After surviving the corona infection, the ghost is not over for many of those affected, they are dealing with Long Covid. A new, persistent disease with many symptoms. Rehabilitation should help those affected.
The 40-year-old IT specialist from Hamburg was never a person who was afraid of Covid-19. “If it hits me, I’ll just stay in bed for a week or two like with the flu,” he thought. He has never had to be treated in the hospital before, says the strong 1.90 meter man. But then a corona infection brought him to the intensive care unit in mid-January, and he was ventilated for twelve days. When he was transferred to a normal ward, the nurses applauded. “It is so nice that you are not carried out in a plastic bag,” a senior nurse told him.
At the end of February he was released from the hospital, completely exhausted. Showering, cooking food, taking out garbage could not be done without help. “After the stairs to my apartment on the second floor, I was lying on the sofa with my muscles ache.” A stay in a lung clinic followed. Five months later, the 40-year-old is still unable to work. This is to change in the Bad Rothenfelde Rehabilitation Clinic, which has developed a special treatment concept for Long Covid patients.
Many patients with long-term consequences
According to a diagnostic guideline published in mid-July, up to 15 percent of all Covid-19 sufferers are affected by the post-Covid syndrome, i.e. they have symptoms of various kinds that last for more than three months, such as shortness of breath, dizziness or difficulty concentrating. Long Covid is used when new symptoms appear after an infection has been overcome or these persist for more than four weeks. There are studies that indicate an even higher proportion of patients with long-term consequences.
The 40-year-old IT specialist is optimistic that he will be able to return to the job in the foreseeable future. Fortunately, he says he doesn’t have any mental problems. His doctors had given him hope that his lungs would only be damaged by a maximum of five percent in a year. The rehab in Bad Rothenfelde includes strength and endurance training on equipment, on this day together with Reinhard Janzen (68) from Dortmund. Janzen proudly presents his therapy booklet with values that have improved significantly since his arrival. “Three weeks ago, ergometer training from the air was unthinkable,” says the retired state official.
“Thrown Out of Life”
Around 15 long-covid patients are being treated at the same time in the rehab clinic of the German Pension Insurance, in the meantime there have been more than 130 since the arrival of the first person affected on April 16, 2020. Very many suffer from Chronic Fatigue Syndrome (CFS), constant exhaustion and a lack of resilience. This severe neuro-immunological disease, which often affects young, previously completely healthy people, was already known before the corona pandemic – for example after infection with the Epstein-Barr virus. It can occur even after a mild course of Covid-19. Affected people are sometimes so powerless that they almost only lie in bed.
“People are thrown out of life,” says chief physician Christoph Preu. After the three to four weeks of rehab, only 20 percent of the patients previously treated in his clinic were discharged completely fit for work. Another 20 percent were gradually reintegrated into work. It is important that those affected continue to receive close care and support after rehabilitation, emphasizes the pulmonologist. “Follow-up care must be encouraged.”
The Long Covid Germany initiative for people affected is committed to providing comprehensive post-Covid outpatient care. “This disease is much more complex than was thought a year ago,” says a spokesman for the organization. So far there are only very few contact points with an interdisciplinary approach. Young people at the beginning of their working life threatened to slip into disability. “Many of those affected work in the healthcare system, where there is already a chronic shortage of staff.” The federal government must invest a lot more money in research into post-viral fatigue and long covid in order to prevent long-term follow-up costs for the health and social system.
Adapted treatment concept
In Bad Rothenfelde, the team of doctors and therapists classified the people with Long Covid primarily as lung patients at the beginning of the pandemic. As the psycho-mental limitations became more and more apparent, the treatment concept was expanded step by step. For this reason, a brain performance test is now carried out when a new person is admitted.
A relatively large group has cognitive impairments, says the head psychologist and psychotherapist Rudolf Schulte. “Some can’t concentrate on reading a column in the newspaper or watching a movie.” Difficulty finding words and impairments in planning activities are also not uncommon. “One patient said he was standing in front of the dishwasher and didn’t know how to put it in.”
Once a week, the Long Covid patients come together in the clinic for a discussion group. Pensioner Janzen and the 40-year-old IT specialist were relieved after the first of these meetings that they had damaged lungs, but at least no memory or concentration disorders. Both were not intubated, but rather ventilated with masks while fully conscious.
afraid of the future
Of the Covid 19 patients who were intubated and put into an artificial coma, 40 to 50 percent died in Germany at the beginning of the pandemic. Survivors can suffer from post-traumatic stress disorder. There are those affected with relatives who were fatally infected. They blame themselves for having infected the dead. It is therefore very important to focus on the psyche in rehab.
“Those affected who have severe restrictions are afraid of the future,” observes Chief Doctor Preu. But he hopes that in a high percentage of the sick, most of the complaints and restrictions will go away again. “But it will take time and there are no guarantees.” Not all Covid 19 sufferers will be completely healthy again – there have already been lung transplants in individual cases.
The German Society for Medical Rehabilitation (Degemed) is calling for an access procedure through which Long Covid patients can quickly get the right offer for their individual complaints. At the moment, those affected often have to wait months for a place in rehab. According to Preu, demand is also high in Bad Rothenfelde, around a third of the lung ward is occupied by long-covid patients. More is not possible, because seriously ill patients with chronic asthma, COPD or cancer also have to be treated.
On the table in a group room at the clinic in the Teutoburg Forest are roses, lavender and cans of peppermint and lime. “We also offer odor training,” says senior physician Ulrike Schumann. “There is little scientific evidence, but for patients, the loss of their sense of smell is a major impairment in their quality of life.” The practitioners learn almost every day about the new disease Long Covid. Schumann says: “In ten years we will know more about long-term effects and the need for therapy.”
