It is a new disease with many faces: Long Covid can indicate more than 30 symptoms ranging from shortness of breath to dizziness to massive memory problems. Many sufferers suffer from crippling fatigue.
The 40-year-old IT specialist from Hamburg was never 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. The strong 1.90 meter man says he has never had to be treated in hospital before. 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’s so nice that you’re not being carried out in a plastic bag,» a senior nurse told him. How does the rehab work for Long Covid?
Symptoms persist months after discharge from hospital
At the end of February he was discharged from the hospital, completely exhausted. Showering, cooking food, taking out the garbage was not possible without help. «After climbing the stairs to my apartment on the second floor, I lay on the sofa with muscle pain.» A stay in a pulmonary clinic followed. Five months later, the 40-year-old is still unable to work.
This is set to change at the Bad Rothenfelde rehabilitation clinic, which has developed a special treatment concept for long-Covid patients.
According to a diagnosis guideline published in mid-July, up to 15 percent of all Covid-19 sufferers are affected by post-Covid syndrome, which means they have various types of symptoms that last for more than three months, such as shortness of breath, dizziness or difficulty concentrating. One speaks of long covid when new symptoms appear after an infection has been overcome or they persist for more than four weeks. There are studies that indicate an even higher proportion of patients with long-term consequences.
Rehab Brings Improvement to Long Covid Through Special Training
The 40-year-old IT specialist is optimistic that he will be able to return to work in the foreseeable future. Luckily he has no mental problems, he says. His doctors had given him hope that his lungs would only be damaged by a maximum of five percent in a year.
The rehabilitation 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 significantly improved values since his arrival. «Three weeks ago ergometer training from the air was unthinkable,» says the retired state civil servant.
Around 15 long-Covid patients are being treated at the same time in the rehabilitation clinic of the German pension insurance; since the arrival of the first affected person on April 16, 2020 there have been more than 130 in total.
Exhaustion usually does not disappear completely after rehabilitation
Many suffer from Chronic Fatigue Syndrome (CFS), constant exhaustion and a lack of resilience. This severe neuro-immunological disease, which often affects young people who were previously completely healthy, was already known before the corona pandemic – for example after an infection with the Epstein-Barr virus. It can even occur after mild Covid-19 courses. Those affected are sometimes so powerless that they almost only lie in bed.
«People are thrown out of life,» says chief physician Christoph Preu. After three to four weeks of rehabilitation, only 20 percent of the patients treated in his clinic were discharged and fully able to work. Another 20 percent made a gradual return to work. The pneumologist emphasizes that it is important that those affected continue to be closely cared for and supported after rehabilitation. «Aftercare must be encouraged.»
Affected initiative is committed to more supply points
The Long Covid Germany initiative for those affected is committed to nationwide care with post-Covid ambulances. «This disease is much more complex than was assumed a year ago,» says a spokesman for the organization. So far there have been very few contact points with an interdisciplinary approach.
Young people at the beginning of their working life were threatened with becoming unable to work. «Many of those affected work in the health sector, where there is already a chronic shortage of staff.» The federal government must invest much more money in research into postviral fatigue and long Covid in order to prevent long-term follow-up costs for the health and social system.
In addition to physical impairments, there are also mental and cognitive impairments
In Bad Rothenfelde, the team of doctors and therapists classified people with Long Covid primarily as lung patients at the beginning of the pandemic. As the psycho-mental limitations became more and more evident, the treatment concept was expanded step by step. For this reason, among other things, a brain performance test is now carried out when new employees are admitted.
A relatively large group have cognitive impairments, says lead psychologist and psychotherapist Rudolf Schulte. «Some cannot concentrate on reading a column in the newspaper or watching a film.» Difficulty finding words and impairments in planning are also not uncommon. «One patient said he was standing in front of the dishwasher and didn’t know how to load it.»
Survivors may suffer from post-traumatic stress disorder
Once a week, the long-Covid patients come together in the clinic for a discussion group. After the first of these meetings, retiree Janzen and the 40-year-old IT specialist were relieved that although they had damaged lungs, they did not have any memory or concentration problems. Both were not intubated, but ventilated with masks while fully conscious.
Of the Covid-19 patients who were intubated and placed in an artificial coma, 40 to 50 percent died in Germany at the beginning of the pandemic. Survivors may suffer from post-traumatic stress disorder. There are those affected with relatives in whom the infection was fatal. They blame themselves because they could have infected the deceased. It is therefore very important to take a look at the psyche during rehabilitation.
«Those affected, who have severe limitations, are afraid of the future,» observes Chief Physician Preu. However, he hopes that most of the symptoms and limitations will disappear in a high percentage of those who are ill. «But that will take time, and there is no guarantee.» Not all Covid 19 patients will recover completely – in individual cases there have already been lung transplants.
Demand for rehabilitation places is high
The German Society for Medical Rehabilitation (Degemed) calls for an access procedure that allows long-Covid patients to quickly get the right offer for their individual symptoms. Currently, those affected often have to wait months for a rehabilitation place. According to Preu, demand is also high in Bad Rothenfelde, around a third of the lung station 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 smell training,» says senior physician Ulrike Schumann. «Although there is little scientific evidence, the loss of the sense of smell is a significant limitation of the patient’s quality of life.» Schumann says: «In ten years we will know more about long-term effects and the need for therapy.»
Long Covid as a challenge for the healthcare system
Before the corona pandemic, around one million people in Germany completed rehabilitation (rehab) every year to get fit for working life again, for example after cancer treatment or a stroke. According to the German Society for Medical Rehabilitation (Degemed), if a few 100,000 people affected by Long Covid were to be added, that would be a major challenge for the care system. Currently, those affected sometimes wait a very long time before they get help.
Most working people can apply for rehabilitation through the German pension insurance, which has set up its own hotline for those affected by long-Covid in the Braunschweig-Hannover area, for example. If you are not insured with the pension insurance, you must contact your health insurance company. If the Covid-19 disease is recognized as an occupational disease or accident at work, the professional association or accident insurance fund can also pay for benefits.
The aim of rehabilitation is always to get people back to work. As a result of their corona infection, thousands of people were absent from work for months this year and last. This was reported by the Barmer and AOK health insurance companies at the end of June. According to the information, Covid 19 patients were on sick leave for a particularly long time after a stay in the clinic.