August 8, 2022

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With over half a million infections in Ireland, Covid-19 has affected the lives of the...

With over half a million infections in Ireland, Covid-19 has affected the lives of the entire nation. For 85pc of people, the infection will be mild and self-limiting but can include fevers, headaches, fatigue, a loss of smell, breathlessness and a cough. While the worst of the symptoms will pass in 10 days, a large minority report some symptoms persisting for six weeks or more. Those still struggling at three months meet the World Health Organisation definition for post-Covid syndrome or long Covid.
ARS-CoV-2 is a novel virus, which means our immune systems are seeing it for the first time and reacting vigorously. Luckily, vaccination allows the body to prepare for exposure to the virus and can either prevent infection or leave us with a milder form of the disease.

Once established in the body, the infection causes a huge surge in inflammation as we combat it. Blood flow is rerouted, muscles are stripped of protein and bones leached of calcium to fuel this fight. At its worst, organ integrity is sacrificed for victory over the virus. Little wonder then that recovery involves replenishing spent resources and repairing damaged organs.
There are countless offers of tonics and supplements to restore an immune system exhausted by a bout with SARS-CoV-2, but there’s little data that any one product will achieve this. The sensible approach is to adopt a balanced recovery strategy. A general multivitamin supplement is a good idea in the month after Covid-19. Deficiencies of zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E have been shown in the laboratory to affect immune function.

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Vitamin D supplementation is also advised, since many Irish adults are mildly deficient, especially in the winter.
General nutrition is important and balanced meals are a key part of recovery. This includes protein from meat, poultry, fish, eggs, beans, or nuts to restore muscle and carbohydrates from wholemeal cereals, bread, potatoes, pasta or rice. Antioxidants are found in fresh fruit and vegetables, while unsaturated fats such as oils also provide energy and facilitate the absorption of fat-soluble vitamins.
Unfortunately, changes to smell can impact nutrition, as food can taste bland or unpalatable. Over-the-counter saline nasal rinses can help. ‘Olfactory rehabilitation’ can also help. This involves sniffing four essential oils (clove, eucalyptus, citrus and rose) in turn for 10 seconds, twice per day, over six weeks.
Exercise is also vital. When the virus and its symptoms are at their worst, patients are encouraged to rest. As recovery ensues, increasing exercise, often beginning with short walks, will minimise the muscle wasting that can occur.
Many patients attending our Post-Covid Clinic report problems with fast heart rates and excessive breathlessness in response to even mild exertion. So, a steady slow increase in exercise intensity is advised. Cut back if you struggle with excessive fatigue afterwards.
Disruptions to breathing patterns are common after Covid19. Breathing shifts from slow deep movements of the diaphragm, to fast short breaths from the upper chest. This can cause breathlessness and fatigue, as well as chest pains and dizziness in extreme cases. We recommend practising ‘box breathing’ when recovering. This involves taking a breath in for four seconds, holding it for four seconds, breathing out for four seconds and holding the breath again for a further four seconds. It helps retrain respiratory muscles.
There are a variety of inspiratory muscle trainers available which also strengthen breathing muscles. These exercises should be done slowly and gently, twice a day initially, seeking advice if necessary.
Finally, the one true panacea of modern medicine is sleep. Effective sleep allows the body and mind to recover from the toll of a difficult viral illness, but seems to be disrupted by Covid-19. The ideal amount is 7 to 9 hours of uninterrupted sleep per night, but longer sleep times and short naps may be necessary. Bedtime and rising time should be as regular as possible. Avoid caffeine beyond lunchtime and alcohol entirely.
It’s important to allow your body to recover at its own pace, and to not get frustrated if it takes longer than expected. Those with unusually severe or prolonged symptoms may need to consult their GP, while those with symptoms beyond three months may need additional support.
If you are a parent with a child who’s been diagnosed with Covid, you may be wondering what to expect.
Covid 19 can cause severe disease in children but most will have a mild or moderate illness. Those with underlying conditions are at increased risk. Symptoms in children are similar to those in adults with some differences. Fever and cough are most common. Gastrointestinal symptoms can occur in 20pc sometimes without respiratory symptoms.
Encourage your child to drink plenty of fluids, use light clothing and appropriate doses of paracetamol. Skin rashes can also occur.
Multisystem inflammatory syndrome in children is a fortunately rare but serious condition associated with Covid-19. Symptoms to look out for include persistent fever for more than 24 hours, abdominal pain, vomiting and diarrhoea with rash, bloodshot eyes and headache, confusion and difficulty breathing.
Persistent symptoms are less common but can include fatigue, sleep disturbance and respiratory problems. Less than 2pc of children will have symptoms beyond 60 days. Most children recover within two weeks and the average duration of illness is six days. Younger children tend to recover quicker.
A word of warning: this advice is aimed at helping those who have had relatively mild Covid symptoms which have been managed at home. If you have had a more serious illness that required medical care, you should of course follow the advice you have been given from your own medical team.
Prof Seamus Linnane is Consultant in Respiratory & General Internal Medicine and Deputy Medical Director at Beacon Hospital and Assistant Clinical Professor University College Dublin

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