal, state, and federal requirements may apply, including those promulgated by the Occupational Safety and Health Administration (OSHA).

Evaluating Healthcare Personnel with Symptoms of SARS-CoV-2 Infection

HCP with even mild symptoms of COVID-19 should be prioritized for viral testing with nucleic acid or antigen detection assays.

When testing a person with symptoms of COVID-19, negative results from at least one viral test  indicate that the person most likely does not have an active SARS-CoV-2 infection at the time the sample was collected.

  • If using NAAT (molecular), a single negative test is sufficient in most circumstances. If a higher level of clinical suspicion for SARS-CoV-2 infection exists, consider maintaining work restrictions and confirming with a second negative NAAT.
  • If using an antigen test, a negative result should be confirmed by either a negative NAAT (molecular) or second negative antigen test taken 48 hours after the first negative test.

For HCP who were initially suspected of having COVID-19 but, following evaluation, another diagnosis is suspected or confirmed, return-to-work decisions should be based on their other suspected or confirmed diagnoses.

Return to Work Criteria for HCP with SARS-CoV-2 Infection

The following are criteria to determine when HCP with SARS-CoV-2 infection could return to work and are influenced by severity of symptoms and presence of immunocompromising conditions. After returning to work, HCP should self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen.  If symptoms recur (e.g., rebound) these HCP should be restricted from work and follow recommended practices to prevent transmission to others (e.g., use of well-fitting source control) until they again meet the healthcare criteria below to return to work unless an alternative diagnosis is identified.

HCP with mild to moderate illness who are not  moderately to severely immunocompromised could return to work after the following criteria have been met:

  • At least 7 days have passed since symptoms first appeared if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7)and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications, and
  • Symptoms (e.g., cough, shortness of breath) have improved.

*Either a NAAT (molecular) or antigen test may be used.  If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised could return to work after the following criteria have been met:

  • At least 7 days have passed since the date of their first positive viral test if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7).

*Either a NAAT (molecular) or antigen test may be used.  If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

HCP with severe to critical illness who are not moderately to severely immunocompromised could return to work after the following criteria have been met:

  • At least 10 days and up to 20 days have passed since symptoms first appeared, and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications, and
  • Symptoms (e.g., cough, shortness of breath) have improved.
  • The test-based strategy as described below for moderately to severely immunocompromised HCP can be used to inform the duration of work restriction.

The exact criteria that determine which HCP will shed replication-competent virus for longer periods are not known. Disease severity factors and the presence of immunocompromising conditions should be considered when determining the appropriate duration for specific HCP. For a summary of the literature,  refer to Ending Isolation and Precautions for People with COVID-19: Interim Guidance (cdc.gov)

HCP who are moderately to severely immunocompromised may produce replication-competent virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test.

  • Use of a test-based strategy (as described below) and consultation with an infectious disease specialist or other expert and an occupational health specialist is recommended to determine when these HCP may return to work.

Test-based strategy

HCP who are symptomatic could return to work after the following criteria are met:

  • Resolution of fever without the use of fever-reducing medications, and
  • Improvement in symptoms (e.g., cough, shortness of breath), and
  • Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

HCP who are not symptomatic could return to work after the following criteria are met:

  • Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

Return to Work Criteria for HCP Who Were Exposed to Individuals with Confirmed SARS-CoV-2 Infection

Exposures that might require testing and/or restriction from work can occur both while at work and in the community.  Higher-risk exposures generally involve exposure of HCP’s eyes, nose, or mouth to material potentially containing SARS-CoV-2, particularly if these HCP were present in the room for an aerosol-generating procedure.

Other exposures not classified as higher-risk, including having body contact with the patient (e.g., rolling the patient) without gown or gloves, may impart some risk for transmission, particularly if hand hygiene is not performed and HCP then touch their eyes, nose, or mouth. When classifying potential exposures, specific factors associated with these exposures (e.g., quality of ventilation, use of PPE and source control) should be evaluated on a case-by-case basis.  These factors might raise or lower the level of risk; interventions, including restriction from work, can be adjusted based on the estimated risk for transmission.

For the purposes of this guidance, higher-risk exposures are classified as HCP who had prolonged1 close contact2 with a patient, visitor, or HCP with confirmed SARS-CoV-2 infection3 and:

  • HCP was not wearing a respirator (or if wearing a facemask, the person with SARS-CoV-2 infection was not wearing a cloth mask or facemask)4
  • HCP was not wearing eye protection if the person with SARS-CoV-2 infection was not wearing a cloth mask or facemask
  • HCP was not wearing all recommended PPE (i.e., gown, gloves, eye protection, respirator) while present in the room for an aerosol-generating procedure

Following a higher-risk exposure, HCP should:

  • Have a series of three viral tests for SARS-CoV-2 infection.
    • Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test.  This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.
    • Due to challenges in interpreting the result, testing is generally not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days.  Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of NAAT is recommended.  This is because some people may remain NAAT positive but not be infectious during this period.

Work restriction is not necessary for most asymptomatic HCP following a higher-risk exposure, regardless of vaccination status.  Examples of when work restriction may be considered include:

  • HCP is unable to be tested or wear source control as recommended for the 10 days following their exposure;
  • HCP is moderately to severely immunocompromised;
  • HCP cares for or works on a unit with patients who are moderately to severely immunocompromised;
  • HCP works on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions;

If work restriction is recommended, HCP could return to work after either of the following time periods:

  • HCP can return to work after day 7 following the exposure (day 0) if they do not develop symptoms and all viral testing as described for asymptomatic HCP following a higher-risk exposure is negative.
  • If viral testing is not performed, HCP can return to work after day 10 following the exposure (day 0) if they do not develop symptoms.

In addition to above:

HCP with travel or community exposures should consult their occupational health program for guidance on need for work restrictions. In general, HCP who have had prolonged close contact with someone with SARS-CoV-2 in the community (e.g., household contacts) should be managed as described for higher-risk occupational exposures above.

Footnotes:

  1. For this guidance an exposure of 15 minutes or more is considered prolonged. This could refer to a single 15-minute exposure to one infected individual or several briefer exposures to one or more infected individuals adding up to at least 15 minutes during a 24-hour period. However, the presence of extenuating factors (e.g., exposure in a confined space, performance of aerosol-generating procedure) could warrant more aggressive actions even if the cumulative duration is less than 15 minutes. For example, any duration should be considered prolonged if the exposure occurred during performance of an aerosol generating procedure.
  2. For this guidance it is defined as: a) being within 6 feet of a person with confirmed SARS-CoV-2 infection or b) having unprotected direct contact with infectious secretions or excretions of the person with confirmed SARS-CoV-2 infection. Distances of more than 6 feet might also be of concern, particularly when exposures occur over long periods of time in indoor areas with poor ventilation.
  3. Determining the time period when the patient, visitor, or HCP with confirmed SARS-CoV-2 infection could have been infectious:
    1. For individuals with confirmed COVID-19 who developed symptoms, consider the exposure window to be 2 days before symptom onset through the time period when the individual meets criteria for discontinuation of Transmission-Based Precautions
    2. For individuals with confirmed SARS-CoV-2 infection who never developed symptoms, determining the infectious period can be challenging. In these situations, collecting information about when the asymptomatic individual with SARS-CoV-2 infection may have been exposed could help inform the period when they were infectious.
      1. If the date of exposure cannot be determined, although the infectious period could be longer, it is reasonable to use a starting point of 2 days prior to the positive test through the time period when the individual meets criteria for discontinuation of Transmission-Based Precautions for contact tracing.
  4. While respirators confer a higher level of protection than facemasks and are recommended when caring for patients with SARS-CoV-2 infection, facemasks still confer some level of protection to HCP, which was factored into this risk assessment if the patient was also wearing a cloth mask or facemask

Definitions:

Healthcare Personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, home healthcare personnel, physicians, technicians, therapists, phlebotomists, pharmacists, dental healthcare personnel, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). For this guidance, HCP does not include clinical laboratory personnel.

Immunocompromised:  For the purposes of this guidance, moderate to severely immunocompromising conditions include, but might not be limited to, those defined in the Interim Clinical Considerations for Use of COVID-19 Vaccines.

SARS-CoV-2 Illness Severity Criteria (adapted from the NIH COVID-19 Treatment Guidelines)

The studies used to inform this guidance did not clearly define “severe” or “critical” illness. This guidance has taken a conservative approach to define these categories. Although not developed to inform decisions about duration of Transmission-Based Precautions, the definitions in the National Institutes of Health (NIH) COVID-19 Treatment Guidelines are one option for defining severity of illness categories. The highest level of illness severity experienced by the patient at any point in their clinical course should be used when determining the duration of Transmission-Based Precautions.

Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.

Moderate Illness: Individuals who have evidence of lower respiratory disease, by clinical assessment or imaging, and a saturation of oxygen (SpO2) ≥94% on room air at sea level.

Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.

Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.

In pediatric patients, radiographic abnormalities are common and, for the most part, should not be used as the sole criteria to define COVID-19 illness category. Normal values for respiratory rate also vary with age in children; thus, hypoxia should be the primary criterion to define severe illness, especially in younger children.

Fever: For the purpose of this guidance, fever is defined as subjective fever (feeling feverish) or a measured temperature of 100.0oF (37.8oC) or higher. Note that fever may be intermittent or may not be present in some people, such as those who are elderly, immunocompromised, or taking certain fever-reducing medications (e.g., nonsteroidal anti-inflammatory drugs [NSAIDS]).

Facemask: OSHA defines facemasks as “a surgical, medical procedure, dental, or isolation mask that is FDA-cleared, authorized by an FDA EUA, or offered or distributed as described in an FDA enforcement policy. Facemasks may also be referred to as ‘medical procedure masks’.”  Facemasks should be used according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures. Other facemasks, such as some procedure masks, which are typically used for isolation purposes, may not provide protection against splashes and sprays.

Respirator: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by CDC/NIOSH, including those intended for use in healthcare.

Cloth mask: Textile (cloth) covers that are intended primarily for source control in the community. They are not personal protective equipment (PPE) appropriate for use by healthcare personnel. Guidance on design, use, and maintenance of cloth masks is available.

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The pleura is a vital part of the respiratory tract. Its role is to cushion the lung and reduce any friction that may develop between the lung, rib cage, and chest cavity.

Each pleura (there are two) consists of a two-layered membrane that covers each lung. The layers are separated by a small amount of viscous (thick) lubricant known as pleural fluid.

OpenStax College / Wikimedia Creative Commons

There are a number of medical conditions that can affect the pleura, including pleural effusions, a collapsed lung, and cancer. When excess fluid accumulates between the pleural membranes, various procedures may be used to either drain the fluid or eliminate the space between them.

This article outlines what the pleurae are, what they do, and what conditions can affect them and impact respiratory health.

The plural form of pleura is pleurae.

Anatomy of the Pleura

There are two pleurae, one for each lung, and each pleura is a single membrane that folds back on itself to form two layers. The space between the membranes (called the pleural cavity) is filled with a thin, lubricating liquid (called pleural fluid).

The pleura is comprised of two distinct layers:

  • The visceral pleura is the thin, slippery membrane that covers the surface of the lungs and dips into the areas separating the different lobes of the lungs (called the hilum).
  • The parietal pleura is the outer membrane that lines the inner chest wall and diaphragm (the muscle separating the chest and abdominal cavities).

The visceral and parietal pleura join at the hilum, which also serves as the point of entry for the bronchus, blood vessels, and nerves.

The pleural cavity is also known as the intrapleural space. It contains pleural fluid secreted by the mesothelial cells. The fluid allows the layers to glide over each other as the lungs inflate and deflate during respiration (breathing).

What the Pleura Do

The structure of the pleura is essential to respiration, providing the lungs with the lubrication and cushioning needed to inhale and exhale. The intrapleural space contains roughly 4 cubic centimeters (ccs) to 5 ccs of pleural fluid, which reduces friction whenever the lungs expand or contract.

The pleura fluid itself has a slightly sticky quality that helps draw the lungs outward during inhalation rather than slipping round in the chest cavity. It creates surface tension that helps maintain the position of the lungs against the chest wall.

The pleurae also serve as a division between other organs in the body, preventing them from interfering with lung function and vice versa.

Because the pleura is self-contained, it can help prevent the spread of infection to and from the lungs.

Conditions That Affect the Pleura

A number of conditions can cause injury to the pleura or undermine its function. Harm to the membranes or overload of pleural fluid can affect how you breathe and lead to adverse respiratory symptoms.

Pleurisy

Pleurisy is inflammation of the pleural membranes. It is most commonly caused by a viral infection, but may also be the result of a bacterial infection or an autoimmune disease (such as rheumatoid arthritis or lupus).

Pleuritic inflammation causes the membrane surfaces to become rough and sticky. Rather than sliding over each other, they membranes stick together, triggering sharp, stabbing pain with every breath, sneeze, or cough. The pain can get worse when inhaling cold air or taking a deep breath. It can also worsen during movement or shifts in position. Other symptoms of pleurisy include fever, chills, and loss of appetite.

Pleural Effusion

A pleural effusion occurs when excess fluid accumulates in the pleural space. When this happens, breathing can be impaired, sometimes significantly.

Congestive heart failure is the most common cause of a pleural effusion, but there is a multitude of other causes, including lung trauma or lung cancer (in which effusion is experienced in roughly half of all cases).

A pleural effusion can be very small (detectable only by a chest x-ray or CT scan) or be large and contain several pints of fluid. Common symptoms include chest pain, dry cough, shortness of breath, difficulty taking deep breaths, and persistent hiccups.

Malignant Pleural Effusion

A malignant pleural effusion refers to an effusion that contains cancer cells. It's most commonly associated with lung cancer or breast cancer that has metastasized (spread) to the lungs.

Mesothelioma

Pleural mesothelioma is a cancer of the pleura that most often is caused by occupational exposure to asbestos. Symptoms include pain in the shoulder, chest or lower back, shortness of breath, trouble swallowing, and swelling of the face and arms.

Pneumothorax

Pneumothorax, also known as a collapsed lung, can develop when air collects in the pleural cavity. It may be caused by any number of things, including chest trauma, chest surgery, and chronic obstructive pulmonary disease (COPD). In addition to shortness of breath, there may be crepitus, an abnormal crackling sound from just under the skin of the neck and chest.

Spontaneous pneumothorax is a term used to describe when a lung collapses for no apparent reason. Tall, thin adolescent males are at the greatest risk for spontaneous pneumothorax, although females can also be affected. Risk factors include smoking, connective tissue disorders, and activities such as scuba diving and flying in which atmospheric pressure changes rapidly.

Pneumothorax can often heal on its own but may sometimes require thoracentesis to extract any accumulated air from the pleural cavity.

Hemothorax

Hemothorax is a condition in which the pleural cavity fills with blood, typically as a result of traumatic injury or chest surgery. Rarely, a hemothorax can happen spontaneously due to a vascular rupture.

The main symptom of hemothorax is pain or a feeling of heaviness in the chest. Others include a rapid heartbeat, trouble breathing, cold sweats, pale skin, and a fever, all indications that prompt medical attention is needed.

Frequently Asked Questions

  • Does COVID cause pleural thickening?

    Research has demonstrated that coronaviruses, like COVID-19 and Middle Eastern respiratory syndrome coronavirus (MERS-CoV) can cause pleural thickening. In some cases, this has been associated with poorer outcomes.

  • Is pleural effusion life-threatening?

    Pleural effusion, or fluid build-up in the pleural space, is a serious but treatable condition. It can be caused by a number of diseases, including cancer. If left untreated, fluid can continue to build up and impact breathing.

  • Is pleural thickening serious?

    Not necessarily, but it depends on the underlying cause. Because multiple conditions can cause thickening of the pleurae, it's important to be evaluated by a healthcare provider and get proper treatment.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Charalampidis C, Youroukou A, Lazaridis G, et al. Pleura space anatomyJ Thorac Dis. 2015;7(Suppl 1):S27–S32. doi:10.3978/j.issn.2072-1439.2015.01.48

  2. Kass SM, Williams PM, Reamy BV. Pleurisy. Am Fam Physician. 2007;75(9):1357-64.

  3. Bintcliffe OJ, Lee GY, Rahman NM, Maskell NA. The management of benign non-infective pleural effusions. Eur Respir Rev. 2016;25(141):303-16. doi:10.1183/16000617.0026-2016

  4. Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and managementOpen Access Emerg Med. 2012;4:31–52. doi:10.2147/OAEM.S29942

  5. Dixit R, Agarwal KC, Gokhroo A, et al. Diagnosis and management options in malignant pleural effusionsLung India. 2017;34(2):160-6. doi:10.4103/0970-2113.201305

  6. Rossini M, Rizzo P, Bononi I, et al. New perspectives on diagnosis and therapy of malignant pleural mesotheliomaFront Oncol. 2018;8:91. doi:10.3389/fonc.2018.00091

  7. Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and management of subcutaneous emphysema: a 10-year experienceIndian J Surg. 2015;77(Suppl 2):673–677. doi:10.1007/s12262-013-0975-4

  8. Mitani A, Hakamata Y, Hosoi M, et al. The incidence and risk factors of asymptomatic primary spontaneous pneumothorax detected during health check-upsBMC Pulm Med. 2017;17:177. doi:10.1186/s12890-017-0538-8

  9. Pumarejo Gomez L, Tran VH. Hemothorax. In: StatPearls [Internet].

  10. National Library of Medicine: Medline Plus. Hemothorax.

  11. Carotti M, Salaffi F, Sarzi-Puttini P, et al. Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: Key points for radiologists. Radiol Med. 2020;125(7):636-646. doi:10.1007%2Fs11547-020-01237-4

  12. American Society of Clinical Oncology. Fluid around the lungs or malignant pleural effusion.

  13. Yale Medicine. Fluid Around the Lungs (Pleural Effusion).

  14. Alfudhili KM, Lynch DA, Laurent F, Ferretti GR, Dunet V, Beigelman-Aubry C. Focal pleural thickening mimicking pleural plaques on chest computed tomography: Tips and tricksBJR. 2016;89(1057):20150792. doi:10.1259%2Fbjr.20150792


Additional Reading


By Lynne Eldridge, MD

 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."

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Elementary school teacher and her students wearing protective face mask in the classroom. Image credit: iStock

FACULTY Q&A

Andrew Ault
Andrew Ault

Since the Centers for Disease Control and Prevention acknowledged SARS-CoV-2 was airborne in spring 2020, University of Michigan aerosol scientists Andrew Ault and Kerri Pratt have advised public school systems on how to mitigate the transmission of COVID-19 in the classroom.

That’s partly because social distancing isn’t enough of a mitigation strategy. Have you ever smelled food burning in a kitchen or cigarette smoke in restaurants before indoor smoking was banned? Distance doesn’t automatically mean particles in the air aren’t reaching you, say the researchers.

Kerri Pratt
Kerri Pratt

Now, as students return to school, Ault and Pratt, both associate professors in the U-M Department of Chemistry, give tips about how teachers can keep their classrooms safer for themselves and their students. The key, they say? Masks, open windows, and HEPA filters, including a do-it-yourself air filter made out of furnace filters taped around a box fan.

Can you describe how airborne transmission of COVID works?

Airborne transmission means that a virus is spread by aerosols, which are tiny particles we exhale into the air when we are breathing and talking. The louder we are talking or harder we are breathing, the more aerosols we emit. When someone has COVID, those aerosols contain virus (SARS-CoV-2), which can infect others that breathe the aerosols in. These aerosols are so small (100 times smaller than the diameter of a human hair) that they can stay in the air for hours.

What are some ways people can visualize airborne transmission via aerosols?

You can think of aerosol transmission like cigarette smoke, which is similar in size to exhaled aerosol. Smoke travels across rooms and builds up in poorly ventilated spaces. When restaurants and bars previously allowed smoking, it didn’t matter if you were one table away or across the restaurant, everyone was breathing in the smoke.

How do aerosols move throughout enclosed spaces, such as classrooms?

Classrooms are just like any other indoor space. If infected kids or adults are in the room, they will exhale aerosols with the coronavirus in them, and these aerosols will hang in the air, like smoke. The best things to do to prevent others from breathing in those virus aerosols are to wear masks and improve ventilation through filtration and opening windows.

What are some affordable ways teachers and school administrators can keep classrooms more safe for students?

There are a number of low-cost steps that schools can take to clean the air and reduce transmission of COVID-19.

  1. All students and adults should wear masks indoors at all times, since respiratory aerosols are released through breathing. Masks reduce the amount of aerosol released to the room by someone infected (including those that are asymptomatic) and also reduce the amount of aerosol breathed in by someone else (reducing the chance of infection). Mask fit is important, with the mask sealing against your face without gaps (i.e., not leaking) for best protection. KF94, KN95 and N95 masks are readily available and provide an even higher level of protection than cloth and surgical masks by removing greater than 90% of aerosols exhaled by others when you breathe in.
  2. Eat outdoors, and in inclement weather, have students eat in individual, well-ventilated classrooms, rather than large cafeterias, to reduce the number of students exposed to an infected individual.
  3. Improve ventilation, which can be as cheap as opening a window. Steps beyond just opening a window are to use fans to bring fresh air in and push dirty air out. Improving ventilation has the added side benefit of improving cognitive function by decreasing carbon dioxide buildup.
  4. Lastly, a cool do-it-yourself option is to make a Corsi-Rosenthal Cube, which is a box fan with 5 MERV-13 furnace filters duct taped together and can be made for less than $100. Research shows that these filters decrease aerosol levels, and they are being used in numerous schools nationwide. There are also commercial HEPA air filtration units available that cost more. There should be at least one HEPA air filter/cube in each classroom and multiple filters/cubes in any larger indoor spaces. Portable HEPA air filters supplement HVAC MERV-13 filters by filtering air immediately around students.

Do not buy ionizers, ozone generators or any products claiming to use ions/chemicals to remove virus particles. We, in the indoor air community, have been trying to raise the alarm about this, but unfortunately many individuals and school districts have wasted a lot of money on products that do not effectively remove virus aerosols, but do introduce other harmful gases. HEPA and MERV-13 level filtration is the best option for aerosol removal, as used in hospitals.

How can teachers or school administrators monitor indoor air quality and know if a room may have high aerosol concentrations?

A carbon dioxide monitor (about $250) will tell you how much exhaled air has built up in a room. With good ventilation, carbon dioxide concentrations indoors and outdoors should be similar (about 420 ppm). If the carbon dioxide levels reach higher than 800 ppm, that means that the room is poorly ventilated and that you are rebreathing the air that someone else has exhaled. This calls for the need for increased ventilation (opening a window to mix in outdoor air) and adding an air filtration unit to remove exhaled aerosol.

How will what we’ve learned about the transmission of COVID through aerosols impact how we handle other diseases such as the flu or the common cold?

What we’ve learned about aerosol transmission of COVID can greatly improve how we handle many other airborne respiratory diseases, like influenza, and improve our health overall. By improving indoor ventilation, we will reduce respiratory disease transmission, reduce exposure to air pollution and allergens like pollen, and improve cognitive function (by reducing exposure to high levels of carbon dioxide). In many countries even before COVID-19, it is customary to wear a mask when sick to prevent infecting others.

We have received public health guidance to social distance—what does this mean in the context of airborne transmission?

Just like standing next to a smoker, there is more exhaled aerosol close to a person, such that social distancing reduces exposure, particularly to droplets. However, aerosols travel across rooms, much farther than 6 feet, and build up in poorly ventilated spaces. Another way to think of it is—if you are in a pool and someone pees in it, you don’t want to stay in the pool, even if you are more than 6 feet away from them. This is why masking and ventilation indoors are so important, in addition to social distancing.

What’s the difference between exhaled droplets and aerosols?

Droplets are emitted during coughing and sneezing and are approximately the diameter of a human hair (100 times larger than aerosols). Droplets stay in the air for only a few seconds while traveling up to 6 feet of distance. Since the early 1900s, most doctors thought that infectious diseases spread primarily via droplets and surface contact. This was in part because droplets and surfaces are easier to measure.

Over the course of this pandemic, we’ve come to realize that this thinking was outdated. Aerosols can stay in the air for hours in poorly ventilated indoor spaces and can infect people across rooms that breathe in the previously exhaled aerosols. There is now overwhelming evidence that aerosols are how COVID-19 is transmitted.

What is the riskiest part of the school day for COVID transmission?

The riskiest part of the school day is anytime students are indoors and unmasked together. For students wearing masks, this risk occurs when eating lunch or snack. When multiple cohorts (classrooms) of students are together in a cafeteria/lunchroom, this increases the number of students exposed to an infected individual, since the aerosols travel across the entire room, far beyond 3-6 feet. Outdoor eating is the best solution, but with inclement weather, the next best solution is for small cohorts to eat in well-ventilated classrooms to reduce the number of students exposed to each other, to prevent outbreaks.

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Anterior decompression and cervical fusion is performed to remove the herniated disc, relieve patients' symptoms, and ensure functional recovery [1]. The anterior approach for incision provides the benefit of easy accessibility to the disc without disturbing the spinal cord, nerves, and neck muscles [2]. Depending on the levels affected, the disc is removed and the space between the two vertebras is filled with a spacer to provide stability to the spine and achieve fusion. Although the procedure can lead to various postoperative complications, it is widely used to ensure better postoperative recovery. The various postoperative complications associated with the method include dysphasia, damage to recurrent laryngeal nerve, neck pain, and other rare complications including fifth cervical (C5) nerve root palsy, and adhesive capsulitis.

C5 nerve root palsy is a rare complication of anterior decompression and cervical fusion, occurring without any known etiology but could be possibly iatrogenic and caused by structural variations [3]. In most cases, there is pre-existing asymptomatic damage to anterior horn cells leading to severe postoperative C5 palsy. Hence, it is important to be alert to possible postoperative complications so that prompt and early identification and management can be ensured [4,5].

We present a patient who underwent anterior decompression and cervical fusion at multiple levels - C4-C5 and C5-C6 - for traumatic prolapsed intervertebral disc (PIVD) and then developed a postoperative complication of unilateral C5 nerve root palsy.

Patient information

The patient was a 58-year-old male who presented to the hospital with the primary concerns of tingling in both upper and lower limbs along with pain in the lower back region. He also reported reduced use of his right upper extremity for the last two months due to the above complaints. The patient had a history of heavy weight lifting two months back following which he started experiencing the symptoms. Intermittent tingling in the right lower extremity more than the left was also present for the last 20 years, for which he was conservatively managed by using a lumbosacral belt. Pain in the lower back was described as radiating to the posterior aspect of both lower limbs. The pain was mild in severity, 5/10 on the numerical pain rating scale (NPRS), and dull aching in nature. The pain aggravated on walking, with a history of claudication present at 200 meters, and relieved on sitting. The patient did not have any other comorbidity.

Clinical findings

On physical examination, typical findings of multiple nerve lesions due to compression by a herniated disc in the cervical spine were seen (Table 1). A few special tests were found to be positive, including the straight leg raise (SLR) at less than 40 degrees suggesting lumbar disc disease, and the foraminal compression test suggestive of cervical disc disease. On postoperative day one, the strength of all upper limb muscles was noted to be grade 5/5 on the left side on Medical Research Council Grading System (MRCGS) and, on the right side, the strength of the deltoid and bicep was grade 4/5 with no sensory deficit. On preoperative examination, the strength of the upper limb muscle was noted to be grade 5/5 on the left side and, on the right, the strength of the deltoid and bicep was 5/5.

Nerve root Positive findings Present or absent
C5 nerve Neck, shoulder, and scapula pain; lateral arm weakness during shoulder abduction, external rotation, elbow flexion, and forearm supination. The reflexes affected are the biceps and brachioradialis Present
C6 nerve Neck, shoulder, and scapula along with lateral arm, forearm, and hand pain. Weakness in shoulder abduction, external rotation, elbow flexion, and supination. Reflexes affected are the bicep and brachioradialis Present
C7 nerve Neck, shoulder, and middle finger pain are common, along with index and middle finger numbness. Weakness during radial extension and forearm pronation and wrist flexion. The reflex affected is the triceps Present
S1 nerve Back pain radiating into buttock, lateral or plantar foot. Sensory loss on the posterior calf, weakness on hip extension, knee flexion, and plantar flexion of the foot Present but without bladder involvement

Timeline of the current episode

The patient was admitted on 6/12/2021 to the hospital and, after a complete examination, a diagnosis was made of cervical disc disease with PIVD at C3-C4, C4-C5, and C5-C6 with lumbar disc disease with PIVD at L5-S1 with neuro-deficit. After mandatory screening for coronavirus disease 2019 (COVID-19), hepatitis B surface antigen (HBsAg), hepatitis C, and HIV, the patient was scheduled to undergo anterior decompression and spinal fusion at C4-C5 and C5-C6 on 8/12/21. The patient was then shifted to the recovery room for a day and then to the general ward for further care and conservative management of lumbar PIVD. The patient was then prescribed a home exercise program.

Diagnostic assessment

An MRI scan plays a very important role in diagnosing the exact location of the lesion. The MRI scan of the cervical spine in our case revealed marginal anterior and posterior osteophytes at multiple cervical levels. At the C3-C4 disc level, a diffuse disc bulge intending over the anterior thecal sac causing narrowing of bilateral neural foramina was noted, along with a posterior annular tear at that level. At the C4-C5 disc level along the disc bulge, there was posterior-central disc protrusion causing narrowing of bilateral foramina. There was an associated posterior annular tear and spinal canal stenosis (4 mm) at this level. At the C5-C6 level, there was a diffuse disc bulge intending over the anterior thecal sac with left posterolateral disc protrusion with spinal canal stenosis (3 mm) at this level, and a disc bulge was seen at the L5-S1 disc level (Figures 1-2). In light of these findings, anterior decompression and cervical fusion were done in which two spacers of 5 mm each were placed at C4-C5 and C5-C6 regions. Then, a postoperative X-ray was taken for confirming the position of the spacer.

Diagnosis

On the basis of MRI and clinical presentation, the patient was diagnosed with cervical disc herniation with radiculopathy, for which he was planned to be managed surgically.

Therapeutic interventions

Surgical Intervention

The patient underwent anterior decompression cervical spine fusion surgery, which is a standard and widely accepted treatment of choice for severe cervical PIVD patients as it provides the benefit of easy accessibility to the disc without causing much damage to the nearby structures while also providing the stability to the spine. The patient was given general anesthesia in the supine position and a longitudinal incision of around 5 cm was done over the left sternocleidomastoid muscle. Osteophytes at the end plate at the C5 vertebra were removed. Discectomy at C4-C5 and C5-C6 was done. Two Jayon spacers of 2 mm were fixed with four screws (Figure 3). The mini drain was then placed.

Physical Therapy Rehabilitation

The intervention was started when the patient was shifted to the recovery room after eight hours of surgery. On physiotherapy assessment, the patient was diagnosed with C5 motor palsy. Hence, along with postoperative management for the cervical spine (Table 2), the patient was additionally managed for C5 nerve root palsy (Table 3) (Figure 4) and lumbar spine PIVD (Table 4).

Serial no. Goal Intervention Rationale
1 Patient education (A) Educating the patient about the importance of physiotherapy for improving his condition and gaining functional recovery. (B) Precautions that are to be taken for a few weeks to prevent secondary postoperative complications: 1. Avoid driving for at least four weeks. 2. Avoid heavy weight lifting It helps to improve treatment effectiveness and increases the patient’s dedication to the treatment
2 To maintain the strength of neck muscles Neck isometric exercises involving five repetitions: one set of each exercise progressing to 10 repetitions Isometric contraction helps in the inhibition of pain and stimulates the healing process
3 To improve swallowing ability post-surgery Shaker exercise and Masako maneuver were explained to the patient and he was advised to perform them thrice a day, beginning with 10 repetitions throughout the day and progressing if the pain does not persist (1) Helps in improving strength and ability to swallow. (2) Improves the function of pharynx constriction by strengthening the muscle. (3) Helps in improving coordination of the larynx and hyoid bone
4 To reduce anxiety and improve breathing capacity Diaphragmatic breathing exercise: twice a day with 30 repetitions throughout the day Encourages full oxygen exchange and improves blood flow
Serial no. Goal Intervention Rationale
1 To reduce pain and facilitate shoulder movements Postoperative day three to week two: Pendulum or Codman`s exercise (to and fro in flexion and extension and in a circular motion), five repetitions twice a day Provides mild joint distraction and reduces pain
2 To improve the strength of the deltoid and bicep muscles Postoperative day three to week one: isometric shoulder abduction exercises (10 repetitions with two sets); isometric elbow flexion exercises (10 repetitions with two sets). Week two to week four: active resisted exercises using manual resistance along with PNF, a technique that involves dynamic reversals using the functional task. Facilitates muscle firing to begin to re-establish neuromuscular control but protects healing tissues
Serial no. Goal Intervention Rationale
1 To reduce low back pain Avoiding bending and lifting activities. Hot fermentation for 10 minutes twice a day It helps to improve blood supply and helps to restore movements
2 To promote muscle relaxation Gentle active pain-free range of motion exercises (10 repetitions each) Maintains the length of muscle fibers and reduces tissue tension
3 To restore muscle strength Week two to four: stretching and flexibility exercises; stretching of hamstrings, quadriceps, gluteal stretch, piriformis stretch, isometric hip adduction (three sets with 15-second holds for each) Helps to reduce the tension on the neurological structure and reduces symptoms of claudication and tingling
4 To improve the strength of abdominal exercises Core strengthening exercise: transverse abdominis activation during core strengthening exercises included: bridging (10 repetitions with five-second hold), dead bug exercise (10 repetitions with three sets) Improves proprioception in the lumbar spine

Follow-up and outcome of interventions

The neck and upper extremity functional scale or neck disability index are used to assess the difficulty that individuals experience while performing activities of daily life, with a total score of 100 indicating no difficulty at all. The Neurogenic Claudication Outcome Score (NCOS) is an expansion of the Low Back Outcome Score developed by Greenough: a scale used to measure the severity of symptoms of claudication. It consists of eight questions which range from those related to when the symptoms begin, their severity, and to those that touch on the extent to which the symptoms are affecting the common activities of daily living. Each question has a choice of four answers from a to d with option ‘a’ being allotted 0 points and ‘d’ 6 points. A maximum score of 100 can be attained, which would indicate no asymptomatic condition. The patient had a post-rehabilitation score of 90, indicating minimal symptoms. The Medical Research Council muscle testing grading system is used to grade the strength of the muscle as assessed by manual muscle testing. It consists of 0-5 grades with 0 indicating no contraction and 5 indicative of the full range of motion against gravity, with maximal resistance. The comparison of preoperative and treatment values with postoperative values for the three outcome measures is represented graphically (Figure 5).

According to a 2012 study by Kim et al., the prevalence of C5 nerve root palsy after anterior decompression and cervical fusion at multiple levels is 4.3% [6]. There is some debate about the exact cause, but the most likely cause has been identified as nerve root injury or spinal cord shifting resulting from nerve traction [7,8]. Despite being a debilitating complication, it is frequently overlooked in patients. It could cause deltoid and bicep muscle weakness, as well as loss of sensation in the C5 dermatome [9]. Our patient complained of cervical PIVD with a history of heavy weight lifting, as well as symptoms of lumbar PIVD due to age-related degenerative changes in the lumbar spine. Physical therapy has been shown to be effective in improving deltoid and bicep strength following C5 nerve root palsy and in managing mild lumbar PIVD conservatively. Kim SW et al.'s 2017 study reported on the successful conservative management of bilateral C5 nerve root palsy in a 58-year-old female patient [10].

Physiotherapy played a critical role in this patient's recovery by preventing surgery, enabling the patient to be managed conservatively for lumbar PIVD, and treating the patient for C5 motor palsy. Physiotherapy rehabilitation improved the patient's upper extremity functional independence while also alleviating the neurologic symptoms of claudication caused by lumbar PIVD. The current study discovered that after one month of intervention, the strength of the deltoid and bicep muscles improved. As a result, physiotherapy has been shown to be extremely beneficial. This case is unique in its own right due to the multiple pathologies and multidisciplinary approach used in treating that helped with improving muscle strength, reducing symptoms, and improving overall functional independence in a patient with postoperative side effects of C5 palsy following anterior decompression and cervical fusion at two levels along with lumbar PIVD.

We discussed the case of a patient with postoperative complications of C5 palsy following anterior decompression and cervical fusion at two levels, as well as lumbar PIVD. This report suggests that a multi-disciplinary approach, including medical, surgical, and physiotherapy rehabilitation, can prove to be highly beneficial in treating these patients in terms of improving muscle strength, reducing symptoms, and improving overall upper extremity functional measures. Early diagnosis and management of postoperative complication aid in achieving faster recovery and better prognosis.



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Hantavirus is a disease caused by one of several types of hantaviruses. Hantaviruses can cause a range of flu-like symptoms that progress over days and weeks. In the later stages of the disease, hantavirus can cause difficulty breathing as fluid builds up in your lungs.

Wild rodents, including mice and rats, can carry hantaviruses. People are most commonly exposed to hantaviruses when they come into contact with rodents and their urine, droppings, or saliva. This can be through food, contaminated air, or, rarely, a rodent bite.

In the United States, most people with hantavirus live west of the Mississippi River, though there have been reports of some people with it to the east of the river.

In North and South America, some hantaviruses can progress into a rare but severe lung disease called hantavirus pulmonary syndrome (HPS). HPS may begin with mild flu-like symptoms but can rapidly progress in a few days.

In other parts of the world, several strains of hantavirus are known to cause hemorrhagic fever with renal syndrome (HFRS).

This article will review the effects of HPS and HFRS, how doctors or other healthcare professionals manage these conditions, and what you can do to protect yourself against hantavirus infections.

Hantavirus is mainly an airborne virus. That means you come in contact from breathing in air that the virus has contaminated. The virus gets into the air when forces, such as the elements or other animal or human activity, stir up rodent urine, droppings, or nests.

But experts believe you can also contract the virus in other ways, including:

  • touching a contaminated object and then touching your nose or mouth
  • eating contaminated food
  • rodent bites, although rare

A person with a hantavirus infection, including those that may cause HPS and HFRS, may develop symptoms anywhere between 1 to 3 weeks after exposure.

Symptoms often begin as mild and progress over a matter of days and weeks. As the disease progresses, the defining signs are:

The two most common diseases associated with hantavirus infections are HPS and HFRS. Let’s take a look at their symptoms.

Hantavirus pulmonary syndrome (HPS)

While many people experience a mild hantavirus infection, some hantavirus infections progress into HPS. HPS can eventually lead to fluid buildup, causing severe lung issues.

At first, a person with HPS may experience flu-like symptoms such as:

  • fever
  • fatigue
  • muscle aches
  • headache
  • dizziness
  • chills
  • nausea
  • vomiting
  • diarrhea
  • abdominal pain

Later, a person with HPS may develop coughing and shortness of breath caused by fluid buildup in the lungs. Such symptoms tend to develop 4 to 10 days after the earliest symptoms.

For some people, HPS can progress to respiratory failure and death. The mortality rate for HPS is high but can depend on the virus you have and where you are. According to the Centers for Disease Control and Prevention (CDC), is fatal in about 38% of people who contract it.

Hemorrhagic fever with renal syndrome (HFRS)

HFRS is a serious disease with early symptoms that resemble those of HPS. Symptoms usually develop in 2 to 4 weeks, but they can take up to 8 weeks to appear.

Once they appear, early flu-like symptoms last for 1 to 7 days. After that, more serious symptoms can develop. These include:

Some of the hantavirus strains known to cause HFRS can be fatal in up to 15% of people who contract it.

Even after recovering from the most serious symptoms, you may still experience mild symptoms for another 3 to 6 months.

People who come into contact with rodents carrying hantavirus are at risk of infection. Because different hantaviruses exist worldwide, the risk of infection exists for most people, though infections tend to be sporadic. But some people may be more prone than others.

You may be at higher risk of hantavirus infection if:

  • You live in a rural area where farms, fields, and forests serve as habitats for rodents who carry hantavirus.
  • You have a barn, shed, garage, basement, or other extension or part of your house that rodents use.
  • You have a rodent infestation inside of your house.
  • You often engage in activities where you might come into contact with rodent droppings, urine, saliva, or nesting materials.
  • You often engage in activities where you might stir the virus into the air, such as cleaning with a vacuum or gardening with a rake in areas where rodents live or have lived.
  • You’re cleaning or opening a long-unused building that rodents may inhabit.
  • You’re a construction, utility, or pest control worker who may come into contact with rodents, especially in small or unventilated crawlspaces.
  • You often camp or hike, especially if you use infested trail shelters or camp in other rodent habitats.

Overall, males appear to be more at risk. This is likely due to a higher percentage of males being involved in at-risk activities.

People 70 years old and older seem to be at greater risk of more serious disease and death.

It’s important for a doctor to diagnose a hantavirus infection early. Early diagnosis can help ensure the best possible treatment and outcome.

But it can be challenging to diagnose early hantavirus. The early symptoms tend to resemble symptoms of the flu or coronavirus disease 19 (COVID-19). If you have a fever and shortness of breath, along with a history of potential rodent exposure, you may have a hantavirus infection.

If you’re experiencing flu-like symptoms and think you’ve recently been exposed to rodents, it’s important to bring this up with a doctor. They can order an enzyme-linked immunosorbent assay (ELISA) to confirm hantavirus.

A doctor may also order the following tests to look for other symptoms:

Hantavirus infection can progress into severe disease. The goal of treatment for hantavirus is to manage your symptoms to lower the risk of damage to your lungs and heart.

Due to severe pulmonary (lung) symptoms, many people will need help breathing. About 40% of people who go to the hospital with hantavirus symptoms require mechanical ventilation. If your symptoms don’t improve, your medical team might try extracorporeal membrane oxygenation (ECMO).

People who develop HFRS may require hemodialysis. This is a way to filter your blood until your kidneys recover.

A doctor may consider prescribing antiviral medication to help remove the virus from your system. No large human trial has shown any antiviral to be effective at treating various hantavirus strains. But some studies have seen positive results.

  • Ribavirin: Some studies suggest that ribavirin effectively treats the Hantaan and Andes viruses. But these effects seem to be useful only before pulmonary symptoms begin. It also has significant side effects. A 2021 animal study found positive results when using ribavirin together with favipiravir to treat the Hantaan virus.
  • Chloroquine: Known as an antimalaria drug, chloroquine has been seen to be effective against the Hantaan and Andes viruses in studies with rodents. There have been no human trials.
  • Monoclonal antibodies: Recent research suggests that monoclonal (human-made) antibodies could prevent infection from the Andes and Puumala viruses in rodents.

Note that these treatments are still being investigated. There’s no FDA-approved treatment for hantavirus.

The best way to prevent hantavirus infection is to lower your risk of exposure to rodents and the various ways they spread disease. Some tips include:

  • Wash your hands after spending time outdoors, such as when hiking. Wash them frequently when doing prolonged outdoor activities such as camping.
  • When camping, keep food and food supplies, as well as trash, contained and covered.
  • Avoid touching rodents or their urine or droppings. If you come into contact, wash your hands afterward.

About half of all infections stem from exposure to the virus around your home. There are steps you can take to protect your home as well.

  • Close up potential rodent entryways into your home.
  • Set traps or hire a pest control professional if you have a rodent infestation.
  • When cleaning an area potentially occupied by rodents, wear a properly fitting respirator mask (such as an N95) and gloves.
  • Keep your kitchen clean and store food off the counters to deter rodents.

Hantavirus is a rare but serious disease. Below are the answers to some common questions about hantavirus.

How long does it take for hantavirus symptoms to show?

Symptoms of hantavirus can start emerging around 1 week following exposure. But some people may not see symptoms until up to 8 weeks after exposure.

How long do hantavirus symptoms last?

The early stage of hantavirus symptoms can last up to 10 days. Symptoms can then progress rapidly.

If your hantavirus infection leads to HFRS and affects your kidneys, the most serious symptoms can last from 2 to 6 days. There will be another 2 weeks where you start to recover. But mild symptoms can linger for up to 1 year in some people.

Can humans transmit hantavirus?

Scientists haven’t observed human-to-human transmission of the hantaviruses that circulate in the United States. This means you can’t catch the disease from being around or interacting with someone who has the virus.

The Andes virus, found in South America, is the only hantavirus known to show human-to-human transmission.

Does hantavirus affect your brain?

Very early research suggested a link between HPS and reduced memory or cognitive impairment. Researchers at the time thought that hantavirus might damage your brain directly.

Recent research suggests that the Puumala virus may affect your central nervous system (CNS). Researchers found that people who developed a mild form of HFRS experienced CNS symptoms such as headache, insomnia, and vertigo. This may be due to the virus damaging people’s blood-brain barrier, but this isn’t clearly understood.

Is there a hantavirus vaccine?

There’s no vaccine for hantavirus available in the United States. While there have been many vaccine candidates, none have yet to be seen as effective or to surpass early clinical trials.

Hantaviruses are rare but serious diseases carried by rodents and transmitted to humans worldwide. Hantaviruses cause a progression of flu-like symptoms followed by respiratory symptoms that can be severe or fatal.

Some people’s infections of hantavirus may progress into HPS, a serious lung-related complication. Some develop into HFRS, a kidney-related complication.

The focus of hantavirus treatment is supportive care to manage your symptoms and prevent damage to your body.

The best way to prevent hantavirus is to avoid contact with rodents and their urine, droppings, and nesting materials.

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Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Two large studies out of the UK and Norway show vitamin D supplementation has no benefit — as low dose, high dose, or in the form of cod liver oil supplementation — in preventing COVID-19 or acute respiratory tract infections, regardless of whether individuals are deficient or not.

The studies, published this week in The BMJ, underscore that "vaccination is still the most effective way to protect people from COVID-19, and vitamin D and cod liver oil supplementation should not be offered to healthy people with normal vitamin D levels," writes Peter Bergman, MD, of the Karolinska Institute, Stockholm, Sweden, in an editorial published alongside the studies.

Suboptimal levels of vitamin D are known to be associated with an increased risk of acute respiratory infections, and some observational studies have linked low 25-hydroxyvitamin D (25(OH)D) with more severe COVID-19; however, data on a possible protective effect of vitamin D supplementation in preventing infection have been inconsistent.

UK Study Compares Doses

To further investigate the relationship with infections, including COVID-19, in a large cohort, the authors of the first of the two BMJ studies, a phase 3 open-label trial, enrolled 6200 people in the UK aged 16 and older between December 2020 and June 2021 who were not taking vitamin D supplements at baseline.

Half of participants were offered a finger-prick blood test, and of the 2674 who accepted, 86.3% were found to have low concentrations of 25(OH)D (< 75 nmol/L). These participants were provided with vitamin D supplementation at a lower (800 IU/day; n = 1328) or higher dose (3200 IU/day; n = 1346) for 6 months. The other half of the group received no tests or supplements.

The results showed minimal differences between groups in terms of rates of developing at least one acute respiratory infection, which occurred in 5% of those in the lower-dose group, 5.7% in the higher-dose group, and 4.6% of participants not offered supplementation.

Similarly, there were no significant differences in the development of real-time PCR-confirmed COVID-19, with rates of 3.6% in the lower-dose group, 3.0% in the higher-dose group, and 2.6% in the group not offered supplementation.

The study is "the first phase 3 randomized controlled trial to evaluate the effectiveness of a test-and-treat approach for correction of suboptimal vitamin D status to prevent acute respiratory tract infections," report the authors, led by Adrian R. Martineau, MD, PhD, of Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.

While uptake and supplementation in the study were favorable, "no statistically significant effect of either dose was seen on the primary outcome of swab test or doctor-confirmed acute respiratory tract infection, or on the major secondary outcome of swab test-confirmed COVID-19," they conclude.

Traditional Use of Cod Liver Oil of Benefit?

In the second study, researchers in Norway, led by Arne Soraas, MD, PhD, of the Department of Microbiology, Oslo University Hospital, evaluated whether that country's long-held tradition of consuming cod liver oil during the winter to prevent vitamin D deficiency could affect the development of COVID-19 or outcomes.

For the Cod Liver Oil for COVID-19 Prevention Study (CLOC), a large cohort of 34,601 adults with a mean age of 44.9 years who were not taking daily vitamin D supplements were randomized to receive 5 mL/day of cod liver oil, representing a surrogate dose of 400 IU/day of vitamin D (n = 17,278), or placebo (n = 17,323) for up to 6 months.

In contrast with the first study, the vast majority of patients in the CLOC study (86%) had adequate vitamin D levels, defined as > 50 nmol/L, at baseline.

Again, however, the results showed no association between increased vitamin D supplementation with cod liver oil and PCR-confirmed COVID-19 or acute respiratory infections, with approximately 1.3% in each group testing positive for COVID-19 over a median of 164 days.

Supplementation with cod liver oil was also not associated with a reduced risk of any of the coprimary endpoints, including other acute respiratory infections.

"Daily supplementation with cod liver oil, a low-dose vitamin D, eicosapentaenoic acid, and docosahexaenoic acid supplement, for 6 months during the SARS-CoV-2
pandemic among Norwegian adults did not reduce the incidence of SARS-CoV-2 infection, serious COVID-19, or other acute respiratory infections," the authors report.

Key Study Limitations

In his editorial, Bergman underscores the limitations of two studies — also acknowledged by the authors — including the key confounding role of vaccines that emerged during the studies.

"The null findings of the studies should be interpreted in the context of a highly effective vaccine rolled out during both studies," Bergman writes.

In the UK study, for instance, whereas only 1.2% of participants were vaccinated at baseline, the rate soared to 89.1% having received at least one dose by study end, potentially masking any effect of vitamin D, he says.

Additionally, for the Norway study, Bergman notes that cod liver oil also contains a substantial amount of vitamin A, which can be a potent immunomodulator.

"Excessive intake of vitamin A can cause adverse effects and may also interfere with vitamin D-mediated effects on the immune system," he writes.

With two recent large meta-analyses showing benefits of vitamin D supplementation to be specifically among people who are vitamin D deficient, "a pragmatic approach for the clinician could be to focus on risk groups" for supplementation, Bergman writes.

"[These include] those who could be tested before supplementation, including people with dark skin, or skin that is rarely exposed to the sun, pregnant women, and elderly people with chronic diseases."

The UK trial was supported by Barts Charity, Pharma Nord, the Fischer Family Foundation, DSM Nutritional Products, the Exilarch's Foundation, the Karl R. Pfleger Foundation, the AIM Foundation, Synergy Biologics, Cytoplan, the Clinical Research Network of the UK National Institute for Health and Care Research, the HDR UK BREATHE Hub, the UK Research and Innovation Industrial Strategy Challenge Fund, Thornton & Ross, Warburtons, Hyphens Pharma, and philanthropist Matthew Isaacs.

The CLOC trial was funded by Orkla Health, the manufacturer of the cod liver oil used in the trial. Bergman has reported no relevant financial relationships.

BMJ. Published online September 7, 2022. 

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Post-Covid: Lifestyle Changes To Improve & Recover Lung Health Post-Covid

Post-covid: Quit smoking today to reduce further lung damage

Covid-19 took the world by storm since it emerged at the end of 2019. The coronavirus often attacks and causes harm to our respiratory system. Our lungs are an integral part of our respiratory system. Studies have shown, covid-19 might cause long-term harm to our lungs.

COVID-19 has the potential to result in lung problems such as pneumonia and, in the most severe cases, ARDS. Another potential COVID-19 consequence, sepsis, can injure the lungs and other organs permanently. More airway diseases like bronchitis that may be severe enough to require hospitalisation may also be brought on by more recent coronavirus strains.

Patients can take several actions to improve their risk of suffering from less severe lung damage. Regaining adequate lung capacity and function is a vital step in the healing process. Enhancing lung function also helps to remove mucus from the lungs, which makes breathing easier. In this article, we list lifestyle changes you can perform to improve your lung health post-covid.

Here are lifestyle choices that can help you recover from covid-19 and improve your lung health:

1. Exercise

Exercise the lung muscles to increase their capacity and function because it is one of the best ways to improve lung function. Similar to any physical activity, exercises that increase lung function concentrate on building and extending lung capacity. gradually increase the body's and the lungs' capacity. These workouts can enhance the way that our lungs expand. Respiratory issues can be managed and shortness of breath can be decreased with the use of pulmonary rehabilitation.

2. Eat well

Our general immune system is strengthened by eating foods high in antioxidants, which also benefits our lung function. Essential nutrients can be obtained via a nutritious diet, which also benefits the lungs. Fruits, vegetables, legumes, nuts, grains, juices, home-cooked meals, and foods high in vitamins and minerals should all be consumed. Water consumption needs to be increased during COVID-19 recovery in addition to important dietary adjustments because it is essential for improving our body's overall health.

3. Quit smoking

Smoking alters the lungs' and immune cells' functional and morphological characteristics. Smoking not only impairs the health and functionality of your lungs but also places additional stress on other crucial organs. Smoking after COVID-19 may lead to lung infections and long-term health issues. Speak to your doctor to navigate the best ways to quit tobacco.

4. Drink in moderation

Alcohol has a similar impact on our body's immune system as smoking does. Our immune system has tougher time-fighting infections as a result. It further affects the functioning and health of other organs such as our liver. Drinking occasionally may not cause the same amount of harm.

In conclusion, just simple lifestyle changes can go a long way in ensuring your lungs stay healthy and function to their best potential. You can improve your lung health and quickly recover from long COVID-19 symptoms by making these important lifestyle adjustments. Make sure to take good care of your lungs and overall body. You must also seek a doctor's help to help you navigate how you can care for yourself post-covid.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

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In recent times, Spanish hospitals have introduced an i. have reportedincrease in dengue cases Incoming, mostly, travelers from Cuba, where the Cuban Ministry of Public Health (MINSAP) last Wednesday reported the detection of 11,634 reactive cases of dengue in a week.

The data presented by the Spanish Autonomous Communities is not yet definitive, as more cases can be counted, but it has been observed that two-thirds diagnosis The summer positives in our country come from Caribbean islands. However, Catalonia, Canary Islands, Murcia and Castilla-La Mancha have not notified any data yet.

According to the data presented by the weekly epidemiological report community of madridTill the 34th week of the year – from August 23 to August 29 of the same month – there are 11 positive cases of dengue in the capital. No case was reported last year. Most of those infected had traveled to Cuba in recent weeks.

have dengue infectious disease which is transmitted by the DENV virus, and which can be transmitted by a mosquito of the species Egyptian temple, which has developed a rare immunity to insecticides. It can transmit not only dengue, but also yellow fever or Zika.

However, it is not only spread by the Aedes mosquito. Most of the cases in Spain are from people who have traveled to places where disease is endemicBut in our country there have been reasons for the spontaneous matter tiger mosquitowhich is increasingly present mainly in autonomous communities in the Mediterranean, Andalusia, Madrid, Extremadura, the Basque Country and Aragon.

symptoms of dengue

Although 80% of people have this disease mild symptoms And even asymptomatic, there are cases in which it is complicated and can be severe.

mild symptoms

  • Severe headache
  • high fever
  • dollar muscular
  • joint pain
  • Nausea
  • Vomiting
  • swelling of lymph nodes
  • Skin rash in the form of red dots

second day of Symptoms Important, as it determines whether the infection develops favorably or, conversely, worsens.

severe symptoms

  • severe abdominal pain
  • Vomiting with presence of blood
  • blood in urine and stool
  • heavy breathing
  • bleeding gums or nose
  • Hepatomegaly (enlarged liver)
  • fatigue

Although medicine is evolving, there is no cure To combat the disease, only to alleviate the symptoms. If the symptoms become complicated, you should go to the hospital.

Dengue can be avoided. Have a vaccine since 2015, Dengvaxia, It is approved in 20 countries and can be vaccinated by people between the ages of nine and 45. Like the coronavirus, this vaccine does not prevent infection, but rather eases symptoms.

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Coronavirus disease 2019 (COVID-19) has spread around the globe. The most common symptoms associated with this are usually respiratory, but different central nervous system manifestations have been reported. There are many cases of Guillain-Barre syndrome (GBS) post-COVID-19. However, only a few simultaneous afflictions of COVID-19 with GBS have been reported. Therefore, our study aims to investigate a case of GBS along with COVID-19 infection in India. A 22-year-old male with no medical history presented with fever along with global weakness and breathing difficulty. There was no history of travel. At the time of admission, he had developed quadriparesis and had muscular strength of 2/5 in bilateral lower limbs and 3/5 in bilateral upper limbs. When the patient developed breathing difficulty, he was transferred to the intensive care unit. The cerebrospinal fluid evaluation showed albumin-cytological dissociation, and a nerve conduction study was done. The patient was managed by neuro physiotherapy 34 days after COVID-19 exposure. After proper physiotherapy and rehabilitation, the patient was able to return to his college life.

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) primarily affects the respiratory system but has also been linked to several neurological symptoms, including headache, confusion, myalgia, dizziness, and loss of taste and smell [1]. Though the first reported case in Wuhan, China showed a para-infectious presentation, this has been characterized as a probable uncommon sequela of COVID-19 [2]. Acute inflammatory demyelinating polyradiculopathy, i.e., Guillain-Barré syndrome (GBS) is defined by symmetrical, increasing limb weakness, areflexia on examination, sensory complaints, and, in some cases, facial paralysis that develops over several days and weeks [3]. GBS is an uncommon, immune-mediated, post-infectious neuropathy that often causes progressive weakening. According to preliminary reports, GBS can be a rare consequence of COVID-19 [4,5]. Since then, the number of cases has been increasing day by day not only in India but also worldwide. There are several high-quality studies suggesting the correlation of GBS with COVID-19, and it is necessary to test for COVID-19 in a patient reporting GBS [6]. Here, we present a unique case of COVID-19 simultaneously with GBS. Because these conditions have overlapping clinical features, such as respiratory involvement and limb weakness, the diagnosis of one may be overlooked by the other. Proper diagnosis and early treatment are required for both.

Cardio-respiratory training and neurorehabilitation, including active-assisted training, and progressing to strengthening, have proved to be effective in previous studies [3]. The Hughes severity score of GBS patients provides a measure of disability [7], and this was used to tailor neurorehabilitation according to the patient’s initial assessment, together with physiotherapy and regular monitoring of the vitals. Within a month the patient was able to become functionally independent without any residual weakness. Early physiotherapy plays an important role in regaining functional independence in such patients.

Case Presentation

Patient information

A 22-year-old male was referred to our hospital from a primary health care center. His presenting symptom was a fever, for which he took paracetamol and antibiotics from the local hospital and got relief. Five days later, he again complained of a fever in the morning, and in the afternoon, he started complaining of sudden weakness in all four limbs, for which he went to a local hospital, where he was assessed and referred to our hospital. The next day he tested positive for COVID-19 (as a protocol before hospital admission) and was placed in isolation for seven days. He was provided with intravenous immunoglobulin but soon developed respiratory distress necessitating transfer to the ICU for oxygen support, which he received for a total of 10 days. He was initially treated with intravenous immunoglobulin and improved. After 15 days, he tested negative and was transferred to the medical ward four days later. The patient was then referred for physiotherapy 34 days after the initial COVID-19 symptom onset.

Clinical findings

The patient was of mesomorphic build, well-oriented, and had intact sensations in bilateral upper and lower extremities. Muscle power was reduced in the right upper and bilateral lower limbs suggestive of weakness with a grade of 4/5 on the Medical Research Council muscle scale in the shoulder and elbow, 3/5 in the wrist, a grade of 3/5 in the hips and knee muscles, and 2/5 over his ankle muscles. Lower limbs were involved more than upper limbs. Deep tendon reflexes were diminished in lower limbs but preserved in bilateral biceps, triceps, and supinators. Abdominal reflexes were absent, bowel and bladder function were affected, and the patient was catheterized. Plantar reflexes were absent on the right and flexor on the left. Breathing was normal with no secretions, but he had difficulty taking deep breaths and was using his accessory muscle (sternocleidomastoid), which was the main reason for early fatigue. Air entry was reduced in bilateral lower lobes. 

Clinical diagnosis

Both the comprehensive metabolic panel and complete blood count were within normal range. The patient's nasopharyngeal swab was sent for SARS-CoV-2 identification on the same day of admission in light of the current global pandemic and his history of fever. One day following hospitalization, a lumbar puncture was performed for cerebrospinal fluid (CSF) analysis. He had albumin-cytological dissociation in his CSF. The patient was identified as having a mild dual diagnosis of COVID-19 and GBS. He was diagnosed with a case of sensory-motor polyneuropathy with nerve conduction velocity findings, which showed that compound muscle action potential amplitude could not be elicited in the bilateral peroneal nerve and was reduced, with prolonged distal motor latency and conduction velocity within the normal limit in the bilateral median, ulnar, and tibial nerves. F-min latency could not be elicited in the bilateral median, ulnar, tibial, and peroneal nerves. Sensory nerve action potential amplitude could not be elicited in the bilateral sural and right ulnar nerve and was reduced in bilateral median nerves

Physiotherapy functional assessment

The functional independence measure score taken on the first day of physiotherapy evaluation was 68/126, and the Hughes severity scale score was 4/6 (confined to bed). By then it was evident that the patient was dependent on caregivers for his activities of daily living (ADL).

The timeline of events in the ICU and wards is shown in Table 1.

S. No. Date of Events Consultation Findings Suggestions
1. On admission (COVID-19 positive) Emergency Bilateral lower limb and upper limb weakness, blurring of vision, diplopia, and COVID-19 Inj. methylprednisolone: 1 mg IV OD; Inj. piptaz: 4 mg IV OD; Inj. Emeset: 4 mg IV; T. favipiravir: 1,800 mg for 1 day; T. Limcee: OD; T. Zincovit OD
2. 26/09/2021 Isolation NCV revealed sensory-motor polyneuropathy Neuromonitoring, watch for SPO2 and respiratory rate. T. favipiravir: 800 mg BD (2nd -7th day) T. Limcee OD T. Zincovit OD IV IG 25 mg (03/10/2020 to 08/10/2020) IV IG 5 mg (09/10/2020)
3. 03/10/2021 Medicine ICU Difficulty in breathing and maintaining saturation, weakness persisting On O2 via facemask for 7-10 days. methylprednisolone 1 g Inj. meropenem 1 g Inj. levofloxacin 500 mg BD Inj. pantoprazole OD
3. 14/10/2021 Medicine ward COVID-19 negative, bilateral lower limb, and upper limb weakness Tab pantoprazole IV NS Ophthalmology call-  no diplopia was found. Neuro physiotherapy call
4. 22/10/2021 Neuro physiotherapist Acute inflammatory demyelinating polyneuropathy -GBS without the involvement of cranial nerves The physiotherapy session started and continued till discharge i.e., 14/11/2020 with a proper home exercise program
5. 02/12/2021 Neuro physiotherapist Difficulty performing complex ADL and IADL Strengthening exercises, gait training, fine motor training

Physiotherapy interventions

After 34 days with symptoms of GBS due to COVID-19, the patient had the effects of de-conditioning due to prolonged bed rest. The chest was clear on assessment, but as the patient had a history of recent COVID-19 infection, chest physiotherapy (breathing exercises, thoracic expansion exercises, pursed-lip breathing along with proper positioning) was provided to increase the chest excursion and reduce the level of stress. For maintaining joint mobility and integrity, range of motion exercises along with a regular change in position were taught to the patient. The treatment protocol is presented in Table 2. This protocol was provided once daily to the patient, with 10 repetitions of each exercise and proper rest periods in between. Along with this treatment protocol, the patient was advised to perform active limb movement, breathing exercises, and stress ball exercises during the evening hours.

Problem identified Probable cause Goal Framed Physiotherapy Intervention
Decreased air entry into the lungs Weakness of the diaphragm and intercostal muscles Mr. X will be able to perform the mild strenuous activity without excursion within two weeks Diaphragmatic breathing (Figure 1C), thoracic expansion exercises, pursed lip breathing, and incentive spirometry
Decreased range of motion Prolonged bed rest Mr. X will be able to perform activities in full range without any difficulty within two weeks Active range of motion exercise involving bilateral upper and lower extremities and calf stretching
Weakness of extremity muscles Decreased nerve conduction Mr. X will be able to regain the reduced strength in his limbs within two weeks of intervention Plan for giving electrical stimulation to increase muscle performance
Inappropriate posture Bedridden for many days postoperatively Proper posture will be gained by the patient by the end of two weeks Chest binders and positioning
Decreased bed mobility Weakness and decreased pulmonary and muscular endurance The patient will gain good bed mobility and endurance within two weeks of intervention Rolling facilitation and transition training (supine-to-sit, pelvic bridging, and supine-to-long-sitting)
Decreased out-of-bed transitions Weakness in girdle muscles and decreased stability Mr. X will get trained in out-of-bed mobility in three weeks Transition training, supine-to-sit, and sit-to-stand
Impaired Proprioception Prolong bed rest Proprioception will be regained with proper training in three weeks Proprioceptive training and joint compression
Reduced muscle strength Weakness due to the disease and hospital stay Mr. X will regain the reduced muscle strength and be able to perform his ADLs by himself within three weeks Upper limb strength training with a water bottle (1/2 L initially, then progressed to 1 L). Lower limb strength training with weight cuff (½ kg initially, then progressed to 1 kg). Hip hikers strengthening along with quadriceps strengthening
Impaired sitting balance Prolong bed rest The patient will regain the sitting balance within three weeks of rehabilitation Proprioceptive neuromuscular facilitation can be taught – alternating isometrics and rhythmic stabilization. Perturbations in a safe manner, with a variety of surfaces
Impaired fine motor training  Distal weakness Mr. X will regain fine motor functions by the end of four weeks Rubber band exercises, stress ball exercises, handwriting practice
Impaired walking pattern Prolong hospital stay and cerebellar improvement Mr. X will be able to walk independently in a good walking pattern after 3-4 weeks of gait training Side leg raises, ankle dorsiflexion, toe raises, heel raises, seated marching, dynamic quadriceps (Figure 1B), knee-to-chest, single-leg stance, squatting, and gait training
Decreased ADL Decreased performance of muscles Mr. X will be able to resume college after 5-6 weeks of intervention Encourage the use of the extremities for ADL

Follow-up and outcome measures

Incentive spirometry measures increased from 900 cc to 1200 cc over 10 days. There was an improvement in overall hand function, proper grasp, and opposition. The Hughes severity score decreased from 4/6 to 0/6, indicating that normal function was achieved post-rehabilitation. Other outcome measures are given in Figure 1A. Figure 1B shows the patient performing resistance dynamic quadriceps exercises, and Figure 1C shows the patient performing breathing exercises.

Results

The Hughes severity scale normalized to 0/6 (normal) by the time of discharge. The patient was able to perform routine ADL and movement transitions (sit-to-stand, squatting, and stair climbing) that were previously difficult. Dorsiflexion and hip internal rotator power also improved post-rehabilitation. There was an improvement in the Berg balance scale and dynamic gait index which indicate improved static and dynamic balance of the patient. All of this led to the enhancement of the quality of life of the patient and early return back to his occupation.

Discussion

GBS is defined clinically by the loss of reflexes and an increase in CSF protein content that progresses rapidly. Small action potentials, prolonged distal motor latency, delayed F-waves, and conduction block are all observed neurophysiologically [3]. In this case report, we presented a patient who developed GBS simultaneously with a COVID-19 infection. GBS was confirmed with clinical features, nerve conduction velocity, and CSF analysis, and COVID-19 was confirmed with a nasopharyngeal swab. The first case of COVID-19-associated GBS during the COVID-19 pandemic was identified in Wuhan as a possible para-infectious illness, where the patient had COVID-19 symptoms seven days following the start of GBS symptoms [1]. There have also been numerous case reports in the past indicating a connection between GBS and COVID-19 infections [7,8]. Early diagnosis and rehabilitation are the keys to early recovery. Following a COVID-19 infection, rehabilitation has been shown to enhance patient health outcomes, with fewer complications in the ICU, faster recovery, less disability, easier early discharge, and a lower chance of readmission [9]. With proper medical management and rehabilitation, the path toward early functional independence can be achieved [10].

In this patient, the medical management for COVID-19 was started from the day of diagnosis along with intravenous immunoglobulin for GBS, and physiotherapy was started after the repeat COVID-19 test was negative [11]. Physiotherapy can be started with proper monitoring to prevent respiratory and other complications. Early rehabilitation has been shown to play a positive role in mitigating neurological manifestations of COVID-19 [12]. Cardio-respiratory rehabilitation, early mobilization, frequent posture changes, bed mobility, sit-to-stand exercises, ADL, neuromuscular electrical stimulation, progressive aerobic exercise, and education on energy conservation are all general rehabilitation considerations in the post-acute phase of COVID-19 infection [13]. Other studies have demonstrated an improvement in the Berg balance score and the functional independence of the patient in the setting of comprehensive rehabilitation [14]. The Hughes severity score improved with normalization of the score, indicating the effectiveness of the intervention provided [15].

Conclusions

Our study concludes that neuro physiotherapy rehabilitation yields positive outcomes and reduces the hospital stay of the patients, making them able to go back to their occupations. The study further demonstrates the importance of the planned physiotherapy protocol in the management of acute cases of GBS along with COVID-19. Amid the COVID-19 pandemic, patients exhibiting paresthesia, tingling feelings, and trouble walking should not be dismissed as simply viral-associated myalgia and arthralgia. Due to COVID-19, GBS should be taken into account as a possible uncommon but serious consequence.



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According to this report, Home Rehabilitation Products and Services Market Research is an intelligence report with meticulous efforts to study the correct and valuable information. The data reviewed is done taking into account both existing top players and future competitors. The business strategies of key players and new entrants in the market industry are studied in detail. The report offers an extensive study of the market for the forecast period 2022-2030.

The Home Rehabilitation Products and Services Market is growing at a High CAGR during the forecast period 2022-2030. Increasing individual interest in this industry is the main reason for the expansion of this market.

Market Segment Analysis:

The report is segmented by product, application, and region type. Report authors assessed detailed geography for each segment. Each type provides information on production over the forecast period 2022-2030. The Applications segment also provides consumption for the forecast period 2022-2030. The segments are studied based on market share, revenue, regional growth, cost and revenue analysis. , and other important factors. The segmentation study identifies high-growth segments of the home rehabilitation products and services market.

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By product type:

  • positioning device
  • body support device
  • general aids
  • bathchair
  • Other product types

cure:

  • Physiotherapy
  • occupational therapy
  • speech therapy
  • respiratory therapy
  • other therapies

Note: Our report highlights the key challenges and risks businesses may face due to the unprecedented COVID-19 outbreak.

Some of the key players operating in the global Home Rehabilitation Products and Services market are:

  • Striker Co., Ltd.
  • performance state
  • Hokoma AG
  • Ekso Bionics Holdings Inc.
  • Ergoline GmbH
  • rehabilitation
  • Alimed
  • Noco Co., Ltd.
  • InvarCare Corporation
  • Prism Medical (Handy Care Group AB subsidiary)
  • Djo Global
  • Active Medical & Rehabilitation Services Pvt. Corporation
  • Lbody Force Co., Ltd.
  • Medline Industries Inc.a

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What is covered in the Impact of the COVID-19 Pandemic chapter?

The coronavirus pandemic has disrupted market dynamics, limiting the opening of offices and manufacturing facilities. This in turn persuaded employees to work from home and halted production globally. Moreover, the gap between supply and demand has widened due to trade restrictions around the world. However, it has created lucrative opportunities for key players in certain regions.

The growth trajectory of the market studied in detail in the report is determined by various factors. Additionally, the report lists the restraints that threaten the Home Rehabilitation Products and Services market. It also measures the bargaining power of suppliers and buyers, the threat of new entrants and product substitutes, and the degree of competition prevailing in the marketplace. The impact of the latest government directives is also analyzed in detail in the report. To study the trajectory of the Home Rehabilitation Products and Services market between forecast periods.

Promising Regions and Countries Covered in Home Rehabilitation Products and Services Market Report:

  • North America (USA, Canada, Mexico)
  • South America (Brazil, Argentina, Colombia, Chile, Peru)
  • Europe (Germany, UK, France, Italy, Russia, Spain, Netherlands, Turkey, Switzerland)
  • Middle East and Africa (GCC, North Africa, South Africa)
  • Asia Pacific (China, Southeast Asia, India, Japan, Korea)

Customize the report:

Please contact us for more information on the report. If you have special requirements and want to customize, please let us know. Then provide the report as desired.

Key benefits for stakeholders in the Home Rehabilitation Products and Services Market study –

The market analysis provides extensive qualitative insight into the region showing lucrative growth and insights into niche segments.

Market analysis provides market shares, supply and demand ratios, supply chain analysis and import/export details.

The report offers an extensive analysis of current and emerging market trends and opportunities in the global market.

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Comprehensive analysis gathers important information about factors driving or restraining market growth.

Extensive analysis of the industry is performed by monitoring top competitors along key product positioning within the market framework.

The Home Rehabilitation Products and Services Market study provides detailed qualitative and quantitative analysis of future estimates and current trends, and helps to evaluate current market opportunities.

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Home Rehabilitation Products and Services Market Trend, Technology Innovations and Growth Prediction 2022-2028

According to business intelligence report on Home Rehabilitation Products and Services market, Covid-19 pandemic will have lasting impact on industry sphere, based on which growth matrix for 2022-2028 is formulated.

The research report on Home Rehabilitation Products and Services market is an in-depth analysis of pivotal drivers, challenges, and growth prospects prevailing in the business space and their impact on the expansion graph over the ensuing years.

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According to the report, Home Rehabilitation Products and Services market is anticipated to record a y-o-y growth rate of XX% over the analysis duration (2022-2028) and is poised to amass substantial revenues by the end of study term.

Various disruptions are being observed on account of lockdowns imposed to control COVID-19 spread, leading to uncertainties. While all industry verticals are facing revenues troubles presently, some sectors will continue to fight these challenges even as economy emerges from pandemic blowback.

As a result, all the businesses are revising their budgets to formulate new profit trajectory for the forthcoming years. Our thorough analysis of this industry space will enable you to come up with contingency plans and prepare you to manage market qualms.

The research document scrutinizes different segmentations to offer comprehensive insights about the growth opportunities in the market.

Major points summarized in Home Rehabilitation Products and Services market report:

  • Impact of coronavirus pandemic on the growth matrix
  • Statistics related to market size, sales volume as well as overall remuneration
  • Analysis of industry trends
  • Growth prospects
  • Projections about growth rate
  • Advantages and disadvantages of direct and indirect sales channels
  • Documentation of established vendors, manufacturers, and traders in the market

Elucidating Home Rehabilitation Products and Services market segmentations:

Regional terrain:

  • Industry survey at geographical as well as country level
  • Sales garnered, revenues accrued, and market share held by each region
  • Estimations about remuneration and growth rate for all the regions over the forecast period

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Product scope:

  • Positioning Devices
  • Body Support Devices
  • General Aids
  • Wheelchairs
  • Physical Therapy
  • Occupational Therapy
  • Speech Therapy
  • Respiratory Therapy

 

  • Pricing pattern for each product type
  • Industry share based on sales and returns recorded by each product segment

Application landscape:

  • Disabilities
  • Geriatric People

 

  • Profit returns contributed and market share held by each application segment
  • Pricing and sales of products based on their applications

Competitive hierarchy:

  • Handicare
  • Stryker
  • Invacare
  • Hocoma
  • Ekso Bionics
  • RehabCare
  • AliMed
  • Active Medical & Rehabilitation Services
  • DJO
  • Medline Industries
  • Ergoline
  • Performance Health

 

  • Business profile, product portfolio, and manufacturing units of leading companies
  • Products and services offered by players
  • Statistics related to price, sales volume, profit returns, overall revenue, and industry stake of each contender
  • SWOT analysis of established companies
  • Summary of commercialization matrix, marketing strategies, and other business centric tactics.

Important Highlights of the Report:

Industry Size & Forecast: Estimations on the global Home Rehabilitation Products and Services industry size on the basis of value and volume are provided in this part of the report

Segmental Analysis: The report has examined the high-growth segments including product type, application, and end-users

Future Prospects: Future opportunities are estimated to emerge in the industry

Geography-Wise Analysis: The authors of the report have studied the regions having growth potential to help companies plan their future investments

Study on Competitive Landscape: The industry experts have offered thorough information about the strategic tactics adopted by the industry participants.

Key questions answered in the report:

  • What will the market growth rate of Home Rehabilitation Products and Services market?
  • What are the key factors driving the global Home Rehabilitation Products and Services market?
  • Who are the key manufacturer Home Rehabilitation Products and Services market space?
  • What are the market opportunities, market risk and market overview of the Home Rehabilitation Products and Services market?
  • What are sales, revenue, and price analysis of top manufacturers of Home Rehabilitation Products and Services market?
  • Who are the distributors, traders and dealers of Home Rehabilitation Products and Services market?
  • What are the Home Rehabilitation Products and Services market opportunities and threats faced by the vendors in the global Home Rehabilitation Products and Services industries?
  • What are sales, revenue, and price analysis by types and applications of Home Rehabilitation Products and Services market?
  • What are sales, revenue, and price analysis by regions of Home Rehabilitation Products and Services industries?

For More Details On this Report: www.marketstudyreport.com/reports/global-home-rehabilitation-products-and-services-market-2022-by-company-regions-type-and-application-forecast-to-2028

 

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Introduction

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow obstruction and alveolar destruction.1 It is one of the leading causes of death worldwide, causing 3.23 million deaths in 2019.2 Although COPD is mainly driven by tobacco smoking, exposure to other environmental toxins are also risk factors.1 The most recognized symptom of COPD is dyspnea or shortness of breath.3 Other non-specific symptoms frequently reported by patients include fatigue, sleep disturbance, stress, anxiety, and depression.3,4 People diagnosed with COPD, particularly the elderly, often have significant co-morbidities. Hence, many struggle to fully understand their illness and cope with their symptoms,5 leading to hospitalizations and high readmission rates.6 This carries significant health-care costs as well as financial and emotional burdens for patients and their families.7

COPD management is multi-faceted. This includes pharmacological treatments (eg, inhalers), pulmonary rehabilitation, and risk factor modification, specifically, assistance with smoking cessation.8 In more advanced stages, patients may require long-term oxygen therapy, non-invasive ventilation devices, and rarely, lung volume reduction surgeries or a lung transplant. There is evidence to suggest that many people with COPD feel overburdened with the treatment and management of their illness.1,4,9 Indeed, a study estimated that an individual with a combination of COPD, arthritis, heart disease or diabetes can spend 50 hours per month on health-related activities, take 6–12 medication per day and see their doctor 2–6 times per month.10 Large time investments in treatment and the requirement of long-term self-management of the disease can lead to (overwhelming) treatment burden for patients.8

Treatment burden is defined as a patient’s treatment workload. It can include learning about and implementing treatments, completing paperwork, arranging, and attending medical appointments/tests, experiencing side effects and financial costs of treatment.11 This differs from disease burden, which encompasses the morbidity or mortality related to the disease.12,13 Treatment burden refers to the negative consequences of treatments that patients experience, including medications, therapies, and medical interventions.13,14 Of course, treatment burden is multiplied for patients with multiple chronic conditions.15

Given the highly burdensome nature of COPD management, there has recently been research published investigating the treatment burden experiences of patients with COPD and their family members.5,8,11,16,17 This body of literature demonstrates the substantial treatment burden that people with COPD experience, including changing daily routines,4,9 and health behaviors, difficulty attending medical appointments because of travel restrictions,5,16 attending specialist appointment because of financial costs,18 not being able to afford medications,18 inconsistent or contradictory information about COPD and treatment,5 experiencing treatment side-effects,19 the burden of transitions between health-care institutions, and lack of communication between health-care professionals.5 Further, Lippiett’s (2019)5 systematic review highlights that frequent hospitalizations compound treatment burden, with hospital stays reported to be confusing, and disruptive.

Although research has begun to shed light on how COPD patients experience treatment burden, most of what we know is limited to personal experiences of individual patients. Perspectives of carers are largely missing, despite carers being acknowledged as a critical source of support for patients.20 Finally, little is known about the perspectives of respiratory physicians (pulmonologists or chest physicians), who play a key role in the treatment and management of COPD. This study seeks to understand important areas of treatment burden from patients’ and carers’ experience, and respiratory physicians’ perspective to identify what should be discussed during a clinical encounter. This may help empower patients and enable clinicians to tailor their care accounting for patient’s personal values, preferences, and capacity to cope with their treatment workload. Using an innovative method of nominal group technique, the aim of this study was to identify and prioritise areas of treatment burden that should be discussed during the clinical encounter from a patient, carer and a respiratory physician perspective.

Materials and Methods

The nominal group technique was used as the primary research methodology in this study. Developed by Delbecq and Van de Ven as a qualitative research technique, the nominal group technique aims to identify strategic problems and develop appropriate and innovative solutions.21 The technique allows for many ideas to be developed, avoids “quick” decision-making, has a high degree of task completion, and anonymously measures the relative importance of the ideas that are developed.22 Although time consuming and regimented, the nominal group technique is particularly useful when investigating health-care problems and producing action-based solutions.23 It has been used widely in chronic disease research, particularly around priorities for treatment outcomes,24 unmet needs,23 and patient-centred care.25 Compared with traditional focus group interviews, nominal group technique provides the opportunity for all participants to express their ideas and democratically vote on their priorities rather than have discussions dominated by outspoken participants.26 Informed consent, including publication of anonymised responses, was obtained from all participants prior to data collection, and Gold Coast Hospital and Health Service Human Research Ethics Committee provided approval for the study (LNR/2020/QGC/61202). The study also complied with the Declaration of Helsinki.

Participants

Purposeful sampling was used to recruit participants diagnosed with COPD for the study. Eligible participants were contacted from lists of outpatient clinics, entries in the electronic medical record, and direct referrals from respiratory physicians and nurses working at the Gold Coast University Hospital (GCUH). Unpaid carers, who provided care to people with COPD, were recruited in a similar way. Respiratory physicians practicing in different Australian hospitals were contacted in person or via email by one of the investigators.

After signing the study consent form, a research assistant collected data on COPD patients’ characteristics: age, sex, marital status, number of people living in the same household, employment status, carer arrangements, type and year of diagnosis of chronic disease(s), number of medications (per day, per week, per month), estimated time spent on treatment work for disease management, including taking of medication, device maintenance, attending medical appointments, filling pharmacy scripts, monitoring health, diet, exercise and other activities (per day, per week, per month). Patients were also asked to rate on a four-point Likert-scale how burdened they currently felt about all the work they had to do for their healthcare: not at all burdened (0), somewhat burdened (1), significantly burdened (2), overwhelmingly burdened (3).

For carers, the following information was collected: age, sex, marital status, relationship to patient they care for, duration of carer’s duties, estimated time spent on helping patient with treatment work for disease management, including preparing and administering medication, accompanying patient to medical appointments, going to pharmacy to fill patient’s scripts (per day, per week, per month). For physicians, we collected information on specialty and location of practice.

Procedure

Nominal group technique sessions were conducted in person at the GCUH or online using a video conferencing platform. Sessions lasted between 2.5 and 3 hours (with a break), and participants attended one session. All the nominal group sessions were audio recorded, and the discussion following the ranking of treatment burden challenges was transcribed and de-identified. The sessions followed the below structure:

  1. Introduction: The aim of the study and nominal group process was explained.
  2. Silent generation of ideas: Participants were encouraged to record, in silence, as many ideas as possible to the following questions.
  3. Patients: What issues related to the patients’ burden of treatment do you think should be discussed between doctor and patient?
  4. Carers: What issues related to the burden of treatment do you think should be discussed between the doctor, you as the carer and the person you are caring for?
  5. Respiratory physicians: What issues related to patients’ burden of treatment do you think should be discussed between doctor and patient/carer? Please think about the elements of treatment that are likely the most burdensome to your patients, and why you think it would be good to discuss these during a consultation.
  6. Round Robin: Each idea was elicited in a round robin approach, meaning that everyone had an opportunity to contribute one idea at a time, until all ideas were exhausted. One researcher recorded the ideas verbatim on a screen visible to all participants. Some new ideas were also generated during this process.
  7. Clarification: All participants were asked to clarify ambiguous ideas to ensure that the meaning was clearly understood by everyone. Similar ideas were then grouped together if there was consensus, and a code was allocated to each idea for ranking reasons.
  8. Ranking: Participants selected their top five ideas, and then ranked them in order of priority, with five marks allocated to their top, and one mark to their lowest, priority. The top five ideas for the whole group were determined by adding up individual votes.
  9. Discussion and solutions: The top five priorities and the potential solutions that could be implemented were discussed together as a group.

Analysis

Quantitative and qualitative data were generated by the nominal group technique sessions; (a) quantitative ranking of treatment burden priorities, (b) qualitative discussions of priorities and potential solutions. Data analysis followed the following process:

  1. Individual group scoring/ranks was reviewed by the entire research team.
  2. Where there are potential overlaps, similar priorities were grouped together under an “umbrella theme.” For example, trouble with parking at the hospital and waiting times for specialist appointments were grouped under the umbrella theme of “access to healthcare”. Umbrella themes were cross-checked by another research team member for validation.
  3. The scores (votes on priorities) for each nominal group session were calculated according to the method based on McMillan et al.27 Specifically:
  4. The scores for all priorities combined under the same umbrella theme were added up from all three patient nominal group sessions, resulting in an aggregate score for each umbrella theme. For physicians and carers, scores for all priorities combined under the same umbrella theme were added up from the one session nominal group session.
  5. Frequency of voting indicated how many times a particular theme was voted for or how popular the theme was.
  6. Ranked priority was the overall priority score for each umbrella theme based on the aggregate scores. If there were equal aggregate scores, frequency of voting was used as secondary ranking criterion with more votes resulting in a higher ranking.

Results

Overall, five nominal group technique sessions were conducted (n = 31); three sessions with patients (n = 18), one with carers (n = 7) and another one with respiratory physicians (n = 6). The mean age of patients was 70.4 years (range = 59 to 82 years), including 13 females (72%), while the carers’ mean age was 70.1 years (range = 54 to 85) including five females (71%). Patients were on average taking 10 pills and/or inhalers per day (range = 3 to 20). In addition to COPD, recruited patients were diagnosed with other chronic conditions including anxiety, diabetes, heart failure, thyroid disease, and asthma. All patients were retired, some because they could no longer work due to their COPD. On a four-point Likert-scale of degrees of treatment burden, nine patients reported being significantly burdened and nine felt somewhat burdened.

For carers, most (n = 5) were spouses/partners of the care-recipient and three were still in paid employment. Some of the assistance provided by the carers included transport, medication management, diet, paperwork/administration, and financial management. Physicians were all specialists in respiratory medicine who worked in different hospitals and private practices in the state of New South Wales, Australia.

Thematic analyses of the nominal group transcripts generated nine umbrella themes. Table 1 lists and describes each of the nine umbrella themes. Top priorities for patients, carers, and the respiratory physicians are presented in Tables 2–4 respectively.

Table 1 Description of Umbrella Themes

Table 2 Priorities for COPD Patients (n = 3 Groups) 18 Participants

Table 3 Priorities for Carers (n = 7 Participants)*

Table 4 Priorities for Respiratory Physicians (n = 6 Participants)

Education and Information

Across all three COPD patient groups, education and information emerged as the most important treatment burden theme to be discussed in clinical encounters (Table 2). Education and information emerged as the third most important priority for carers (Table 3) and fourth for respiratory physicians (Table 4). For patients, they needed information about and referral to services which provide support with symptom management and education about treatment options. Considered and personalized discussions between the patient and respiratory physician were deemed more important than generic written information:

I think it’d be ideal to have someone who can consult with you and give you a bit more information than just a pamphlet about what’s available. (Patient)

Carers, on the other hand, preferred this information to be given in writing:

Maybe a folder that would at least help with the diet, with medications or allergy or things that reacts with other medications. That might be something that we can go back to ask the doctor. (Carer)

There were extensive discussions about health professionals (including respiratory physicians) being too busy and not spending enough time with patients to explain their symptoms and treatment options. Some participants reported that they found out about support services from friends and other people. Rather, they would have preferred this to be discussed during a consultation. When education about treatment and self-management were not offered to the satisfaction of patients, other channels and sources of support were utilized:

I’m lucky I’ve got a really close friend who’s a really good physio … and she showed me different breathing exercises to do. I mean that sort of education is really good. (Patient)

Patients also believed that health professionals should be empathic and patient when conveying this information. Patients felt the personal responsibility to invest time into learning about the condition, the management, and be ready to ask the relevant questions to their doctor:

I think also, you need to be prepared for when you go to the doctors to have your questions ready, written down. (Patient)

This was reiterated by respiratory physicians, who said that patients often do not voice their concerns nor indicate that they are depressed or anxious, which makes their job harder. They agreed that all health professionals needed to be good listeners and probe patients for further information:

I think you can jump in with a question and probe a little deeper, and if you’ve known the patient for a little while, you can read them, and even if you’ve met them for the first time, you can read body language and with symptom burden. (Physician)

Finally, all groups agreed that the information given by all health professionals, including the hospital paperwork, needed to be simple and easy to understand.

Regarding solutions, it was suggested that a checklist could be developed to assess patients’ physical, psychological and social level of function as well identify their information and education needs specific to COPD, its progression and communication preferences. A need for a designated person with time and good interpersonal skills to 1) provide this holistic, personalized information, 2) help them navigate the system, and 3) identify suitable services was also discussed as a solution:

Someone within the practice who has the information to be able to guide you to different services. (Patient)

Carers agreed and extended this sentiment to also include the designated person having an advocacy role to support the patient and family through their COPD journey. Respiratory physicians acknowledged that multiple health-care professionals can provide COPD specific information and education for example respiratory nurses and pharmacists. The respiratory physicians emphasized the need for there to be more specialized nurses in community outreach positions.

Accessing Healthcare

Do you have to wait until you’re so low that you go back to hospital?. (Patient)

As illustrated by the above quote, COPD patients perceived difficulties with accessing treatment as a source of treatment burden. Although it did not emerge as one of the top five priorities for carers, this was the second most important priority for patients and the most important priority for respiratory physicians for discussion during clinical encounters. Physicians also acknowledged the difficulties with accessing health services, particularly with long waiting times for specialist appointments and pulmonary rehabilitation:

I think access is an issue, probably the waiting list (Physician)

The travel difficulties that many patients experienced were also commented on by the physicians. Disappointment and frustration were clearly expressed by patients when talking about issues of healthcare access. There was acceptance that insufficient government funding contributed to burden associated with accessing healthcare.

… you’ve got to wait another two years, before you’re eligible for it, because of the funding. Well two years down the track, Jesus, you wouldn’t know where we were going to be. (Patient)

Despite not being a top five priority, accessing healthcare was nevertheless discussed in the carer group, particularly in the context of the Coronavirus disease 2019 (COVID19) pandemic. Carers’ discussed how the COVID19 pandemic negatively affected the ability to access healthcare in a timely manner:

During the COVID when Brisbane was going through the lockdown, I was not allowed to go into the hospital. I had to sit outside the hospital in the rain for five hours. (Carer)

Beyond the straightforward solutions of providing patients with a choice of appointment timeframes, access to free or subsidized community transport, and the need for long-term pulmonary rehabilitation programs that are easily accessible, patients and physicians discussed alternative, virtual delivery models of care. Physicians posited a hybrid model of care for the delivery of pulmonary rehabilitation programs including online group-based, and one-on-one private sessions. It was commented that younger patients may appreciate the opportunity to exercise via online social media or communication platforms while older cohorts can continue with more traditional group based, face-to face programs and supplement with one-on-one sessions as required.

Worry About COPD Treatment and Prognosis

Worrying about COPD treatment and prognosis was burdensome, and patients wanted to share their experiences with physicians. This theme emerged as either second or third most important priority across all groups, although it was a higher priority for carers and physicians, compared to patients. Although, for one of the patient groups (see Table 2), it was the highest priority. Respiratory physicians discussed how people with COPD worried as they made significant lifestyle modifications, particularly in their home environment, but at times did not have the capacity or capability to undertake the work. There was also discussion on how some patients became further stressed and worried during treatment or medical tests:

It can feel quite stressful. You’ve got this person saying, keep going, keep going, keep going [lung function test], and that causes them anxiety. (Physician)

For patients, one aspect of this type of burden was worry about their condition worsening and requiring intubation, with one participant voicing concern and anxiety which resonated across the patient groups:

That’s one of my biggest fears … I’m scared to death of it [intubation]. (Patient)

Many expressed worries about their COPD worsening and end-of-life treatment options and wanted their respiratory physicians to discuss these issues with them openly and honestly. Currently, such discussions were mainly held with social workers and other allied health staff but, according to patients, should also be proactively broached by the treating physician. The importance of having conversations about advanced care directives and formally documenting them were also highlighted by carers. One carer discussed a personal family experience:

I just know that when my dad was in ICU [Intensive Care Unit] following heart surgery and he didn’t come through. My mum was not listed as being allowed to speak on his behalf. I stood there in the ICU and said he has not signed a DNR [Do Not Resuscitate], you guys need to do everything you can. But there was nothing on paper. (Carer)

As a solution to minimise this type of burden, patients, carers and respiratory physicians all agreed that clear and empathetic communication about the condition, its prognosis, treatment plan, goals and outcomes were required. Patients wanted their GP or respiratory physician to initiate conversations about prognosis and the management of advanced symptoms, end-of-life care and resuscitation orders. Patients and carers both thought that it was important to be provided with information about their health and prognosis even if the news is not positive than affirmative action is taken in response.

If you are giving a nasty prognosis, follow up with would you like a referral to the social worker, the psychologist, the chaplain, someone who helps you process it?. (Patient)

Disconnect and Lack of Coordination of Care

COPD patients frequently discussed the difficulties they experienced when health-care services and providers were disconnected and offered little continuity and coordination of care. Patients ideally wanted consistent messaging, information, and guidance about how to manage their COPD and continuity in the health-care professionals they consulted. When asked what they wanted to be a discussion point in a clinical encounter, one patient responded:

Better communication obviously between specialists, doctors, overall. (Patient)

There were considerable discussions around the lack of coordination of care between respiratory physicians working at the hospital and family physicians. According to one patient, it was mostly the hospital-based specialist physicians not sufficiently communicating with their family physician rather than the other way around:

As far as the COPD part goes, no they’re in the dark. The hospital doesn’t forward that stuff back to them automatically. (Patient)

One participant voiced her frustration on this issue:

If they’ve got it on a computer, all they’ve got to do is put in an email address, and press send. How hard can that be?. (Patient)

Another participant echoed this frustration, adding that the e-health system should have addressed this issue, only if physicians in her words, “learnt how to use it”. Relocation of respiratory physicians or GPs (General Practitioners) was also a problem and contributed to potential disconnect between physicians and other health professionals. Despite not being happy with their care coordination, the patient groups did however acknowledge that physicians may not have the time to adequately communicate with the family physician:

I think the problem is, the specialists are so busy, they’re not going to have a great deal of time to communicate very much with the GPs. (Patient)

For carers, there was also a sense of disconnect in communication between the respiratory physician and the nurse, with carers’ expressing a desire for better communication and coordination between the two. In the respiratory physician group, although the importance of coordination between them and the family physician was discussed, this theme did not emerge in their top five priorities.

One solution for reducing the burden of disconnected care was having specialist referrals automated, which would overcome patients having to visit their GP for a new specialist referral. Further, if appointments and tests could be arranged to occur on the same day, it could save patients having to attend the hospital on multiple occasions:

I used to have an x-ray, blood test, scan, if necessary, all lined up, one after another, so I only had to make one visit to the hospital for one day. (Patient)

Medication Related Burden

Burdens related to medicine use were the fourth and third most important priority for patients and respiratory physicians, respectively (Tables 2 and 4). Although patients did acknowledge the burden of having to take multiple medications and experiencing side effects, most of the discussion on medications were around the correct use of medications and the need for regular medication reviews. Patients wanted their respiratory physicians to spend time discussing and reviewing their medications to ensure that they were being used correctly and still indicated:

Because I take that many tablets and puffers, that I’m sure it can’t be doing my health any good long term. (Patient)

The importance of communication and continuity around medication prescription between the GP and the respiratory physician was also discussed:

… when they give you different medications, I don’t know whether they actually look back on what they’ve already given you, or do they know what you’ve taken?. (Patient)

Respiratory physicians were also aware of the burden patients experienced because of medication use, with one physician pointing out his own personal experience:

To take medications every day is a burden. We all just write up prescriptions but from a personal point of view, I hate taking medicines every day and it’s something hard to do. (Physician)

Although medication-related burden did not emerge as a top five priority for carers, there were discussions in the group around the ways carers’ jobs could be made easier:

I guess every patient is different. They are on different treatment. They take different medications. So is there any like say they could give you a printout. (Carer)

Another carer added:

Maybe a folder that would at least help with the diet, with medications or allergy or things that reacts with other medications. (Carer)

Regular and routine review of medications was the main solution that was proposed by patients. GPs, respiratory physicians and pharmacists could all undertake a medication review. Again, there was acknowledgement that physicians may not have the time to adequately discuss and review medications during a short consultation. One participant suggested that community pharmacists could assist.

Patients and carers felt that there needed to be more responsibility taken by the person who is prescribing the medication to ensure all other medications are also necessary, check for interactions and communicate any changes in a timely manner to the patient’s GP. Carers wished to be provided with a summary of the patient’s medications, its indication, interactions and side-effects. From the perspective of respiratory physicians, solutions to minimize the burden of medications included tailoring prescriptions to a patient’s specific needs and context:

The right device for the patient, but also communicating it back to the referring GP as to why that particular device and combination of medications was chosen. (Physician)

Carers’ Needs

Issues associated with being a carer, such as their involvement in treatment decisions and the burdens caring for the care-recipient, were the highest priority for the carer group (Table 3). However, this theme did not emerge as a priority for physicians and emerged as a priority only during one of the three patient group sessions (not top five). Nevertheless, there was recognition in the patient and physician groups that carers should be involved in the care of the patient wherever possible. Regarding involvement in treatment, carers’ believed that the physicians should consider patients’ carers and other family members, and involve them in the care process:

I think it’s not just looking at the patient as the patient but realising the patient has people around them. It’s a holistic approach I suppose is required. (Carer)

One carer suggested that their involvement had increased treatment efficacy, especially when the patient was unable to fully participate in decision-making about treatments:

Because the doctor knows that he has memory issues and when doctors are asking him questions, his answers are not what doctors are expecting. So, my presence there is helpful to doctors. (Carer)

Although involvement of carers was discussed positively, carers did acknowledge potential privacy and confidentiality issues:

… sometimes the doctors are also very careful about the privacy issues. (Carer)

One carer, who was not invited into consultation by the care-recipient’s physician suggested the following, when asked what she preferred to have happened:

The doctor to have said to him, is your partner with you or your wife with you and if so invite her in because she needs to be across what I’m saying. (Carer)

The burden and struggle of being a carer was also discussed in the carer group. One participant, who felt lonely and isolated in her caring role, commented:

I wasn’t able to own up myself what I was going through or even tell anyone what I go through with my husband. (Carer)

Providing a space for carers could go to in the hospital to find solace, rest and re-energize (while the person they care for is hospitalized) was identified as a solution to reducing the burdens carers experience. The idea of a “chronic condition” support group was also favourably received by several members who had found attending the nominal group technique session cathartic. Carers, however, were not aware of any such support groups, nor did they know how they could find out if any existed.

Discussion

This study is one of the first to concurrently focus on treatment burden priorities and potential solutions among COPD patients, carers and respiratory physicians. For example, for patients, the most important priorities were receiving more education and information during the clinical encounter, difficulties they experienced with accessing healthcare and worry about COPD treatment and prognosis. In contrast, respiratory physicians believed burdens associated with accessing healthcare should be the first priority for treatment burden discussions between the physician and patient/carer, followed by education and information, and then discussions about worry. Carers were aligned with the priority to discuss worry about COPD treatment and prognosis, and the need for education and information emerging as the second and third priority, respectively. In contrast to patient and physician groups, carers’ first priority was carers’ needs.

The results indicated that the education and information needs of patients may not currently be fully fulfilled in a clinical encounter. There is evidence from other studies to suggest that many COPD patients struggle with managing their condition because they lack basic understanding of their illness and its treatment.18,28 For example, Bauer et al, in their qualitative study, found that patients voiced frustration with COPD-related information and support received during clinical encounters, particularly at the time of diagnosis.18 The need for education and information has been identified as a priority in many other chronic conditions, and patients’ understanding of their illness(es) and treatments is an important determinant of engagement with health advice and treatment.29 Perhaps, the desire for better education and information reflects COPD patients’ need to feel in control of their condition and presents an opportunity to be heard in the context of all the worry they experience living with and treatment of COPD. We recommend that health professionals simplify treatments where possible, provide written and verbal explanations of treatment tasks to their patients, and make sure that patients have a basic understanding of their illness and its treatment.

Education and information emerged as the fourth most important priority for physicians. Although this may be construed as being less of an important priority for physicians than patients, the results must be interpreted in context. Only one session with physicians was conducted as opposed to three with patients and while this theme emerged as the most important priority for two of the patient groups, it was the fourth most important priority for the other. Either way, the need for education and information emerged as a top five priority for physicians and for patients signalling a common perception of its importance.

Furthermore, difficulties around access of healthcare have been described as a major source of burden for patients with COPD,16 and patients with chronic disease in general.13,30,31 Indeed, there are many documented examples of patient’s having to wait months or travel long distances to seek specialist treatment.12 The solution discussed by respiratory physicians regarding the hybrid model of care, specifically, the delivery of pulmonary rehabilitation programs for improving healthcare access, warrants further research attention. During the COVID-19 pandemic many patients were undertaking pulmonary rehabilitation online but future research is required to determine its effectiveness compared with the traditional model.

For the burden associated with worrying about COPD treatment and prognosis, there was mostly agreement across all participant groups. Physicians and carers ranked this as the second most important priority whereas the patients ranked it as the third most important priority for discussion in a clinical encounter, although this was ranked as the highest priority for one patient group (group 2). While the reasons for this could be complex, one possible explanation of this variation could be that two of the six patients in this group (group 2) were using continuous positive airway pressure treatment for an average of 7 hours each night, while this was 4.7 hours for group 1 and none for group 3. The burden associated with worrying about COPD treatment and prognosis is not surprising given COPD on its own is recognized as a “difficult” illness, with many people experiencing high symptom burden, difficulties performing everyday tasks, social isolation and making lifestyle changes.3,18 There is also evidence to suggest that patients struggle to follow health professionals’ treatment advice (eg, following diet advice and restrictions) and worry about their condition worsening.32 Clearly, treatment advice needs to be given in the context of specific circumstances and capacity of patients and carers to follow that advice.

Regarding disconnect and coordination of care, our results seem to confirm previous research that patients and carers find it difficult when there is a lack of teamwork and continuity of care between their health-care professionals.4,33 According to Haggerty et al’s34 seminal work on continuity of care, our results suggest that patients and carers preferred informational continuity, over management and relational continuity. That is, they wanted information on past events and personal circumstances around COPD and its treatment to be consistently used to inform current care and decisions. Haggerty et al34 suggests that information can be disease- or person-focused but it is equally important that it reflects knowledge of patients’ preferences, values, and context. However, in our study, the results indicated that patients and carers struggled with even the basic continuity around disease information and wanted their respiratory physicians to be aware of this.

Finally, although only one group was conducted with carers, our results confirm the widely reported frustration that unpaid carers experience. Research has frequently indicated that the burden a patient experiences is often inseparable from the carer’s burden.20,35 It is also important to remember that many carers have chronic health conditions themselves, which means that they are faced with the overwhelming work of providing care for somebody else while at the same time managing their own health condition(s). Despite providing a valuable role in society, our findings confirm that carers’ need may still not be sufficiently recognized and addressed by physicians and the broader health system. As discussed in the group, formal mechanisms of recognition, such as a carer card, could potentially minimize treatment burden and increase the quality of life of both the carer and the care-recipient. Other existing support strategies, such as accredited training, no interest loans for medical expenses, discount vouchers, etc. can also be more strongly advertised.

Limitations and Strengths

Although our findings offer a unique perspective into treatment burden of patients with COPD, they are based on a small group of participants. While we intended to recruit more participants from diverse backgrounds into each of the nominal group sessions, data collection was conducted during the COVID19 pandemic, and it was challenging to conduct group sessions with research participants in a health-care setting with changing regulations. The data reflect the opinions and experiences of a small group of mostly females, in one treatment centre and may therefore not be generalizable to other people and settings. Nevertheless, we believe that many of the raised issues are relevant to many patients with COPD, their carers and physicians, as they align with the findings in previous studies of patients with chronic diseases.

During the nominal group process, discussion among participants was limited, which may have inhibited the full expression and development of ideas. The decision to condense the priorities into umbrella themes, is a potential limitation of the nominal group technique. This may have also biased the results by potentially having different priorities contained under a particular theme. However, team discussions and consensus agreement during the development of the umbrella themes would minimize the risk of this bias.

The use of nominal group technique to elicit the priorities of participants is a key strength of our study. This data collection strategy made sure that the discussion was not dominated by one or two outspoken participants. Everyone’s voice was heard, thereby empowering, and motivating them to discuss their experiences and expectations of what they wanted discussed in a clinical encounter. Finally, the nominal group technique allowed us to compare the priorities between three different types of participants (patients, carers and physicians) with their unique views and priorities regarding treatment burden.

Conclusion

This study provides an insight into the preferences of treatment burden topics that patients, carers and physicians wish to discuss in a clinical encounter. Challenges around accessing healthcare, the need for better education and information, and the worry caused by COPD treatment and prognosis, emerged as top priorities. Carers’ needs were only identified as a priority by informal carers. Understanding and creating opportunities to discuss these issues in the clinical encounter is important to not only reduce treatment burden, but also improve health outcomes and quality of life for those living with and affected by COPD.

Acknowledgments

We would like to acknowledge Helen McEvoy with project management and Dr Bajee Krishna Sriram for assisting with recruitment. We would also like to thank all the participants for sharing their thoughts and priorities.

Funding

This study was funded by a grant from the Gold Coast Health Collaborative Research Grant Scheme (application ID RGS20190034). CCD had salary support (independent of the study) from the Australian National Health and Medical Research Council (NHMRC) (application ID APP1123733).

Disclosure

Adem Sav reports grants from Gold Coast Health Collaborative Research Grant Scheme, during the conduct of the study; and grants from the Gold Coast Health Collaborative Research Grant Scheme, outside the submitted work. Claudia C Dobler reports grants from Gold Coast Health and Australian National Health and Medical Research Council (NHMRC), during the conduct of the study. The authors report no other potential conflicts of interest in this work.

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Residents of Liverpool, Sefton, St Helens and Knowsley suffering from the long-term effects of coronavirus can seek assistance with their recovery thanks to Mersey Care’s Long COVID Service.

Mersey Care’s Tier 3 Long COVID Assessment and Treatment Service is open in all four areas to help people who have had COVID-19. At clinics, people can be seen by different members of the team. Each patient will have different issues and the aim is for them to see the right people to help meet their needs.

Members of each team include a GP, community matron (a very experienced nurse) or a care coordinator, occupational therapist, social prescriber, psychologist, and pulmonary rehab physiotherapist.

Phil Cumberlidge, a GP and a member of Mersey Care’s Long COVID service, said: “Our focus is on rehabilitation and support. We aim to help patients regain a normal life.”

Since opening, the service has received 1,337 referrals with 209 patients assessed within six days of the service receiving the referral. Many patients have been successfully referred onto intermediate, social or community care.

Referrals to clinic are by GP only and clinics are designed to help people who still have symptoms related to a COVID infection after 12 weeks. The aim of the clinic is to identify what symptoms a person is experiencing and how this is affecting them day to day. The service helps them find resources and/or treatments to manage these symptoms effectively so they can rehabilitate to living a fulfilling life.

Teams are keen to share decision making as there may be choices available regarding whether to have treatment, which treatment to choose, and whether treatment should be continued. They need to know what is important to the patient so that they can help them make the right decision about their healthcare.

Symptoms of Long COVID include fatigue, breathlessness, anxiety and depression, palpitations, chest pains, joint or muscle pain, not being able to think straight or focus (‘brain fog’), dizziness, persistent cough, loss of taste or sense of smell.

If you think you have, or know someone who may have Long COVID, and you live in Liverpool, Sefton, St Helens or Knowsley, speak to your GP and ask to be referred to the service.

Further information about the service can be found on Mersey Care’s website.

For further information please contact: Myles Hodgson, Media Manager, 0151 473 2797 [email protected] or Communications on 0151 471 2336.

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You may have noticed pulse oximeters getting a lot of press recently in light of coronavirus. These simple devices are available on the high street for relatively low prices and are also included in many fitness wearables. But what do they do and what's the connection with the ongoing pandemic?

In a New York Times article, US doctor Richard Levitan argues that pulse oximeters could be used to detect breathing problems sooner in Covid-19 patients, so they get treatment earlier, thereby reducing the risk of developing more severe symptoms. He explains that by the time patients actually notice they're having trouble breathing, they often require ventilation.

So are these cheap devices the magic bullet for treating coronavirus? Unfortunately, it's not as clear cut as that, because, as Levitan warns, they’re not 100% accurate and this is especially true of some cheap consumer devices. As such, if you’re worried you may have coronavirus symptoms, it goes without saying that you should consult a qualified professional before anything else.

In the meantime, to learn what pulse oximeters do, what their shortcomings are, and how to interpret the data they record, read on. After this, you will find a selection of pulse oximeters that you can buy today.

How to choose the best pulse oximeter for you

What is a pulse oximeter?

A pulse oximeter – sometimes referred to as an SpO2 sensor – is a sensor that uses light to measure your pulse and “sats”, or how saturated with oxygen your blood is. Once the preserve of medical settings, they are increasingly found in fitness trackers and even smartphones, letting you check your sats quickly and easily, wherever you might be.

Blood oxygen saturation is given as a percentage, with readings above 95% considered to be normal and healthy. Low blood sats can be associated with a number of medical conditions including anaemia, sleep apnoea, COPD and pneumonia.

How reliable are they?

Calibrated pulse oximeters offer a cheap, non-invasive method of assessing a patient’s blood oxygen saturation but come with a number of caveats. To name a few pitfalls, cold fingers, low blood pressure and ambient light can all result in inaccurate readings.

Because they’re susceptible to giving unreliable results, it’s best to look out for trends in your blood sats rather than fixating on individual readings, Michael S. Lipnick, M.D., assistant professor of anaesthesia and critical care at the University of California, San Francisco tells ConsumerReports.org. In other words, if you notice unusually low readings compared to your baseline, then it’s worth taking note.

However, other experts warn the US consumer site that it’s always best to interpret results with a certain amount of caution. Indeed, they say a pulse oximeter could even give a false sense of security if you’re struggling to breathe but the device gives a normal reading.

When readings from medically approved devices need to be taken with a pinch of salt, it goes without saying that the same is true of those in fitness wearables and smartphones, which won’t typically have such certification. Fitness wearables, for instance, offer unreliable readings because they’re worn on the wrist, where they’re free to move around and won’t necessarily be assessing the same blood supply as you’d find on a fingertip.

Garmin recommends that, to get the best readings, you should make sure the device is snug on your wrist and that you keep it still at the same height as your heart. Irrespective of whether you manage this, though, both Fitbit and Garmin’s mobile apps have prominent disclaimers that they’re not intended for medical use, instead recommending you see your doctor if you have any concerns about your SpO2 readings.

For smartphones, the evidence is even more damning. Indeed, a study from April 2020 concludes that "it is not physically possible to measure SpO2 using current smartphone technology."

Is there any benefit to using a consumer pulse oximeter if I suspect I might have coronavirus?

That’s not for us to say. As Levitan argues in his New York Times piece, anyone using a pulse oximeter should consult their doctor first. If you have a consumer pulse oximeter or a fitness wearable that measures blood oxygen sats, there’s no harm in asking whether they believe there’s merit in using the data from the device.

However, it’s worth highlighting that at the time of writing, NHS advice remains the same regarding coronavirus. If you have a high temperature or a new continuous cough, then you should get a test to check if you have coronavirus, and self-isolate in your home until you get your result (anyone you live with should also stay at home too).

The best consumer pulse oximeters to buy

1. Kinetik Wellbeing Finger Pulse Oximeter: The best budget pulse oximeter

Price: £20 | Buy now from Argos

A certified class IIa medical device used by NHS Scotland, this pulse oximeter has received overwhelmingly positive reviews from happy customers, with 87% of buyers giving it a four or five-star rating on Amazon. Worn on the finger, it promises readings in a matter of seconds and its lanyard means you can always keep it nearby.

Buy now from Argos


2. Salter Finger Tip Pulse Oximeter: The best oximeter from a known brand

Price: £40 | Buy now from Amazon

Salter is a household name when it comes to kitchen scales as well as health products such as blood pressure monitors, so it’s no surprise that it has its own oximeter. And according to customer reviews, it’s a trustworthy product, too – with relatively accurate readings and a straightforward user interface.

Like the other non-wearables on our list, the Salter oximeter works by putting it on your fingertip for a few seconds. The device will record your oxygen saturation, pulse rate, perfusion index and pulse bar while displaying a live graph onscreen.

The best fitness trackers with pulse oximeters to buy

N.B. Although some of Fitbit’s wearables have SpO2 sensors – including the Charge 3, Charge 4, Ionic, Versa, Versa Lite and Versa 2 – it’s not currently possible to use any of them on the fly. Instead, they take measurements while you sleep, and measure SpO2 variability instead of giving you a percentage rating. For this reason, we’ve not included any of these in the following list, instead opting for devices that give you instant readings.

1. Honor Band 5: The best budget fitness tracker with a pulse oximeter

Price: £23 | Buy now from Amazon

At just £30, the Honor Band 5 is only £10 more than the budget pulse oximeter listed above, yet it also doubles up as an activity tracker, keeping tabs on your steps, sleep and heart rate throughout the day. To check your SpO2, swipe to the appropriate screen, tap it and the tracker will start measuring your blood oxygen levels.

Read our full review of the Honor Band 5 here

2. Vivosmart 4: The cheapest Garmin with an SpO2 sensor

Price: £100 | Buy now from Argos

Garmin’s Vivosmart 4 is the cheapest Garmin wearable that lets you track your blood oxygen saturation levels – and it's a pretty great fitness tracker, too. To check your SpO2 levels, tap the menu button, swipe to the icon with a heart and tap it. After this, tap the Pulse Ox symbol and the tracker asks you to keep still while it takes a reading.

Read our full review of the Garmin Vivosmart 4 here

3. Garmin Fenix 6 Pro: The best premium sports watch with SpO2 tracking

Price: £450 | Buy now from Argos

Garmin’s Fenix 6 Pro is the best sports watch we’ve ever tested and among its plethora of features is SpO2 tracking. You can choose to enable the feature during sleep or all day, but just bear in mind that the latter results in a hefty battery life penalty. When enabled, simply navigate to the Pulse Ox widget and the watch starts taking a reading within seconds.

Read our full review of the Garmin Fenix 6 Pro here

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