Different symptoms, different groups, different scenarios! Expert guidance for the recovery period of COVID-19 patients, save it!

In order to help and guide the self-health management of patients infected with the new coronavirus who are in the recovery period, the Beijing Municipal Health Commission organized experts to develop the "Expert Guidelines for Health Management of Patients Infected with the New Coronavirus in the Recovery Period (First Edition)".

This guideline brings together the opinions of experts and scholars in different fields and summarizes relevant clinical experience. It aims to help and guide the self-health management of people infected with the new coronavirus who are in the recovery stage. If you are infected with the new coronavirus and are in the recovery stage, please read this guideline carefully and follow it as a reference, and be the first person responsible for your own health.

01

Target Group

According to the "New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Ninth Edition)" and expert recommendations, when a person infected with the new coronavirus meets any of the following criteria and other symptoms have significantly improved, they have entered the recovery period:

1. Two consecutive nucleic acid tests were negative, and the Ct value was ≥35;

2. The results of antigen tests are negative for three consecutive days;

3. When the home quarantine is completed for 7 days, the fever symptoms have subsided for more than 24 hours without the use of antipyretics.

02

Major health issues and rehabilitation suggestions during the recovery period

According to the World Health Organization's "Guidelines for Personal Recovery from COVID-19", combined with clinical observations and population surveys, people in the recovery period of COVID-19 infection currently have the following main health problems: shortness of breath, limited physical activity and exercise, decreased physical strength and fatigue, hoarseness and cough, swallowing problems, smell and taste problems, anxiety, depression and sleep problems, body pain, etc.

1. Shortness of breath

Shortness of breath is common after COVID-19 infection. Advice for shortness of breath: You can try various positions to relieve shortness of breath to see which ones work. Prone position: Lying flat on your stomach (prone) can help relieve shortness of breath; Forward sitting position: Sitting at a table, leaning forward from the waist, with your head and neck resting on a pillow on the tabletop and your arms resting on the table, or sitting in a chair, leaning forward with your arms resting on your knees or chair arms; Forward standing position: Standing position, leaning forward, lying on a window sill or other stable support surface; Back-leaning standing position: With your back against a wall, your hands at your sides, your feet about 30 cm from the wall, and your legs apart. In addition, pay attention to the following situations that require prompt medical attention: Very obvious shortness of breath after mild activity that does not improve with any position to relieve shortness of breath; Changes in the degree of shortness of breath when you are still and do not improve with any breathing control technique; Chest pain, rapid heartbeat, or dizziness during certain positions, activities, or exercises; Weakness in the face, arms, and legs, especially on one side of the body.

2. Cough

Coughing is an important defensive reflex of the body, which is conducive to clearing respiratory secretions and harmful factors. Suggestions for coughing: General mild coughs do not need treatment. If there is a lot of sputum or the sputum is difficult to cough up, you can take expectorants such as acetylcysteine, ambroxol hydrochloride, eucalyptus lemon pinene capsules, and carbocysteine. If the cough is mainly dry cough, you can take dextromethorphan, compound methoxyphenamine capsules, antihistamines, etc. In traditional Chinese medicine, if accompanied by throat pain or cough (especially dry cough), without other symptoms, you can take Jingfang Baidu Powder, Yinqiao Powder, Sangju Drink, to transform heat and produce fluid, moisten the lungs and relieve cough, and you can also use traditional Chinese medicine external treatments such as scraping. If the cough is severe, affects daily work or sleep, or lasts for more than 3 weeks, it is recommended to go to the hospital for treatment.

3. Fatigue

Feeling weak or tired, and no significant relief after rest, is the most commonly reported symptom of the recovery period of COVID-19 infection. Suggestions for fatigue: maintain a regular rhythm of daily life, determine the priority of activities, and make a reasonable work plan. The symptoms are mild and there is no dyspnea. While the underlying disease is treated routinely, appropriate treatment of qi-tonifying drugs can be given, such as lily, platycodon and other drugs to replenish lung qi and promote qi. If dyspnea cannot be relieved, go to the hospital for medical treatment in time. You can use traditional Chinese medicine external treatments such as soaking and washing. Take 3 slices of ginger (about the size of a one-yuan coin) and add 5 grams of moxa and 5 grams of salt. Boil for 10 minutes, add water above the ankle joint, control the temperature at 40-43℃, and keep this temperature for about 30 minutes, once a day. It is advisable to sweat slightly, not sweating profusely. If you have heart disease, the soaking time needs to be halved, and it must not be too long. If dyspnea cannot be relieved, go to the hospital for medical treatment in time.

4. Insomnia

During the recovery process of COVID-19 infection, you may experience symptoms such as difficulty falling asleep, short sleep duration, shallow sleep, and frequent dreams. Advice for insomnia: Have regular bedtimes and wake-up times. Make sure your environment is free of distractions, such as excessive light or noise; try to stop using electronic devices such as mobile phones and tablets one hour before bedtime; minimize nicotine (such as smoking), caffeine, and alcohol intake; try relaxation techniques that help you fall asleep, such as meditation, mindfulness-based stress reduction therapy, mindfulness or bathing, aromatherapy, Tai Chi, yoga, and music. You can also use Chinese medicine bathing and other methods.

5. Pain

During the infection and recovery of the new coronavirus, pain symptoms such as bone and joint pain, muscle soreness, and sore throat often occur. Advice on pain problems: For joint, muscle or whole body pain, you can take analgesics such as paracetamol or ibuprofen with meals. For sore throat, you can use drugs such as Jinhoujian and mint lozenges. Good sleep can help relieve pain symptoms. Listening to relaxing music or meditation can also help relieve pain. Adjusting the rhythm of daily activities is one of the keys to controlling pain. You can also use traditional Chinese medicine external treatments such as hot compresses and scraping. If you have obvious chest pain, you should go to a medical institution for treatment in time.

6. Palpitations

During the recovery stage of COVID-19 infection, some patients experience symptoms of panic and palpitations. At this time, it is recommended to pay attention to rest, adjust your daily routine, and get enough sleep. At the same time, you should strengthen your nutrition and eat more foods rich in protein and vitamins to improve your body's disease resistance. If the symptoms of palpitations are obvious, the beats per minute continue to exceed 100 times and less than 60 times, or irregular beats occur, you need to be alert to the occurrence of viral myocarditis. It is recommended to go to the hospital for examination in time to find out the cause and take measures.

7. Sound issues

COVID-19 infection can cause a sore throat, an irritating cough, and a feeling of phlegm in the throat, which requires frequent throat clearing. A weak, wheezy, or hoarse voice may also occur, especially after being on a ventilator in the hospital. Advice for voice problems: Stay hydrated and drink small amounts of water frequently throughout the day to keep your voice as normal as possible. Don't strain your voice. Don't speak above a whisper, as this can strain your vocal cords, and try not to speak loudly or shout. Inhaling steam (from a cup of boiling water with a towel over your head) for 10-15 minutes can relieve dryness and moisturize your vocal tract. It is recommended to stop smoking.

8. Swallowing problems

If you have trouble swallowing food and drinks, the muscles that help you swallow may be weak. Tips for swallowing problems: Sit upright when eating and drinking. Never eat or drink while lying down. Stay upright (sitting, standing, walking) for at least 30 minutes after eating. Try different textures of food, such as softer, smoother or moister foods, or cut solid foods into very small pieces. Chew your food slowly and don't gulp it down. Pay attention when eating or drinking. Try to choose a quiet place to eat. Avoid talking while eating or drinking. Make sure there is no food in your mouth before eating or drinking. Swallow once if necessary. If you feel tired after eating a full meal, eat smaller and more meals throughout the day. Keep your mouth clean by brushing your teeth and drinking water. If you cough or choke when eating or drinking, consult a healthcare provider because food or drink may have entered your lungs.

9. Decreased sense of smell and taste

If you experience a loss of smell or taste, try the following: Brush your teeth twice a day to ensure oral hygiene. Practice smell training, which includes smelling lemons, roses, cloves, or eucalyptus twice a day for 20 seconds. Try adding herbs and spices to your food, such as lemon juice and fresh herbs. Most people with a loss of smell and taste will recover within a month after a COVID-19 infection.

03

Psychological adjustment and nutritional support during the recovery period

1. Psychological adjustment during the recovery period

It is natural to feel fear, tension, and anxiety during the COVID-19 infection and recovery process. You don’t need to be overly nervous. To overcome fear, tension, and anxiety, you can start from the following aspects:

1. Keep a regular work and rest schedule, get enough sleep, exercise moderately, read, listen to music, and eat healthily. Do not adopt negative coping styles such as denial, avoidance, over-dependence on others, blaming and complaining, transferring emotions, losing temper, and impulsiveness, especially do not try to relieve tension through smoking and drinking.

2. Actively adjust your psychology, communicate more with others, encourage each other, provide psychological support to each other, and divert attention.

3. You can adjust your emotions through breathing relaxation training, aerobic exercise, mindfulness meditation, etc.

2. Nutritional support during the recovery period

You can eat small meals frequently, and pay attention to eating at regular times and quantities, with a variety of foods and a reasonable combination. Maintain a variety of foods, pay attention to the combination of meat and vegetables, and coarse and fine foods; eat more fresh vegetables, fruits, soybeans, milk, and cereals; eat fish, poultry, eggs, and lean meat in moderation, preferably fish, shrimp, poultry, and lean meat, eat less fat, and eat a light and non-greasy diet. Avoid eating spicy and irritating foods, fried and greasy foods. Ensure the amount of water you drink, preferably boiled water, and drink less or no sugary drinks.

Rationally use medicated food for diet and therapy. Combined with the characteristics of winter climate, it is recommended to use Chinese medicine dietary therapies such as snow pear monk fruit water, corn silk and orange peel water, white radish honey water, walnut, scallion and ginger soup, pear soup, yam, winter melon and lotus seed porridge, coix seed, poria and yam porridge.

04

Daily life precautions

During the recovery period of COVID-19 infection, although the nucleic acid and antigen test results have turned negative, the body has not yet recovered to the pre-disease level, and it will take 1-2 weeks or even longer to fully alleviate. During this stage, personal protection, daily life, daily activities and exercise, and returning to work should be gradually restored to normal in accordance with the principle of gradual progress and within one's ability.

1. Things to note in daily life

1. It is currently the peak season for respiratory infectious diseases in winter. The risk of overlapping epidemics of COVID-19 infection with influenza, common cold and other winter and spring respiratory infectious diseases cannot be ruled out. Self-protection standards should not be lowered because of "positive health". When going out, we must continue to wear masks scientifically, reduce gatherings, and avoid going to crowded and confined places unless necessary. Keep hands clean at all times, especially after contact with suspicious contaminants or high-frequency contact surfaces of public objects.

2. Ensure adequate nutrition, regular work and rest, and good sleep. In terms of diet, pay attention to consuming more high-protein and nutritious foods. For those who have the habit of smoking and drinking, especially those with risk factors, smoking and drinking will aggravate the underlying disease. It is recommended to quit smoking and limit alcohol after "Yang Kang". For those who have a poor appetite or taste disorders after "Yang Kang", it is recommended to eat small meals frequently. Diabetic patients should maintain a regular diet to avoid large fluctuations in blood sugar.

3. After the acute fever symptoms subside, you can take a bath if your physical strength allows, but you should avoid saunas. When bathing, you must avoid getting cold, pay attention to the appropriate indoor temperature, and the bath water temperature should not be too high.

(II) Notes on daily exercise

1. On the basis of regular living, adequate nutrition and sleep, start with low-intensity activities, such as walking, Ba Duan Jin, simple daily housework, etc. If there is no obvious discomfort, the intensity of activities can be gradually increased within a few weeks, such as going up and down stairs, brisk walking, jogging, cycling, swimming, dancing until the normal activity state before the disease is restored.

2. If you experience chest pain, palpitations, dizziness or other discomfort during exercise, you should stop exercising immediately and seek medical attention if necessary. For inpatient rehabilitation patients, patients with pre-existing cardiopulmonary diseases, and patients with residual symptoms such as fatigue, chest tightness, and dyspnea, strenuous exercise or heavy work should be avoided within 2 weeks. Low-intensity exercise can be maintained for at least 1-2 weeks, and higher-intensity exercise can be performed when the body gradually adapts.

(III) Notes on returning to work

1. When you return to work, start with lighter work and gradually return to normal workload and working status, avoiding stress, overtime, staying up late, etc.

2. If possible, take a 20-30 minute lunch break.

3. Due to differences in individual physique, age, medical condition, etc., recovery time will also vary. Therefore, recovery work should be gradual, and the intensity should be based on not feeling tired.

05

Home disinfection advice

After the COVID-19 infection enters the recovery period, indoor ventilation should be strengthened. On the basis of cleanliness and hygiene, key areas and used items should be disinfected. Physical disinfection methods such as sunlight exposure and heat should be used as the disinfection method. Chemical disinfectants can be used to wipe the surface of the home environment. Disinfectants such as chlorine-containing disinfectants, quaternary ammonium salt disinfectants, hand disinfectants, etc. can be used for home disinfection. Alcohol or quaternary ammonium salt disinfectant wipes can also be used.

1. Disinfection methods for different objects

1. Indoor air. Open windows regularly every day to keep indoor air flowing. If natural ventilation is not possible, mechanical ventilation can be performed using exhaust fans, air conditioning systems, etc.

2. Object surfaces. If there are pollutants on the surfaces of tables, chairs, furniture, door handles, faucets, etc., they should be cleaned first, and then wiped and disinfected with 500mg/L chlorine-containing disinfectant. You can also choose a quaternary ammonium salt disinfectant with less irritation. After 30 minutes, wipe it clean with water. Small items such as mobile phones, remote controls, and mice can be wiped and disinfected with alcohol wipes.

3. Surfaces such as the ground and walls that may be contaminated. If there are contaminants, they should be completely cleaned before disinfection. 500mg/L chlorine-containing disinfectant can be used for wiping or spraying, and the disinfection time should be no less than 30 minutes.

4. Tableware: Wash first and then disinfect. Boil for 15 minutes first, or soak in 500mg/L chlorine-containing disinfectant for 15 minutes and then wash with clean water.

5. Clothes, bedding, towels and other textiles. They can be boiled for 15 minutes or washed with heated water, kept at 56°C or above for 30 minutes. They can also be soaked in 1000mg/L quaternary ammonium disinfectant or other clothing disinfectant for 30 minutes and then washed as usual. Fabrics that cannot be washed can be left at room temperature for 7-10 days.

6. Mops, rags and other sanitary utensils should be used in designated areas to avoid cross-use. After use, they should be soaked and disinfected in 1000mg/L chlorine-containing disinfectant, rinsed with clean water after 30 minutes, and dried and stored.

7. Toilet. The toilet seat and surrounding areas can be cleaned and wiped with a disinfectant containing 1000mg/L-2000mg/L of effective chlorine. Toilet door handles, faucets, wash basins and other areas that are frequently touched by hands can be wiped with a disinfectant containing 500mg/L of effective chlorine. After 30 minutes, wipe them clean with clean water and strengthen the ventilation of the bathroom.

8. Refrigerator and frozen food. If the frozen food stored in the refrigerator is contaminated, it is recommended to dispose of it as garbage; if you need to eat it, you can also cook it thoroughly before eating. When processing food, take personal protection measures, wear masks and gloves, and strictly maintain hand hygiene. If the inner wall of the refrigerator is contaminated, it is recommended to refer to the "surface" disinfection method after the temperature in the refrigerator returns to normal temperature.

9. Domestic garbage. Garbage should be collected and cleaned in a timely manner. It is recommended that the garbage be tightly wrapped in double-layer plastic bags, and then the outer surface of the garbage bags should be sprayed with chlorine-containing disinfectant containing 500mg/L-1000mg/L of effective chlorine before being transported to the garbage disposal point.

10. Other items. For items that are not suitable for disinfection, such as books and valuables, they can be sealed and left at room temperature for 5-7 days.

2. Precautions for disinfection

1. Disinfectant should be prepared before use. Take a chlorine-containing disinfectant with an effective chlorine content of 5% as an example: when preparing 500 mg/L, add 1 part of disinfectant to 99 parts of water and mix well; when preparing 1000 mg/L, add 1 part of disinfectant to 49 parts of water and mix well.

2. Disinfectants, especially chlorine-containing disinfectants, are irritating to a certain extent. When preparing and using them, personal protection should be taken to prevent splashing into the eyes. Disinfectants are also corrosive to a certain extent. Please wipe with clean water after the disinfection time is reached to prevent damage to items.

3. Disinfectants should be used alone and not mixed with other chemical ingredients. Read the instructions of the disinfectant product carefully before use and use it correctly in strict accordance with the scope of use, usage methods, action concentration, and action time specified in the instructions.

4. Home disinfection should be scientific and standardized, avoid excessive disinfection, do not use disinfectants directly to disinfect the human body, do not disinfect indoor air in the presence of people, do not use alcohol to disinfect the air, and do not conduct large-scale disinfection.

5. Disinfectants should be stored in a cool, dark place, out of reach of children.

06

Health guidance for key groups

1. Elderly people

1. Elderly people often still have a certain degree of fatigue after their nucleic acid or antigen test turns negative, which may even last for several weeks. If you feel tired, please rest as much as possible and try to adjust your daily pace and not do too many things at once.

2. If your energy allows, please gradually resume your daily routine and make a daily schedule for yourself, including sleep, meals, activities, etc.

3. Exercise in a safe and fatigue-free manner to restore strength and endurance. If walking is difficult for you, consider exercising in bed or on a chair, starting with stretching exercises and gradually increasing the amount of activity, such as doing housework, walking, Tai Chi, Ba Duan Jin, etc. When you first start exercising, start with 5-10 minutes, then increase one minute each day. If you are worried about falling, exercise with family or friends. If you feel dizzy, chest pain, or difficulty breathing during or after exercise, stop and rest and consult a doctor.

4. Drink 1500-2000ml of water every day, eat three meals a day, and add snacks as needed. It is recommended to record the food you eat every day to help you understand whether you are eating healthily.

5. Stay socially connected. Talk to loved ones and people you trust as much as possible every day through phone calls, video calls, or other forms of communication.

6. Try to think of three happy things every day. Try to repeat words such as "relax" and "calm" while taking deep breaths. Try to avoid negative or unhealthy thoughts. If stress, worry, fear, and sadness interfere with your daily activities for several days in a row, contact your doctor and seek psychosocial support.

7. List emergency contact numbers: such as the phone numbers of nearby medical institutions, social and psychological support hotlines, family doctor numbers, family members, friends, etc.

8. Elderly people with underlying diseases will have their underlying diseases aggravated after being infected with the new coronavirus. For example, elderly people with hypertension may have unstable blood pressure after being infected, elderly people with diabetes may have unstable blood sugar after being infected, elderly people with cerebrovascular disease may have the risk of cerebral infarction or bleeding after being infected, and elderly people with chronic obstructive pulmonary disease may have coughing and worsening breathing difficulties after being infected. After treatment, the nucleic acid or antigen test of the elderly turns negative, but the aggravated underlying disease may not necessarily stabilize. It is necessary to closely monitor blood pressure, blood sugar, finger oxygen saturation, etc. If the unstable condition lasts for a long time, please go to the hospital in time for treatment and adjust the treatment plan for the underlying disease.

2. Pregnant women

1. Regardless of the gestational age, pregnant women should take good rest within 1-2 weeks after recovering from COVID-19 infection. They can do some exercise, but the intensity and duration of exercise should not be too high and should be gradual. Warm up before exercise and drink enough water before and after exercise. If you have threatened abortion, placenta previa or other conditions that are not suitable for exercise, you should follow the doctor's advice.

2. Pay attention to ensuring reasonable and adequate nutritional intake throughout pregnancy.

3. Keep a happy and stable mood. Don’t worry too much about the adverse effects of the new coronavirus infection on the fetus. It is currently believed that the probability of vertical transmission of the new coronavirus to the fetus causing intrauterine infection is extremely small, and generally will not cause deformities.

4. Pregnant women should have regular prenatal checkups, and those in the second and third trimesters should monitor fetal movements on their own. If there are symptoms such as abnormal fetal movements, abdominal pain, abdominal discomfort, vaginal bleeding, etc., they should go to the hospital immediately for treatment.

3. Children and adolescents

Generally speaking, the vast majority of children and adolescents infected with the new coronavirus have a good prognosis, present a self-limiting course, and have a very low chance of developing serious complications and sequelae. Parents should first maintain a calm attitude, understand the natural course of the new coronavirus infection, and not be overly anxious.

1. Continue to take protective measures and develop good hygiene habits.

(1) Do not take children and adolescents to crowded places, poorly ventilated indoor places, or to long-term contact with others. Wear a mask when going out (children over 3 years old) and keep a distance from others as much as possible.

(2) When staying at home for a long time, the room should be well ventilated. Try to ventilate when children and adolescents are outside, or ventilate each room separately.

(3) When family members come home from outside, they should wash their hands and face and change clothes before coming into contact with children. If there are people with respiratory infections at home, they should be isolated from the children and wear masks.

(4) Guide children and adolescents to develop good hygiene habits, including washing hands before meals, after defecation, after sneezing, coughing, cleaning the nose, and after returning from outside.

2. Develop good living habits and enhance your own resistance.

(1) Have a regular schedule and get enough sleep. Go to bed and get up on time. Children under one year old should sleep at least 12 hours a day, 11 hours before kindergarten, 10 hours in kindergarten, at least 9 hours a day for elementary school students, and 8 hours a day for middle school students.

(2) Take it step by step and exercise. After recovering from COVID-19 infection, it is recommended to gradually increase outdoor activities and physical exercise, with the intensity being appropriate to the child without discomfort.

(3) Eat three meals a day regularly and eat a balanced diet. Do not be picky about food and develop healthy eating habits.

(4) Others: Add or remove clothes appropriately and pay attention to mental health.

3. Treat the symptoms of the recovery period correctly. Some children and adolescents will continue to cough for a period of time after being infected with the new coronavirus. If the general condition is good, it does not affect daily life, and no special treatment is required, antitussive drugs are usually not recommended. However, if the child originally has bronchial asthma, allergic rhinitis, etc., and the cough lasts for more than 3 weeks and still does not recover, and the cough mainly occurs at night, he or she should also seek medical attention in time.

4. Parents should be vigilant for high-risk groups such as those with congenital heart disease, chronic lung disease, nervous system disease, severe malnutrition, tumors, obesity, diabetes or hereditary diseases, immunodeficiency or long-term use of immunosuppressants, premature infants or newborns who are prone to severe illness. If a child has a persistent high fever for more than 3 days, shortness of breath, mental depression, persistent chest tightness or chest pain, or the condition worsens, they should seek medical attention in time.

Source: Healthy Beijing

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