More than half of Covid-19 patients had a pulmonary dysfunction abnormality after 6 months discharge from hospital.

The long-standing health consequences of patients with COVID-19, who have been discharged from hospitals, are severe and needless to say, subject to study in all over the world.

According to a cohort study done at JinYin-tan Hospital, the first designated hospital for patients with COVID-19 in Wuhan, Hubei, China. At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue ormuscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations are the main target population for intervention of long-term recovery[1].

A total of 1733 patients with COVID-19 participants were enrolled for questionnaire interview, physical examination, laboratory tests, and 6-min walking test. The follow-up study was done from June 16, 2020, to Sept 3, 2020.

The results of lung function assessment in this study showed that a considerable proportion (22–56% across different severity scales) of participants had a pulmonary diffusion abnormality 6 months after symptom onset.

This was consistent with findings that the most common abnormal CT pattern was pulmonary interstitial change (GGOs and irregular lines), which were similar to the long-term lung manifestations of SARS or influenza. Respiratory viral infection might potentially induce distinct fibroblast activation in the convalescence phase. The disease severity in the acute phase was found to be associated with pulmonary diffusion abnormality and percentage change of CT score in the multivariable analysis. These results support that those with severe disease need post-discharge care.

Another study done by the national prospective observational Swiss COVID-19 lung study shows how four months after SARS CoV-2 infection, severe/critical COVID-19 were associated with significant functional and radiological abnormalities, potentially due to small airway and lung parenchymal disease[2].

“A systematic follow-up for survivors needs to be evaluated to optimize care for patients recovering from COVID-19”.

With the analysis of pulmonary function, physical performance, oxygenation and radiological findings four months after COVID-19 their study adds to the growing body of evidence on post COVID-19 trajectories. Identified DLCO %-predicted at four months as the single most important factor associated with severe/critical respiratory COVID-19 which translates to reduced walking distance and oxygen desaturation on exercise. These results also emphasize the importance of a systematic follow up rehabilitation programme after severe and critical COVID-19, with appropriate management of pulmonary sequela.

Needless to say, an appropriate management programme for Post-Covid 19 patients is still to be define. Whether or not, in futures study we can observe different type of sequela and consequence, is imperative to improve the quality life of these patients.

NMES may be an effective treatment for muscle weakness in adults with advanced progressive disease and could be considered as an exercise treatment for use within rehabilitation programme. Since has also been showed benefit on people who suffer chronic obstructive pulmonary disease could be also used on Covid-19 patients. However, there still lack of clinical trials on post-discharge patients.

Respiratory Neuromuscular Stimulation

Beijing Yaguo Technology has designed one of the best devices for post covid-19 patients’ respiratory muscles rehabilitation. Based on NMES technology, Respiratory Neuromuscular Stimulator stimulates the phrenic nerve and abdominal muscles enhancing strength and endurance of respiratory muscles, relieve the symptoms of dyspnea, and promote pulmonary rehabilitation. Patients’ needs to take regularly session for a month to see an improvement in their quality life.

The Respiratory NMES device may be a new choice and method of respiratory muscles weakness rehabilitation for post Covid 19 patients.

During special Covid 19 epidemics, it is important to use new technologies and devices to solve new problems with new ideas.

[1] Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA 2020; 324: 782–93.

[2] Guler SA, Ebner L, Beigelman C, et al. Pulmonary function and radiological features four months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study. Eur Respir J 2021; in press (https://doi.org/10.1183/13993003.03690-2020).