Dear,

I don't know which test is used in your patients, but actual test in France seems to have a sensibility near to 60-70% so patient could be false negative for coronavirus testing. Positive predictive value of the test seems to be high.

I think you should maintain barriers protection advices and considered them to have coronavirus or another transmissible disease (diseases existing before the coronavirus epidemic are still there).

Hope this could help

This virus has an affinity for the respiratory system. Strenuous exercise has been shown to acutely depress the immune response in healthy individuals, with a positive rebound ~4 hrs later. Prolonged bed rest has a catabolic effect on muscles. Ergo the most sound advice for a suspected person is to remain active, perform exercise that would engage large muscle groups using resistive training with moderate weights/loads (with a focus on muscle hypertrophy). Avoid excessive cardiovascular activity, but do engage in light to moderate cardiovascular exercises such as walking or light cycling. Follow a healthy diet and maximize sleep.

Roberto Sandoval sir, can we add Diaphragmatic Breathing Exercise and Segmental Breathing Exercise; so that these exercise can help the patient to deal with dyspnea

diaphragmatic breathing is certainly a good option. Note that the cilia cells in lungs are most affected, leading to poor removal of secretions and dyspnea. Thus, you may also include postural drainage of affected lung segment(s).

As a Therapeutic Yoga Specialist, Yoga research investigator and Doctor of physical therapy... I would recommend developing a solid foundation by initiating instruction in gentle breathing activities as tolerated ..beginning with gentle equal length breathing... then slowly encouraging a gentle lengthening of the exhalation. This can help to reduce anxiety, begin to balance the nervous system , encourage oxygen saturation and provide a sense of empowerment for the patient. As this is tolerated —-as the foundation to treatment, then I would introduce basic movements that are performed (stretching, isometrics, to Gentle calisthenics that are performed with emphasis on maintenance of smooth breathing during participation in said activities. Here is an example. https://youtu.be/ePwUG_OHcyY

https://www.youtube.com/watch?v=EQlFeBLrbS0

This video gives a good demonstration of a breathing technique to use to improve lung function.

What else you should do if you get Covid-19.

These recommendations apply to young adults with no medical conditions. If you have medical conditions or any concerns it is best to speak to your doctor for specific advice. This is particularly important if you have a pre-existing lung condition or are taking immunosuppressant medications.

Prepare for a nasty chest infection.

Things you have to hand

• face tissues,

• Acetaminophen; for a fever over 38°c, take acetaminophen rather than Ibuprofen.

• Generic, cough medicine to thin mucus (check the label make sure that it does not contain paracetamol; otherwise you could double dose and get side effects)

• vaporub for your chest is also a great suggestion.

• humidifier would be useful; however, turning on a hot shower and breathing in the steam in the bathroom may also help.

• Food: soups are ideal

• Drink: stay well hydrated, water is fine

• Rest and do not leave your house. You could be infectious for fourteen days. Avoid elderly people and those with pre-existing health conditions.

• Wear gloves and a mask to avoid transmitting the infection

• If you do not live alone. Isolate yourself in your bedroom. Ask those you live with to leave things outside to avoid contact.

• Wash your bed linen and clothes frequently. Clean your bathroom with sanitisers.

The vast majority of Covid-19 cases in healthy adults can manage at home with rest, hydration, acetaminophen, cough medicine.

Go to hospital if you are having trouble breathing or your fever is very high (over 39°C) and not settling with acetaminophen and cooling with ice packs or if you are worried, in distress or feel your symptoms are getting worse

• Hello.
• The persons Alone in your house will eable to do some breath slowly and make it in different position. Breath as slowly they can for 10 repetitions.
• They can do this lying on bed, then lying on each side, then sit on the edge of the bed.
• They can also cough to spit out pulmonar secretion
• if they have any.

The Covid-19 is a new disease and experience for all of us world-wide. So there is no validated experience regarding a home-protocol for exercise therapy now-a-day. Perhaps it would be convenient to recommend a feasible physical activity program trying to accomplish the beneficial effects of an exercise program taking into account the particularities of the patient, his or her familiy and their community; and always avoiding the contagious possibilities.

Dear Darshan,

Inpatient facilities and many home services manage patients who require physical therapist services that are vital to their recovery or maintained health. There are many resources on various aspects of the management of patients with COVID-19.

Critical Care and Respiratory management:

• American Physical Therapy Association (APTA), the APTA Cardiovascular and Pulmonary Section, the APTA Academy of Acute Care Physical Therapy, the World Confederation for Physical Therapy, and other international professional associations have endorsed the Physiotherapy Management for COVID-19 in the Acute Hospital Setting: The guidance, published in the Australian Physiotherapy Association's Journal of Physiotherapy, focuses on workforce planning and preparation including screening for physical therapy, as well as the actual delivery of interventions and PPE requirements. It includes more than 60 recommendations ranging from shift planning to the specific types of PPE PTs should wear.
• The World Health Organization provides technical guidance on the clinical management of severe acute respiratory infection when COVID-19 is suspected as well as home care for patients with suspected COVID-19 who have mild symptoms.
• Physiopedia has free online documents and courses for the respiratory management of COVID-19, including specific clinical syndromes associated with COVID-19 outlined by WHO. Also, the British Thoracic Society has compiled information, guidance, and resources to support the respiratory community during the COVID-19 pandemic, including information specific to management of critical care patients, safety of nebulizer use, interstitial lung disease, obstructive sleep apnea, and more.

Wound Care:

• The Alliance of Wound Care Stakeholders state that wound care is an essential, not elective, service that prevents hospital admissions and ED visits among a fragile cohort of patients at high-risk of COVID-19.

Post Intensive Care Syndrome:

• For post-intensive care syndrome, or PICS, a systematic review published in Physical Therapy in 2018 examined impairments in physical, mental, or cognitive abilities, or a combination of these in individuals who have survived a critical illness that required intensive care.

Regards

Today the greatest threat on the planet Earth is the invasion by the tiny particle causing Corona Virus Disease (COVID-19). Most people infected with the COVID-19 virus usually experience mild to moderate respiratory illness and recover without requiring special and very advanced treatment. Older people and those having medical problems like cardiovascular disease, diabetes, chronic respiratory disease and cancer are more likely to develop serious illness.

The best way to prevent and slow down transmission is to be well informed about the COVID-19 virus, the disease it causes and how it spreads. One of the best practices to stay safe from infection is by washing hands or using an alcohol based rub (sanitizer) frequently without touching the face.

The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, so it is important to practice respiratory etiquette (for example, by coughing into a flexed elbow).

I'd say the most important message is to just stay active.

I agree with Roberto in that exercises that stress/focus on the cardiorespiratory system should be used with care. Generally, it's difficult to perform really intense exercise at home, so that's less of a concern.

I would also recommend mobility exercises such as stretching and balance, especially assuming that most people have increased their sitting times substantially.

As exercise and nutrition go hand-in-hand it's also important to keep an eye on the diet; e.g. some food can improve immune function.

Above, Nydia Darby gives a wonderfully concise explaination of initiating a simple, but powerful breathing program. This combined with postural training and immunity-boosting nutritional education would all be very helpful for patients with or recovering from covid-19.

You can go through the CDC guidelines.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html

As other contributors to this discussion are suggesting, home protocol is a good idea to help stop the spread of COVID-19, including virtual practice in physiotherapy, as indicated on the Internet:

"Virtual care may be a good option for you if you are not feeling well, as it can ensure that you still receive treatment while also keeping others safe.  Virtual Practice in Physiotherapy

FAQs: COVID-19 Patients and Caregivers

• What is physiotherapy tele-practice or virtual care? Is virtual care appropriate for me? Tele-practice or virtual care is the provision of physiotherapy services where the physiotherapist is in a location away from the patient.  Tele-practice incorporates the use of technology such as telephones, video conferencing, email, apps, web-based communication or wearable technology. During a public health emergency, virtual care options enable physiotherapists to provide care to patients without in-person interactions that could expose you, them and others to the virus. Depending on the technology your physiotherapist uses, you will be able to participate in virtual care over the phone, on your smartphone, or through your computer."

https://www.apta.org/patient-care/public-health-population-care/coronavirus

Following

Through teaching Covid-19 to my physiotherapy students I came across several articles involving exercice prescription for these patients. Here is an interesting read regarding rehabilitation from in-patient to home based rehabilitation.

I don't know

An Update for COVID-19 patients and their families - April 16, 2021, as follows:

"Caring for Someone Sick at Home" (USA Center for Disease Control website):

Advice for caregivers in non-healthcare settings

Updated Apr. 16, 2021

Languages

Print

If you are caring for someone with COVID-19 at home or in a non-healthcare setting, follow this advice to protect yourself and others. Learn what to do when someone has symptoms of COVID-19 or when someone has been diagnosed with the virus. This information also should be followed when caring for people who have tested positive but are not showing symptoms.

*Note: Older adults and people of any age with serious underlying medical conditions are at higher risk for developing more severe illness from COVID-19. People at higher risk of severe illness should call their doctor as soon as symptoms start.

Provide support

Help cover basic needs

📷

Make sure the person who is sick drinks a lot of fluids and rests

• Help the person who is sick follow their doctor’s instructions for care and medicine.For most people, symptoms last a few days, and people usually feel better after a week.
• See if over-the-counter medicines for fever help the person feel better.
• Make sure the person who is sick drinks a lot of fluids and rests.
• Help them with grocery shopping, filling prescriptions, and getting other items they may need. Consider having the items delivered through a delivery service, if possible.
• Take care of their pet(s), and limit contact between the person who is sick and their pet(s) when possible.

Watch for warning signs

• Have their doctor’s phone number on hand.
• Use CDC’s self-checker tool to help you make decisions about seeking appropriate medical care.
• Call their doctor if the person keeps getting sicker. Call local emergency service and tell them that the person has or might have COVID-19.

When to seek emergency medical attention

Look for emergency warning signs* for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

*This list is not all possible symptoms. Please call your medical provider for any other symptoms that are severe or concerning to you.

Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.

Protect yourself

In This Section

• Limit contact
• Eat in separate areas
• Avoid sharing personal items
• When to wear a mask or gloves
• Clean your hands often
• Track your own health

Limit contact

📷

Keep a separate bedroom and bathroom for a person who is sick

COVID-19 spreads between people who are in close contact (within about 6 feet) through respiratory droplets, created when someone talks, coughs or sneezes. Staying away from others helps stop the spread of COVID-19.

The caregiver, when possible, should not be someone who is at higher risk for severe illness from COVID-19.

The person who is sick should isolate

The sick person should separate themselves from others in the home. Learn when and how to isolate.

• If possible, have the person who is sick use a separate bedroom and bathroom. If possible, have the person who is sick stay in their own “sick room” or area and away from others. Try to stay at least 6 feet away from the sick person.
• Shared space: If you have to share space, make sure the room has good air flow.Open the window to increase air circulation. Improving ventilation helps remove respiratory droplets from the air.
• Avoid having visitors. Avoid having any unnecessary visitors, especially visits by people who are at higher risk for severe illness.

Caregivers should quarantine

Caregivers and anyone who has been in close contact with someone who has COVID-19 should stay home, except in limited circumstances. Learn when and how to quarantine.

When it's safe for a person who has been sick to be around others

Deciding when it is safe to be around others is different for different situations. Find out when someone who is sick can safely end home isolation.

Eat in separate rooms or areas

• Stay separated: The person who is sick should eat (or be fed) in their room, if possible.
• Wash dishes and utensils using gloves and hot water: Handle any dishes, cups/glasses, or silverware used by the person who is sick with gloves. Wash them with soap and hot water or in a dishwasher.
• Clean hands after taking off gloves or handling used items.

Avoid sharing personal items

• Do not share: Do not share dishes, cups/glasses, silverware, towels, bedding, or electronics (like a cell phone) with the person who is sick.

When to wear a mask or gloves

The person who is sick

• The person who is sick should wear a mask when they are around other people at home and out (including before they enter a doctor’s office).
• The mask helps prevent a person who is sick from spreading the virus to others. It keeps respiratory droplets contained and from reaching other people.
• Masks should not be placed on young children under age 2, anyone who has trouble breathing, or is not able to remove the covering without help.

media iconLow Resolution Video

Caregiver

• Put on a mask and ask the sick person to put on a mask  before entering the room.
• Wear gloves when you touch or have contact with the sick person’s blood, stool, or body fluids, such as saliva, mucus, vomit, and urine. Throw out gloves into a lined trash can and wash your hands right away.Practice everyday preventive actions to keep from getting sick:  wash your hands often; avoid touching your eyes, nose, and mouth; and frequently clean and disinfect surfaces.

Note: During the COVID-19 pandemic, medical grade masks are reserved for healthcare workers and some first responders.

Clean your hands often

• Wash hands: Wash your hands often with soap and water for at least 20 seconds. Tell everyone in the home to do the same, especially after being near the person who is sick.
• Hand sanitizer: If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
• Hands off: Avoid touching your eyes, nose, and mouth with unwashed hands.
• Learn more about handwashing.

When and how to clean surfaces and objects

Cleaning with a household cleaner that contains soap or detergent reduces the amount of germs on surfaces and objects and decreases risk of infection from surfaces. In most situations, cleaning alone removes most virus particles on surfaces.

• Clean high-touch surfaces and objects regularly (for example, daily or after each use) and after you have visitors in your home.
• Focus on high-touch surfaces and objects (doorknobs, tables, handles, light switches, phones, remote controls, and countertops).
• Clean other surfaces in your home when they are visibly dirty or as needed. Clean them more frequently if people in your household are more likely to get very sick from COVID-19. Disinfect if certain conditions apply.
• Clean surfaces using a product suitable for each surface, following instructions on the product label.

When Someone Is Sick

If someone in your home is sick or someone who has COVID-19 has been in your home in the last 24 hours, clean and disinfect your home. Disinfecting removes germs and reduces their spread. See Caring for Someone Who Is Sick at Home for more information.

For more information on cleaning and disinfecting safely, see Cleaning and Disinfecting Your Home.

Track your own health

• Caregivers should stay home and monitor their health for COVID-19 symptoms while caring for the person who is sick.Symptoms include fever, cough, and shortness of breath but other symptoms may be present as well. Trouble breathing is a more serious warning sign that you need medical attention.
• Caregivers should continue to stay home after care is complete. Caregivers can leave their home 14 days after their last close contact with the person who is sick (based on the time it takes to develop illness), or 14 days after the person who is sick meets the criteria to end home isolation.
• The best way to protect yourself and others is to stay home for 14 days if you think you’ve been exposed to someone who has COVID-19. Check your local health department’s website for information about options in your area to possibly shorten this quarantine period.
• Use CDC’s self-checker tool to help you make decisions about seeking appropriate medical care."
• www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html

This is a very timely and useful paper on physical activity in this time of COVID-19 pandemic.

Check https://www.apta.org/patient-care/public-health-population-care/coronavirus/management-of-patients

Also check https://www.apta.org/patient-care/public-health-population-care/coronavirus

physical exercise training plays a key role in promoting immune system regulation, delaying immunity dysfunction, reducing circulatory inflammation markers, and preventing sarcopenia and thus could prevent the risk of acquiring COVID-19 infection and reduce the complications of recommended self-isolation in older adults and elderly individuals. Additionally, immunity biomarkers were optimistically demonstrated in older adults following physical exercise training, thereby reducing mortality and morbidity rates. Finally, all populations are strongly recommended to practice regular home exercise training at home to promote immune system functioning.