Long-Covid effect study ongoing at Cavan General

The Herculean task facing patients dealing with the long-term effects of Coronavirus is being witnessed first hand by two local chartered physiotherapists.

Catherine Elliott and Sarah McCaul, both based at Cavan General, are studying the significant ongoing impact of post-Covid symptoms, not just on elderly people treated in ICU (Intensive Care) or HDU (High Dependency), but younger virus survivors as well.

It has meant the two physios are well positioned to gauge first-hand the scale of rehabilitation some survivors require to begin to return to lives they once knew.

“It has been a steep learning curve, certainly,” says Catherine earnestly. “In some cases, we’re talking four months post discharge and still there are some who have had ongoing symptoms, even at that stage.”

Varying widely in age from 35 to 62 years, some involved in the programme required several weeks of treatment, including ventilation.

Catherine and Sarah set about regularly monitoring their patients’ progress after discharge but, what has been among the most remarkable findings, is the long-lasting effects are often as much mental as they are physical.

They include a 50-year-old hospital healthcare worker diagnosed with COVID-19 on April 2 who attempted to return to work after two weeks but was unable to continue.He has been on sick leave since and, despite completing the rehabilitation programme, still suffers ongoing levels of anxiety and fatigue with regular panic attacks.

Two more cases involve previously fit and healthy members of the armed forces.

The first (55) was diagnosed with Covid at the end of March, after which he was admitted to ICU for three weeks. Post ICU, he presented with extreme muscle weakness, including being unable to sit on the end of a bed without the assistance of three physiotherapists. He also suffered extreme confusion and disorientation.

Subsequently referred to the Monaghan Rehabilitation Unit, the man currently has to wear foot orthotics to enable him to walk safely.

The other (35) was only diagnosed with Covid in August. Admitted to hospital for three weeks, he too has ongoing muscle weakness in both legs, is unable to lift more than a two-litre bottle of water without becoming breathless, and has difficulty even climbing stairs.

Catherine and Sarah’s eight-week rehabilitation programme saw patients each complete pre and post exercise tolerance tests. They included measuring the distance a person can walk over the course of six minutes, as well as a sit-to-stand test counting the number of times a person can get in and out of a chair without using their arms in one minute.

Before, the average distance performed was 364m, compared to the expected distance for a healthy person being between 500-580m.

Some of the techniques used by Catherine and Sarah are the same used to help treat people diagnosed with Chronic Obstructive Pulmonary Disease (COPD), a service historically provided to patients at Cavan General.

Along with exercises, it meant rolling-out education around conditions, though in this case specifically related to Covid recovery.

On completion of the programme, patients involved showed improvement, with walking distances, on average, increasing by at least 77m, and sit-to-stand reps rising by seven.

The most recent patients to complete Catherine and Sarah’s Covid rehabilitation class did so only two weeks ago.

“There is a lot of worry out there,” acknowledges Catherine, who has worked as a physio for the past 10 years. In that time, while addressing individual conditions, Catherine has never seen anything like the multiple effects brought on by Covid.

“The variety of different symptoms people are still having has been surprising. Shocking really. There have been vascular symptoms reported, [Covid] has been shown to affect the brain, the heart, the lungs, there is evidence people have developed blood clots from it.”

She adds: “Even memory problems for some, concentration problems, fatigue is a massive, massive ongoing issue for many people. And then anxiety as well. This is a hugely traumatic thing for people to go through, and worryingly nobody is able to tell them when this will all be over. No one can give them an answer for when they’ll get back, or are ever going to get back to normal.”

While there are similar programmes engaging with Covid survivors elsewhere in the country, the Cavan General study being conducted by Catherine and Sarah stems from a recognised need among discharged patients in the community here.

Catherine and Sarah are in the early stages of working on publishing their findings in a medical journal. The outcome could be that the Cavan study results could be used to better model care guidelines in future.

Even still, and despite the positive results, the level of ongoing impairment among patients remains a “real concern” for Catherine and Sarah, who noticed that residual impacts of the disease do not appear to reflect the severity of the initial illness.

“Especially in young patients, I don’t think myself or Sarah have ever seen anything quite like it. We have people never admitted to ICU with it, and some of those are among the cohort suffering from the most severe long-term effects of Covid.

“We have seen young, previously fit and healthy patients now having difficulties caring for their young children, who cannot walk for longer than five minutes without severe fatigue or breathlessness.”

Catherine states: “[Covid] takes no prisoners, it’s no respecter of age, how fit you are before you got it. It really doesn’t discriminate.

“It has left an awful lot of people, not just here in Cavan, but elsewhere across Ireland, really struggling, and struggling to manage even the simplest tasks of everyday life.”

From the frontline, she notes: “It has been tough, very challenging at times. It has certainly being exhausting. But there are other times when it has been really rewarding, where for instance you’ve been able to rehab someone to the point they’ve been able to walk out to the front of the hospital to see their family for the first time in seven to eight weeks. Moments like that stay with you, and in many ways it makes the hard stuff to deal with more manageable.”