When Charlie Coulton regained consciousness after 42 days in intensive care against Covid-19 – half of that time on a ventilator – he wondered if he had woken up in a science fiction movie.
Surrounded by nurses and doctors wearing full protective suits, masks and gloves, and drowsy with sedatives and painkillers, the 65-year-old widower was weak and had difficulty breathing.
“There were tubes in my nose, in my throat and squeaky monitors – I didn’t know if it was real,” says Charlie, a retired Plymouth bakery worker who lives alone.
He had called an ambulance in March after a persistent cough, high temperature, and breathing problems. Initially admitted to Derriford Hospital’s Covid-19 ward, Charlie was transferred to intensive care (ICU) within three days.
When Charlie Coulton regained consciousness after 42 days in intensive care battling Covid-19 – half that time on a ventilator – he wondered if he had woken up in a science fiction movie
“My last memory was that I was taken to intensive care and told I needed a respirator because my breathing was so poor and my blood oxygen level was so low.”
Later, he discovered that his heart stopped three times while on a ventilator, and that he had also had kidney dialysis after developing sepsis.
“They almost lost me several times, but I have no memory of it,” he says.
After the illness disappeared, he was taken off the ventilator, but was still struggling to breathe and was constantly coughing up mucus. Charlie lost the 2nd in the hospital and was so weak he couldn’t even get out of bed.
Doctors warned him that recovery could take up to 18 months, although he would get back on his feet quickly with rehabilitation therapy. “But it was my lungs that I was most concerned about because they said they were badly damaged and full of mucus.
“I was shocked when I saw the CT scan – there were a lot of white areas, which meant my lungs were damaged. I had fibrosis [scarring of the lungs] what I have learned since then is permanent. ‘
But treatment by a specialized respiratory physiotherapist has helped him on the long road to recovery
But treatment by a specialized respiratory physiotherapist has helped him on the long road to recovery.
Charlie’s experience is not unique. It is estimated that up to 60 percent of patients hospitalized with Covid-19 may experience permanent lung damage, including shortness of breath and fatigue.
Until recently, the work of respiratory physiotherapists has received little attention, but they could be key to helping Covid patients restore their lung function and quality of life.
They start working with patients, even if they are in ventilator intensive care, using manual manipulation techniques to remove mucus. Later in a patient’s recovery, they can teach him breathing techniques and gradually build up their exercise tolerance, lung capacity and muscle strength using, for example, an exercise bike.
But the Chartered Society of Physiotherapy (CSP) warns that there may not be enough of these specialists to cope with the extra workload of the pandemic – leaving Covid patients unable to get the care they need .
Charlie’s experience is not unique. It is estimated that up to 60 percent of patients hospitalized with Covid-19 may experience permanent lung damage, including shortness of breath and fatigue
The specialists are physiotherapists who have received postgraduate training in helping patients restore lung function after ventilation and CPAP masks, which also assist in breathing.
There are an estimated 2,000 in the UK and they normally care for patients with chronic lung and heart and neurodegenerative diseases, such as motor neuron disease, that affect muscle function in the lungs.
Even before Covid-19 struck, the CSP estimates that the UK was 4,000 physical therapists short and now that demand is even greater, “it’s hard to know how many more will be needed,” said a spokesman.
Hospital audit data, based on patients treated up to mid-May, shows that 62 percent (29,854) of those admitted to Covid-19 may require ongoing rehabilitation for shortness of breath, muscle weakness, and other lung conditions.
Last week’s NHS guidelines found that 30 percent of Covid-19 patients may need long-term care for lung problems. And a CSP study found that one in four rehabilitation physiotherapists thought that Covid patients were not receiving the rehabilitation needed after intensive care.
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The CSP CEO, Professor Karen Middleton, told Good Health: “We know that patients recover much faster when rehabilitation begins in hospital and continues seamlessly around the home.
It’s tragic to think that thousands of people fought Covid-19, but that they struggled with multiple conditions due to a lack of aftercare.
“Rehabilitation services have been under-resourced for decades, and now more than ever we need quality community rehabilitation to be a priority.”
Physios are being redeployed to work with Covid patients, under the supervision of respiratory physiotherapists. But access to rehabilitation care in the community is patchy, says the CSP, who wants a national strategy to provide unified rehabilitation services across the UK to cope with Covid-19’s legacy.
And the problem will only get worse over time. “Those with very weak lungs don’t have much exercise tolerance, so they become breathless with minimal effort,” said Ema Swingwood, president of the Association of Chartered Physiotherapists in Respiratory Care.
Further down, some of these patients may need long-term oxygen support at home.
It’s not just about treating patients with obvious damage, she adds. In some patients, the damage may not be apparent at first, but it may become apparent within a few years as fibrosis progresses.
EXERCISES TO TRY IF YOU ARE UNDAMAGED
These are specifically designed to reduce breathlessness by physiotherapists and nurses at Lancashire Teaching Hospitals NHS Trust.
- LEAN FORWARDS: If you are short of breath, one of these positions can help you control your breathing. They can be used at the same time as the control exercises (see the following bullets).
Sit with your forearms on your knees, relax and lean forward. Or, when standing, you can lean forward or back, supported by a wall and with your feet slightly apart. Or lie on your side with your shoulders and head up on pillows, slightly bent knees. Repeat as often as necessary.
- BREATHE THROUGH YOUR NOSE: This can help reduce breathing effort. Sit in a relaxed position with your arms supported and inhale and exhale through your nose (if it is easier, exhale through your mouth). While exhaling, try to release the stress and slow your breathing slowly. Repeat once an hour.
- ‘STEP’ YOUR BREATH: This helps keep your lungs flexible and can make you cough more productively. Leave an hour after eating or drinking and stop if you experience chest pain.
Breathe out completely. Then inhale a little and hold. Repeat until you feel you can no longer breathe air into your lungs, and hold for two to five seconds. Breathe out all the air from your mouth. Repeat once an hour. If your breathing pattern changes outside of this exercise, stop and contact your doctor.
“This is because the lungs may never fully recover and worsen fibrosis at an early stage.”
Conditions, such as hyperventilation (over-breathing) and chronic cough, may also worsen.
Physical therapists are also concerned about Covid patients they don’t know because they have not been hospitalized.
“People can be isolated at home and struggle with shortness of breath,” says Ema Swingwood.
“All these patients need rehabilitation to regain their previous quality of life and / or return to work.”
Rachael Moses, respiratory physiotherapist and Deputy Director of Rehabilitation at Royal Brompton Hospital in London, believes that at least half of hospital admissions in Covid-19 require ongoing rehabilitation.
“Some post-Covid patients fall through the net,” she says. Many have been released from the hospital, where they received a lot of rehabilitation, quickly because of the risk of infection. What they get in the community is a postcode lottery.
“Some of these patients fail to go up the stairs at home or return to work if they don’t receive aftercare.”
Charlie Coulton attributes his sustained recovery to respiratory physiotherapists. “Every day I had to pedal on an exercise bike at the end of my bed and learn how to inhale through my nose and through my mouth,” he says.
“They helped me take a shower – it took 50 minutes the first time because I was so weak – and walked upstairs to improve my exercise tolerance. It was so hard, but they made me believe it was possible. ‘
Charlie was fired six weeks ago after two weeks in a department. He has since had home visits from respiratory physiotherapists.
“When I first got home, I struggled to walk upstairs – I had to stop every step and was exhausted from coughing all day and night.
“I am much better, but I am still breathless and tired, although now I only cough in the morning.
“It’s a long way back to where I was before, when I easily walked 10,000 steps a day.”