COVID-19 is a highly contagious virus that mainly attacks the lungs. It is transmitted through droplets created from sneezing and coughing from those infected. The virus enters the body via the nose, mouth and eyes.
The most commonly reported symptoms of COVID-19 are:
- A new continuous cough
- A fever
- Muscle aches
- Shortness of breath when moving around
- Sputum production
- Loss of appetite/taste/smell
The severity and duration of symptoms for people who have COVID-19 can vary. For most people, symptoms last 7-14 days and will be very mild.
To manage mild symptoms:
- Stay hydrated
- Take paracetamol if you have a temperature
- Get up and move about at regular intervals
Monitor your symptoms regularly. If you get one of the following:
- Worsening shortness of breath
- A new or returning fever
- Worsening ability to concentrate
- Chest pain
Please call 111 for more advice or for a medical emergency, dial 999 immediately.
If you’re worried about symptoms four weeks or more after having COVID-19, please contact your GP.
Recovery from COVID-19 will take time and varies from person to person. It can range from a few days or weeks and most will make a full recovery within 12 weeks. But for some people, symptoms can last longer and it’s important not to compare yourself to others.
Post COVID-19 effects could include:
- Muscle weakness and joint stiffness
- Extreme tiredness (fatigue) and a lack of energy
- A persistent cough
- Loss of appetite +/-taste, weight loss and swallowing difficulties
- Sleep problems and nightmares / flashbacks particularly if you have been in a intensive care unit
- Memory problems – for example, not being able to remember some events, think clearly and being forgetful
- Changes in mood, anxiety, depression
The British Lung Foundation has a support line for people who have recovered from COVID-19. Further information can be found at: www.blf.org.uk
NHS England’s website for ‘Your COVID Recovery’ can be found at https://www.yourcovidrecovery.nhs.uk/
There are also various social media sites available.
During your treatment with the team, you may be seen by some or all of the following professionals depending on your needs:
- Occupational therapists
- Speech and language therapists
- Rehabilitation assistants
As a team we are here to help you through your recovery.
COVID-19 Rehabilitation team contact details:
01883 733892 or firstname.lastname@example.org
You may have ongoing breathlessness following COVID-19, particularly on exertion. Anxiety can also lead to feeling more breathless as your breathing becomes more rapid.
There are a number of techniques that you can use when you feel breathless:
Exercises to help manage your breathing
Breathing exercises can help you manage your breathlessness and reduce its impact on your everyday activities. Sit in a comfortable position relaxing your shoulders. Place your hands on your tummy. Close your eyes concentrating on your breath.
- Take a slow breath in through your nose
- Allow the air to fill up from the bottom of your lungs to the top of your chest
- Breathe gently out through your nose if you can, or through pursed lips (as if you were going to blow out a candle) to create space for the next breath in
- Try to slow your breathing down. You should feel your tummy move forwards and backwards with each breath.
Breathing control while walking
This will help you walk on the flat, climb stairs and negotiate slopes. Try to keep your shoulders and upper chest relaxed and use your breathing control. Time your breathing with your stepping.
- Breathe in – 1 step
- Breathe out – 1 or 2 steps.
Make sure you have good air circulation in the room by opening a window or door.
Use a wet flannel to cool the area around your nose and mouth this can help reduced the sensation of breathlessness.
For further information on breathing control and exercises to help manage your breathlessness, please refer to the information online:
‘Pursed lip breathing’ and ‘blow as you go’ are techniques that are discussed here are useful to use if you are struggling with shortness of breath whilst at rest or on exertion.
Please note additional oxygen will not make you feel less breathless!
Breathe a rectangle
If you find breathing control difficult to do, try to breathe a rectangle. Please see the diagram below:
- Find a comfortable position
- Look for a rectangle shape in the room such as a window, door or TV screen
- Move around the sides of the rectangle with your eyes, breathing in on the short sides and out on the long sides.
Positions to manage breathlessness
Following COVID-19 you may find you have continued breathlessness. You should monitor this and if it gets worse seek further review from your GP or 111.
These positions can help ease your breathlessness and can be used when resting or when mobilising.
For further information on positions to help ease breathlessness, please refer to the following information online:
How to cope with being short of breath – positions https://www.acprc.org.uk/publications/patient-information-leaflets/
Managing your cough
A dry cough is one of the most commonly reported symptoms for COVID-19 however in some cases it may be productive of phlegm (chesty).
Strategies to manage a dry cough:
- Stay well hydrated
- Sipping a soft drink – take small sips, one after the other, avoid taking large sips
- Steam inhalation – pour hot water into a bowl and put your head over the bowl. If comfortable, cover your head and bowl with a towel. Do not use boiling water with small children to avoid the risk of scalding
- Drink warm honey and lemon or another warm drink, this can help to soothe the throat
- If you do not have a drink to hand, but need to cough, try swallowing repeatedly. This can work in a similar way to sipping water.
Strategies to manage a productive (wet or chesty) cough:
- Keep well hydrated
- Steam inhalation
- Try lying on either side, as flat as you can. This can help drain the phlegm
- Try moving around; this will help to move the phlegm so that you can cough it out.
Exercises to help clear your chest
Following COVID-19 you may find that you have a productive cough and mucus on your chest.
These exercises and positions can help you clear your chest. These may be recommended by your physiotherapist or nurse.
Active Cycle of Breathing Technique (ACBT) exercise consists of three breathing exercises that together help to clear the mucus off your chest.
1. Breathing control - Gentle, relaxed breathing
with your shoulders relaxed
- Breathe in and out gently through your nose if possible.
- If you breathe out via your mouth, use ‘pursed lips’
- Try to make the breaths slower.
- Do as many of these as you can and try this technique between other exercises.
2. Deep breaths
- Take a slow breath in through your nose if you can.
- Try to breathe out gently, like a sigh.
- Don’t exceed 3-5 deep breaths in a row as it may make you feel light-headed or dizzy.
- You may find it helpful to hold your breath for 2-3 seconds before the breath out
3. Forced expiration techniques (Huff)
- Take a medium sized breath in
- Breath out forcefully for a short time
- Keep your mouth open and use your stomach and chest muscles
- Think ‘huffing’ a mirror to polish it
- Repeat 1-2 times
- Always finish on a cough or huff
- Stop when your huff is dry on two consecutive cycles.
How often and how long?
- Continue to do until you feel your chest is clearer
- Clear as much mucus as you can without becoming exhausted
- Perform for at least 10 minutes, but no longer than 30 minutes
- If productive 2-3 times per day.
If huffing doesn’t clear your phlegm, then you may need to cough. Avoid long coughing fits as they can be tiring, give you a sore throat and make you feel breathless. Clearing your chest should be done regularly. You may only need to do it once or twice a day. If you’re producing more phlegm, you may need shorter but more frequent sessions.
Remember to drink plenty of fluids - this will make it easier to cough up the phlegm
Positions to help keep your chest clear
Use the following positions, along with ACBT to help clear your chest.
- Don’t do immediately before or after a meal
- Stop if you have any side effects
- Chose the position below that you feel would best drain your lungs. You can do this in discussion with a health care professional.
Do not do this if have:
- Acid Reflux
- Become significantly breathless
- Have blood in your phlegm
- Have a recent chest, spine or rib injury
- Feel wheezy
If you have any of the above, please speak with a health care professional before doing this.
For further information on how to do the Active Cycle of Breathing technique please refer to the following leaflet online:
The Active Cycle of Breathing Techniques https://www.acprc.org.uk/publications/patient-informationleaflets/
The weather can have a huge impact on your breathing. Please follow the below advice to help you cope in extremes of temperature
Home during winter
- Recommended temperatures for living room are 21 degrees Celsius and 18 degrees Celsius for bedroom
- Close curtains at dusk to keep heat in the room.
- Shut windows at night
- Make sure thermostats are set correctly. Hot water thermostats should be set at 60-65 C and central heating thermostats should be set at 21 C
- Avoid placing furniture directly in front of radiators, you end up heating the furniture rather than the room.
Outside during winter
- Wear a hat coat and scarf, place the scarf loosely over your mouth to reduce the effect of cold air on your lungs
- Try to reduce your outdoor activities, when it is very cold (less than 4 degrees C) or if it is wet and windy. You want to avoid getting to the point that you are shivering.
- Contact your GP about your flu Jab when appropriate.
Home during summer
- Stay in the coolest rooms of the house during the hottest part of the day
- Close the curtains in the rooms that get lots of sun
- Keep windows closed when the rooms are cooler than it is outside.
- Open windows at night to let cooler air in
- Splash cold water onto your face and neck. Take cool showers or baths.
Outside during summer
- Avoid going out during the hottest part of the day (11am-3pm). Plan your day around this as much as possible
- Whilst out, take water with you, wear a hat and loose fitting clothing. Stay in the shade as much as possible.
COVID-19 is a new coronavirus. We are on a steep learning curve about how it behaves and guidance is constantly evolving, but we are discovering more as time goes on.
One of the things that we are becoming aware of is that a small proportion of people experience a range of ongoing symptoms following coronavirus, including overwhelming fatigue.
They are finding that they are not able to return to previous levels of energy and health in the weeks following the infection. Some degree of fatigue or weakness is quite common after a viral infection. This is known as post viral fatigue. Often it is short-lived and people return to normal after a few weeks, but for some a full return to health can take months rather than weeks.
From our current knowledge of post viral fatigue and other previous similar viral infections such as SARS, there are some general principles around managing fatigue that can help in supporting the natural recovery process.
The initial phase
If you have or have had coronavirus it is likely that you will experience fatigue as a symptom.
This is the body’s normal response to dealing with an infection.
For most the infection and initial fatigue will be a mild to moderate with recovery occurring over a week or two.
During this initial phase it is important to:
Sleep – you may find that you need to sleep much more. This is normal during an infection so sleep as much as you feel you need.
Rest – this allows your body to focus on dealing with the infection. In this situation, rest means periods of time during the day doing very little, physically or mentally. Even low-level activity such as TV or reading may need to be paced or minimised, depending on your level of illness.
Eat and hydrate – eat and drink little and often if you can, increase your fluid intake if your appetite is low, sipping water regularly throughout the day.
Move – If you feel well enough, move at regular intervals throughout the day to keep your body and circulation moving. This could be simple stretches either in your bed or chair if you are unable to walk around.
Pause your work/education - allow yourself to fully recover from the initial infection before returning to your previous activity levels.
The recovery phase
When people start to feel better after an infection, it is often tempting to return to previous levels of work, leisure and social activities.
However, if fatigue and other symptoms are continuing it can be important to do this slowly and gently. Don’t try to ‘push through’ what you feel you can manage easily.
The most important aspect of managing post infection fatigue is giving yourself time for recuperation, or convalescence as it has been known. This requires a combination of rest, relaxation and gentle activity.
In practice this involves:
Activity Management – balancing periods of low- level gentle activity with periods of rest. You could start with some light activity or tasks followed by longer periods of rest. Mix up the physical and mental activities throughout the day
Setting the limits – Finding the right balance of activity management is very individual to you and the stage that you are at with your recovery. Once you’ve worked out what is a suitable level and duration to do an activity try to set the limit before you start something and do not exceed this i.e. unload just the top layer of the dishwasher or check through emails for 5 minutes.
Routine – Try to resume a pattern of sleep, mealtimes and activity. Avoid doing too much on a good day, that then might exacerbate the fatigue and other symptoms. Having a basic routine, that has some flexibility, can be helpful for when you are ready to start increasing. A regular routine can also help you sleep better.
Rest – Your body will continue to need rest to help with healing and recovery. You may find that you do not need to rest for long periods like you did initially, but regular short rests throughout the day will continue to be helpful. Take as much rest as you need.
Relaxation/meditation – adding in approaches such as mindfulness or relaxation/ breathing techniques can help to aid restorative rest. There are some useful resources online.
Sleep – Whilst we encourage resuming a routine for sleep, sleeping for longer can often be an important requirement for ongoing healing following an acute infection. You may find in this phase a short day-time nap, 30 – 45 minutes, not too late in the afternoon is helpful.
Diet – Maintaining a healthy diet with regular fluid intake will help to improve your energy levels. If possible, avoid caffeine and alcohol as much as you can.
Mental wellbeing – Looking after your emotional health is another important factor in managing fatigue. We know that stress and anxiety can drain the energy battery very quickly. We know that fun and pleasurable activity can help both well-being and energy levels so build these into your activity plan. This can be something small, such as chatting to a friend or watching your favourite TV show.
Work/education - It might be advisable to avoid going back too soon to work once the initial viral symptoms of fever or cough have subsided and to give yourself a little time to recover. You may find a phased or gradual return helpful, for example, starting with just mornings every other day and slowly building up over the next few weeks. You may be able to get support from occupational health or a ‘fitnote’ from your GP.
Exercise – Depending on the stage of your recovery, some exercise may be helpful. This might be some gentle stretches or yoga or a short walk. For people who usually do a lot of exercise, it is important to only do a small fraction of what you would normally do and at a gentle pace. Resume slowly and gradually increase over time as your illness improves.
You may be starting to feel better after a few weeks and over time you may feel able to increase your activity gradually.
Resist pushing through the fatigue and maintain some degree of routine, rest and activity.
In most cases people do eventually recover from post-viral fatigue after a period of convalescence, but it can sometimes take many months.
However, if your health is not improving, or if you continue to experience persistent symptoms after a few months that interfere with your capacity to carry out normal everyday activities, it is advisable to speak with your GP.
They can check to find out if there aren’t any other causes for the fatigue.
Fatigue can sometimes have other causes such as anaemia or thyroid function and, in a small number of cases, viral infections can sometimes trigger serious chronic, long-term illnesses such as Myalgic Encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS).
As you recover you are likely to find that your energy levels fluctuate from day to day.
Walking around your home might be difficult, including managing the stairs, accessing toileting facilities and managing your daily routine. This may result in you needing to adapt the activities that you do to enable you to conserve your energy.
Whilst you recover, you may need:
- To consider a different set up such as single level living either downstairs or upstairs whilst you recover
- Specialist equipment to make things easier.
With this analogy in mind it may be useful to keep a note of how tiring different activities are for you in order to help you understand the pattern of your fatigue and enable you to manage and adapt to this better.
Conserving your energy using the ‘four Ps’
Planning includes organising daily routines to allow completion of essential activities when you have the most energy. For example many find it more helpful to perform strenuous tasks such as dressing early in the day when strength and stamina are often at their peak. It is important to think about the task prior to performing the task and expending physical energy.
Consider the following:
- Think about the steps that need to be completed and items required for the task.
- Prepare the required items ahead of time.
- Keep frequently used items in easily accessible places.
- Have duplicate items available to limit unnecessary trips between the bathroom, bedroom, or kitchen.
- Consider using a bag, basket, or rolling trolley to carry tools or supplies in one trip.
- Consider your weekly routine. It will be beneficial to schedule strenuous activities, such as going to the hairdresser, attending religious services, and shopping, evenly throughout the week instead of all in one day.
Once activities are planned, pacing allows individuals to sustain an energy level until the task is completed.
Consider the following:
- Allow plenty of time to complete activities and incorporate frequent rests.
- Perform tasks at a moderate rate and avoid rushing. Although a task may be completed in less time, rushing utilises more energy and leaves less ‘in the bank’ for later activities.
- Allow plenty of time for rest and relaxation. Take a morning or afternoon nap prior to activities or outings to build up energy.
- Breathe easily and properly during activities. Using these techniques helps decrease shortness of breath.
- Rethink activities with rest in mind. For example, sit instead of stand while folding clothes or preparing food. Instead of writing 25 holiday cards in one day consider writing five cards per day over five days.
The third strategy is often the most challenging. When faced with limited energy reserves individuals must look critically at work, family, and social roles and keep only those roles that are necessary and pleasurable.
Consider the following:
- Can a friend or family member assist with chores e.g. emptying the rubbish, vacuuming so you have more energy for necessary and pleasurable tasks?
- Eliminate unnecessary tasks, chores or steps of an activity. Look for shortcuts and loosen the rules
- Be flexible in daily routines enables you to enjoy activities you would like otherwise miss because of fatigue.
Positioning is extremely effective, but not often considered when addressing energy conservation. Current methods of performing tasks may be using more energy than required.
Consider the following:
- Storing items at a convenient height to avoid excessive and prolonged stooping and stretching
- Make sure all work surfaces are at the correct height. If a counter is too short, slouching and bending can occur which results in more energy expenditure
- Use long-handled devices such as reachers or telescope cleaning tools to avoid unnecessary bending and reaching
- Facilitate bathing - use a shower seat and a hand-held shower head.
For further information on fatigue management please refer to the Royal College of Occupational Therapists guidelines online. It can be found by following the below link;
The experience of having COVID-19 can be very frightening. It is very understandable that the experience can have an emotional impact.
Whether you have had mild or more severe symptoms, these are some common difficulties that you may be having and remember everyone is different and there is no right or wrong way to react:
- Feeling anxious when breathless
- Worries about health or about family or friends getting ill
- Feeling low in mood
- Poor sleep
- Memory loss
- Difficulty collecting your thoughts
- Post-traumatic stress symptoms i.e. anger, jumpiness, hallucinations, fear, nightmares
- Problems socialising
If you were treated in hospital, you may also experience:
- Unpleasant images from your stay, that might seem to come ‘out of the blue’
- Feelings of panic with any reminders of hospital
What can help?
- Avoid watching too much news or social media if it is making you feel anxious, try limiting yourself to looking at the news once a day
- Speak to family and friends
- Try to do activities that you find enjoyable and relaxing
- Don’t be too hard on yourself if there are some things you find harder to do. Remind yourself that recovery takes time
- Focus on what is in your control, like eating well
- If you continue to feel overwhelmed by your symptoms, please speak to your GP
Thinking about being very unwell can release adrenaline from the body and this stimulates the ‘fight’ or ‘flight’ response. This can cause some unpleasant feelings in your body. Although unpleasant they will not harm you, such as:
- Increased heart rate
- Increased breathing rate – can make you faint or dizzy
- Inability to relax
- Disturbed sleep patterns
- Feeling hot and clammy
What can I do to help myself?
- Talk through your feelings. If you feel unable to talk to a relative, friend or colleague, the Samaritans are a listening service. You can find more information at www.samaritans.org
- For further support following a period in intensive care go to www.icusteps.org this is a support group for people who have been affected by critical illness.
- Read the following section on Anxiety, relaxation and stress.
- If you find that your breathing rate is getting fast refer to the exercise sheet:
‘How to Cope With Being Short of Breath – Breathing Exercises’
- Set yourself small goals and write down your thoughts and your achievements.
Top tips for anxiety and panic attacks
If you experience panic attacks or anxiety, try some of the tips below. They can help you to manage stresses in your life and help manage panic and anxiety so you feel more in control.
Some situations can make us feel anxious. In order to work through this we need to expose ourselves to the situation that is making us feel anxious. Try and break this down into smaller stages that you can achieve, practice and build on. The more exposure you have to the situation the less likely it will affect you. Mastery of this will allow you to work through the anxiety so it is no longer problematic.
First relax your shoulders and stomach muscles. As you breathe in, allow your stomach to rise and not your chest. Then breathe out slowly, so your stomach falls. Repeat until you feel calm. This technique may take a lot of practice so keep working on it. This technique works well if you are experiencing a panic attack.
Distract your thoughts
Try counting backwards from 100 in 3s. Alternatively keep something on you that comforts you, such as a picture of happy memories. Draw your attention to reliving that memory and how this made you feel. Focus on this until you feel calm.
Use positive statements such as ‘I am in control’, ‘I can do this’, ‘Life is great’. Say these statements out loud on a regular basis. The more you hear this, the more you believe it and the more you will feel it!
Talk to someone
Sharing your concerns with someone you can trust can help relieve your anxieties. A problem shared is a problem halved! Talking to others may help you find a solution or offer a different way of looking at the situation.
Practice relaxation techniques
Start by gently breathing in through your nose and out through your mouth, keeping the pace slow and regular. Slowly tense, and then relax all the muscles in your body, starting at your head and working down to your toes. Afterwards, take some time to focus on how your body feels.
Everyone experiences anxiety from time to time.
If your anxiety persists for 2 weeks or more, or it is significantly impacting on your daily activities, you will need to see your GP
Top tips for stress relief
Be realistic about what you can achieve and communicate this with others. Unrealistic expectations will reduce productivity and increase your stress. Taking a regular break and not regularly exceeding work hours will ensure optimum productivity.
Sort out your worries by writing them down
Divide them into those that you can do something about (either now or soon) and those that you can’t. Prioritise what order you can work on jobs to be done. Easy tasks can be ‘quick wins’ which can boost your motivation to keep going.
This includes saying no! Effective communication is vital in ensuring a good working relationship with others. It can reduce the likelihood of situations being misinterpreted and help with feeling valued and heard. Be aware of your tone when asking for help. Remember people are more likely to help if there is something in it for them.
Start with a positive attitude; ‘I can do this’. This will help you to get started on a positive note. Quite often you cannot control or change an event or situation, but you can always control your actions or reaction to it. Focus on the element of the situation that you can control and let go of what you can’t.
Ask for support
This could be from, a colleague/friend or from an external service. If your stress is work related, speak to your manager. Talking to others may help your situation allowing a different perspective.
List your achievements
Keep a track of all of the things you have achieved and just how far you have come. This will help you keep a sense of perspective and will give you a boost to keep going.
Keep expectations realistic
What would you say to a friend in a similar situation? Quite often our expectations of ourselves are far higher than those we would expect of others. Thinking of advice you may give to a friend if they were in a similar situation can be helpful.
De-clutter your environment by filing, using note books, diaries, etc. This can help you to feel calmer and organised and may save you time in the long run.
Look after your health
Physical activity, healthy eating, relaxation, etc. will all affect your ability to manage stress. Make time for family, friends and hobbies and enjoyable activities.
If you would like further information on managing anxiety, panic and stress please visit www.mindmattersnhs.co.uk/surrey
A wide range of services, support and self-help material can be found on this website.
If you would like Face to Face support you can self-refer to one of the following:
Think Action Surrey 01737 225370
Think Action Surrey is an experienced provider of high quality, wide range of psychological therapies in Surrey at various locations and times.
Mind Matters 0300 330 5450
Mind Matters provide talking therapies to adults (18+) registered with a GP in Surrey who are experiencing common mental health problems such as depression, anxiety and stress. We provide quick and easy access to our talking therapies, in line with individual needs and best practice.
Online talking therapy 01954 230 066 or visit www.iesohealth.com/surrey
IESO Online talking therapy is provided in partnership with the NHS. Cognitive Behavioural Therapy is delivered online in real time using typed conversation. You meet with an accredited therapist in a secure online therapy room, at a scheduled time and location that is convenient to you. All that is required is access to the internet. Online talking therapy is suitable for those experiencing common mental health problems.
Mood Gym which can be accessed online at: moodgym.com.au
This offers an interactive self-help book which helps you to learn and practise skills which can help to prevent and manage symptoms of depression and anxiety.
If you would like further information on managing this please visit http://www.mind.org.uk/information-support/tips-for-everyday-living/stress-guide.
This explains what stress is, including possible causes, and how you can learn to cope, with tips on how to relax.
Top tips for relaxation
Relaxation helps to reduce stress and anxiety and improve your mental wellbeing; this in turn will enable you to manage any challenges that come your way. Try out our top tips on relaxation.
Pause for thought
Introduce small moments of relaxation into your day. Take a moment to observe the natural rhythm of your breathing. Focus on the here and now, letting your thoughts come and go without becoming caught up in them. Concentrate only on the present moment.
Start by gently breathing in through your nose and out through your mouth, keeping the pace slow and regular. Slowly tense then relax all the muscles in your body, starting at your head and working down to your toes. Afterwards take some time to focus on how your body feels.
Meditation and relaxation apps can be a great way to unwind. Try doing this twice a day, once before getting up and once before going to sleep. This will help reduce any tension, leaving you feel more in control of life’s stresses.
Practicing gentle exercise like yoga, tai-chi or Pilates, or taking a walk in the fresh air can give you time to unwind your body and mind. Exercise also releases endorphins, the ‘feel good’ hormone, which can help you to relax.
Listen to music
Listening to your favourite music can help you to switch off. Tracks with a slower tempo, or designed with relaxation in mind, are very helpful when you want to unwind.
Unplug electronic devices
Technology has moved a long way forward and we rely on electronic devices more than ever. Social media, emails, text messages, notifications etc. can bombard us 24/7 leaving us little time to switch off. This can induce an undercurrent of stress so it is important that we switch off from our devices for a period of time daily.
Being relaxed does not come easily for a lot of people. Don’t worry, just keep practising and you will soon get the hang of it. Ensure that when you practice relaxation you are in a warm place, free from distraction or any interruptions. Don’t worry if some of these techniques don’t work for you, just enjoy the ones that do!
If you would like more information about relaxation please visit www.mind.org.uk/information-support/tips-for-everyday-living/relaxation/#.WbJfq9SGPDc
This website offers additional tips and techniques on relaxation to try.
If you would like further support on relaxation, the following apps are free to download and use at your convenience:
Calm: Meditation to relax, focus and sleep better
Calm is the #1 app for mindfulness and meditation to bring more clarity, joy and peace to your daily life. Join the millions experiencing less anxiety and better sleep with the guided meditations, breathing programmes and sleep stories. Recommended by top psychologists and mental health experts to help you de-stress.
Stop Breathe & Think
Stop Breathe & Think is an award winning meditation and mindfulness app which helps you to find peace anywhere. It allows you to check in with your emotions, and recommends short guided meditations, yoga and acupressure videos, tuned to how you feel.
www.mindmattersnhs.co.uk/surrey and www.mind.org.uk/information-support/tips-for-everyday-living/relaxation
A wide range of services, support and self-help material can be found on this website.
This is a self-refer psychological therapy service, without seeing your GP. They offer therapies, such as cognitive behavioural therapy (CBT), for common problems including stress, anxiety, depression and phobias. Once you have referred yourself the service will contact you and you’ll be recommended a therapy.
The therapy you are offered will depend on the problems you are experiencing and how severe they are. The service will also tell you how long you'll wait for your first therapy session. There are different types of psychological therapies available, including online therapy programmes, but they all involve working with a trained therapist.
Many people experience loss of appetite and reduced food intake when unwell with COVID and during their recovery. It is important to try and eat well and keep hydrated to aid your recovery.
What makes food & drink important?
Eating well is important as your body needs energy, protein, vitamins and minerals to help you fight infections and when recovering. Having a good intake of protein and energy rich foods supports you with rebuilding muscles, maintaining your immune system and increasing your energy levels to allow you to do your usual activities.
What can you do to make the most of your food & drink?
Use the information in the following sections to help ensure you are maintaining good nutrition and hydration and minimising any weight loss:
- ‘Eating for health’ – if you are a normal weight or overweight and have a good appetite
- ‘Food first advice’ – if you are underweight, losing weight unintentionally or have no appetite
- ‘Side effects and symptoms of COVID-19’ – if you are struggling with ongoing effects of COVID-19 which are affecting your intake
- ‘Accessing food’ – if you are not able to access food as easily as normal
Eating for health
A good diet is important for good health. ‘Eating for Health’ means including foods from all the food groups in your diet, and reducing your fat, salt and sugar intake. It is important to eat a wide variety of foods and continue to enjoy your food.
If you are a normal weight or overweight and have a good appetite, you should have a varied diet and try to include foods from all the following groups:
Starchy foods are the body’s main source of energy; aim to eat 2 portions at each meal and try to choose wholegrain varieties. Examples of a portion include:
- Rice & Pasta - 2-3 tablespoons (cooked)
- Potato - 2 egg sized
- Bread - 1 medium slice from a large loaf
- Breakfast cereal - 2-3 tablespoons (unsweetened)
Protein foods are needed for growth and repair; eat 2-3 portions a day, choosing lean meats and avoiding processed meat. Examples of a portion include:
- Meat & Poultry - 80g (cooked weight) the size of a pack of cards
- White & Oily Fish - 140g (cooked weight) the size of a slim glasses case
- Soya, Tofu & Quorn® - 120g (the size of a snooker ball)
- Pulses (peas, beans & lentils) - 3-4 heaped tablespoons
- Eggs – 2 eggs
Dairy foods are rich in calcium and high in protein; aim to have 2-3 portions per day, opting for low fat and unsweetened varieties. Examples of a portion include:
- Cheese – 30g (the size of a small matchbox)
- Yoghurt and Fromage Frais – 1 small pot approx. 150g (e.g. low fat, plain yoghurt)
- Milk – 1 glass approx. 200mls (e.g. skimmed milk)
Fruit and Vegetables are good sources of vitamins, minerals and fibre; eat at least 5 potions per day and make sure it is a mix of fruit and vegetables or salad. All fresh, tinned, dried and frozen fruits and vegetables count. A portion is around 80g or a handful.
Keep hydrated - The amount of water you drink has a direct effect on your health and wellbeing.
Adults should aim to have between 1600ml-2000ml fluid per day, but this can vary depending on factors such as temperature and activity levels.
Try to choose water, low-fat milk and sugar free drinks. Tea and coffee also count towards your fluid intake but if you drink a lot of these you should be aware of the amount of caffeine you are consuming.
Vitamin D helps your body to absorb calcium and keep your bones, muscles and teeth healthy. It’s found in oily fish, eggs, meat, milk, margarine and fortified breakfast cereals and yoghurts.
It’s difficult to get all the vitamin D your body needs from food alone. This is because your body makes most of its vitamin D from sunlight during the summer months.
Current guidelines advise those over the age of 65 to take 10 micrograms of Vitamin D each day as a supplement, and all adults should consider taking a supplement during the autumn and winter months. You should also consider taking a vitamin D supplement if you’re indoors for most of the day.
You can buy a vitamin D supplement from most pharmacies and supermarkets. A supplement only needs to contain 10 micrograms to meet the recommendation.
Food first advice
Eating little and often when you have a poor appetite, or have lost weight, can improve your intake of energy, protein, vitamins and minerals. Unintentional weight loss can slow down recovery.
The ‘Food First’ approach may help to increase your intake and prevent further weight loss.
This includes 3 daily goals:
- Aim to have 1 pint of fortified whole milk per day
- Include 2 nourishing snacks or drinks a day
- Have 3 fortified meals every day
You may have also lost some muscle mass during your illness. Try to have a 2-3 portions of protein every day to help recover your strength. Examples of a portion size can be found in the ‘Eating for Health’ section.
Ensure all the milk you have is whole milk. This can be fresh, long-life or UHT milk.
Fortify it by mixing 4 tablespoons of skimmed milk powder into 1 pint (568 mls) of whole milk. Mix the powder with a small amount of milk first to make a paste, then add the remaining milk, stirring continuously. Once made up, keep it in the fridge to use throughout the day, for example in drinks, on cereal or when cooking.
A 200ml glass of fortified milk makes an excellent nourishing drink!
Nourishing drinks and snacks
Try to have at least 2 nourishing drinks or snacks per day, between meals or in the evening. Adopting a ‘little and often’ eating pattern by having small, nourishing meals, snacks and drinks every two to three hours can really help to increase your intake.
Why not try some of these snack ideas?
Sweet snack ideas*
- Thick & creamy yogurt
- Scone with clotted cream & jam
- Tinned fruit with ice-cream or cream
- Teacake or hot cross bun
- Buttered fruit loaf or malt loaf
- Chocolate or fruit mousse
- Chocolate biscuits
- Crème caramel
- Custard / jam tart
- Milk pudding
- Muesli bar or flapjack
- Jelly and ice cream
Savoury snack ideas
- Cheese and crackers
- Crackers and dip
- Crumpets with butter
- Savoury scone with butter
- Toast with peanut butter or other nut butter
- Mini scotch eggs
- Houmous and bread sticks
- French toast / eggy bread
- Savoury pastry/ pasty
Homemade nourishing drink ideas:
- 200mls whole milk
- 1 scoop of ice cream
- 2 tbsp skimmed milk powder
- 3 tsp vitamin fortified milkshake powder, such as Nesquik or Tesco Milkshake Mix
- Add all the ingredients together and whisk.
- Serve chilled or warm.
- Calories: 399
- Protein: 19.9g
- 100mls fresh or long-life fruit juice
- 100mls lemonade
- 1 scoop ice cream
- 1 tbsp sugar
- Mix all the ingredients together.
- Serve chilled.
- Calories: 192
- Protein: 2.3g
- 1 instant soup sachet
- 200ml full fat milk
- 2 tbsp skimmed milk powder
- Warm the milk.
- Gradually add the soup sachet and milk powder, stirring well.
- Calories: 351
Readymade milkshakes,* drinks and smoothies, such as Frijj®, Mars® or Yazoo®, are available in most supermarkets and convenience stores. You could include these in your diet as a nourishing drink too!
Or how about a hot chocolate, milky coffee or malted drink, such as Ovaltine® or Horlicks®, made with fortified milk?
You may also be prescribed nutritional supplement drinks; these provide additional calories, protein, vitamins and minerals when you are struggling to meet your needs from food alone.
They are intended to be used to supplement normal food, not as meal replacements, and should be taken as prescribed like any other medicines. In addition to your prescribed nutritional supplements, it is important to ensure that you follow the ‘Food First’ advice on this leaflet.
Fortify your meals
If you are only able to eat small portions of meals, these can be made more nourishing by adding high energy foods to them. This will mean you are getting more energy from your food without struggling to eat a larger meal. You can add these things to homemade meals and convenience foods such as ready meals, tinned foods and frozen meals.
Make every mouthful count!
How to fortify your food:
- Add cream to cereals, porridge, sauces, soups, mashed potato and puddings.
- Add evaporated milk to sauces, custard, jellies, tinned fruit, puddings and coffee.
- Add cheese to mashed potato, soups, sauces, baked beans, scrambled egg and vegetables. Cream cheese and cheese spreads are good for crackers and on toast.
- Add butter or margarine to potatoes, vegetables, soups, pasta. Use thickly on bread.
- Use sugar or honey* in drinks, on cereals and in pudding.
- Add jam or golden syrup* to puddings, yoghurts, porridge.
- Add salad dressings or mayonnaise to salads.
- Non-dairy options could include nut butters, plant-based milks or yoghurts, coconut cream or Oatly™ cream alternative and dairy-free cheese.
*If you have diabetes, continue to choose sugar free drinks, you can have a moderate amount of sugar containing foods. You may also need to monitor your blood sugar levels more closely than normal. Contact your GP or nurse if you have any concerns.
Side effects and symptoms of COVID-19
If you are struggling with ongoing side effects and symptoms of COVID-19, which are limiting your intake, the following tips might help rejuvenate your appetite and desire for food whilst helping you to stop losing further weight.
I have lost my sense of smell and taste
- Try to make your food look as appetising as possible.
- Use strong seasonings, herbs and spices such as pepper, cumin or rosemary to flavour your cooking.
- Sharp-tasting foods can be more refreshing, such as fruit and fruit juice.
- Cold foods may taste better than hot foods.
- Don’t wait until you are hungry to eat. If you have lost your appetite, think of eating as a necessary part of your recovery and treatment.
I have a sore throat
- Drink plenty of fluids.
- Try milk or milk-based drinks, such as malted drinks, milkshakes and hot chocolate.
- Cold foods may be more soothing, try ice-cream or soft milk jellies.
- Avoid rough-textured foods like toast or raw vegetables.
- Keep your food moist by adding sauces and gravies.
- A homemade honey and lemon drink may be soothing; mix 1-2 teaspoons of honey with lemon juice and boiling water.
I don’t have any energy to eat
- Try using convenience foods such as frozen meals, tinned foods and ready meals.
- If you really don’t want to eat, try a nourishing drink. You can make one of the recipes above using fortified milk.
- You may find softer foods easier to chew and swallow, such as porridge, scrambled egg, Shepherd’s pie, fish pie, macaroni cheese, baked potatoes (avoiding the skin), or sponge cake with custard.
- It may be easier to eat smaller meals more often throughout the day rather than a few bigger meals.
- Local meal delivery services may be useful.
I have loose bowels/ diarrhoea
- Ensure you are having a good fluid intake to replace the fluid you are losing.
- Limit caffeine intake from tea, coffee and soft drinks.
- Try reducing whole-wheat breakfast cereals and breads, choosing white versions instead.
- Eat less fibre (for example cereals, raw fruits and vegetables) until the diarrhoea improves.
- Eat small, frequent meals made from light foods, for example white fish, poultry, well-cooked eggs, white bread, pasta or rice.
- Avoid greasy, fatty foods such as chips and beef burgers, and highly spiced foods.
I feel sick
- Eat ‘little and often’, choosing small meals and snacks more regularly during the day.
- Avoid drinking whilst eating; try having drinks between meals instead.
- Avoid cooking smells where possible.
- Try foods containing ginger such as ginger biscuits, ginger ale or ginger tea.
- Avoid letting your stomach get too empty or overloaded.
- Keep your mouth and teeth clean.
- Try dry meals, for example with less/no sauce or gravy.
- Try salty or sharp tasting foods, for example crisps or cheesy biscuits.
- Avoid eating too near to bedtime.
- Nibble a dry biscuit or dry toast before getting out of bed, especially if your nausea is worse in the mornings.
Self-isolation, particularly for older adults, may mean you are not able to access food as easily as normal. The following information includes helpful hints to try and ensure you have adequate access to food:
- Take advantage of shopping hours set aside for vulnerable and older people.
- Register through the https://www.gov.uk/coronavirus-extremely-vulnerable if you have a medical condition that makes you extremely vulnerable to coronavirus; you’ll be able to ask for help getting deliveries of essential supplies like food.
- Ask a friend or neighbour who may be able to help with your shopping.
- Contact Age UK who can deliver meals, groceries and essential medication to your doorstep (Contact telephone numbers - Surrey: 01483 503414, Sussex: 01903 731800)
- Can you access a meals at home delivery service, such as Meals on Wheels, Wiltshire Farm Foods or Oakhouse Foods?
It’s useful to have a store of basic foods if you can’t get to the shops regularly; the list below provides some simple store cupboard and freezer suggestions:
Meat, fish and alternatives
- Canned meat or fish
- Chickpeas, lentils, beans/ baked beans
- Packets of tofu
- Frozen meat, Quorn and fish
- Fish fingers, breaded fish & chicken
- Samosas, pakoras, falafel
- Ready meals
Milk, dairy and alternatives
- Long-life, dried, evaporated or condensed milk
- Cans, packets or pots of milk pudding
- Cheese in squeezable tubes
- Ice cream, frozen yoghurt
Cereal and starchy foods
- Breakfast cereals, porridge, breakfast drinks
- Crisp bread, flatbread, crackers, oatcakes
- Pasta, rice, spaghetti
- Instant mash or canned potatoes
- Frozen chips, mashed potato and baked potatoes
- Freeze bread, rolls, bagels, chapattis, naan bread
Fruit and vegetables
- Tinned fruit and vegetables, such as tomatoes, sweetcorn, peaches
- Packets and pots of fruit including dried fruit
- Frozen fruit and vegetables
Drinks and other
- Drinking chocolate and malted milk drinks such as Horlicks and Ovaltine
- Long life fruit juice
- Rich fruit loaf, tinned sponge pudding
- Peanut butter
- Cans, jars and dried soups and sauces
- Herbs and spices
- Frozen desserts
If you are concerned that you are continuing to lose weight or struggling with your appetite, ask one of the team to refer you to a dietitian.
Breathing and swallowing share a common pathway, this is the mouth, throat and voice box. Shortness of breath and respiratory problems can lead to poor co-ordination in swallowing, resulting in food going down the wrong way.
Following or during COVID-19 you may experience problems with your swallowing. This can impact on your eating and drinking as well as management of your saliva.
Common signs of difficulty
- Repeated chest infections
- Choking or coughing during or after eating or drinking
- Difficulties with chewing foods or a feeling of something stuck in the throat
- A wet or gurgly voice after eating and drinking
- Prolonged mealtimes
- Food/drink spilling from the nose or mouth
- Pain on swallowing
- Losing weight unintentionally
- Difficulties managing saliva
Physical weakness due to loss of muscle mass during illness has been seen in COVID-19 patients and can impact your ability to feed yourself, chew or safely swallow food, drink and saliva. Following COVID-19 you may additionally experience:
- Tiredness during mealtimes and general fatigue
- Changes to taste and sense of smell
These problems may take some time to recover and should be supported by a Speech and Language Therapist.
We may recommend you change the foods you are eating or the consistency of your drinks to support safe eating and drinking. We can discuss managing excess /not enough saliva with you and your GP
Problems with swallowing can also be associated with dehydration and malnutrition so it is really important to inform your family/GP so a referral can be made for swallowing assessment.
If the changes to swallowing are significant, you may need to have short/long term supplementary tube feeding to support recovery.
Swallowing difficulties may be persistent if long term respiratory support is needed e.g. oxygen therapy or ventilation.
This may also make you more vulnerable to further chest infections. Other changes to respiratory function post-COVID can include chronic cough.
Things you can try to help with safe swallowing
- Sit as upright as possible for eating and drinking
- Take your time and focus on eating and drinking e.g. turn off the TV
- Eat slowly and take small mouthfuls.
- Choose easy to chew foods and add sauces to reduce fatigue and shortness of breath.
- Small sips, no gulping.
- Avoid eating and drinking when you are short of breath. Ideally you want to be breathing through your nose.
- Eat little and often, resting as required.
- Do not talk when eating.
- Avoid straws or cups with lids unless otherwise advised
- Ensure any dentures fit correctly
- Keep your mouth clean with regular teeth brushing and good oral hygiene
- If you use oxygen use nasal prongs whilst eating.
A dry mouth can be a common complaint with people who have respiratory problems. It can result from breathing through your mouth, some medications and the use of oxygen. Not only can a dry mouth be uncomfortable, it can cause swallowing and denture problems along with affecting the taste of food.
Tips to avoid a dry mouth
- Sip water throughout the day.
- Saliva substitute if needed.
- Suck sugar free sweets of chewing gum.
- Apply lip balm.
- Reduce alcohol and caffeine intake.
- Regular dental check ups
- Medication review with your GP
Changes in voice quality
As a result of the COVID-19 virus you may experience some changes to the sound of your voice, and to your comfort and effort levels when using it.
These changes are similar to changes you would expect to experience with a cold or 'flu’ but are expected to be more intense and longer lasting. We anticipate that these voice problems may take 6 – 8 weeks to gradually resolve.
During the illness you are likely to have been coughing excessively for prolonged periods. This brings your vocal cords forcefully together and can leave them swollen and inflamed.
This makes them less able to vibrate freely so the sound of voice changes. Your voice may sound rough or weak and can be very effortful to produce
You may experience changes in your voice quality. Below are some examples:
- Oedema (swelling) and ulceration of the vocal cords
- Vocal fold palsy
- Acute and long-term impaired voice quality e.g. weakness, hoarseness, vocal fatigue, reduced pitch and volume control
- Severe dryness of the throat
- Lump in the throat
- Excessive mucous at the back of the throat.
- Voice fatigue after a period of time speaking
Things you can try to look after your voice
- Keep well hydrated. Drink 1½ - 2 litres (4-5 pints) of fluid each day, unless advised otherwise by your GP. Avoid caffeine and alcohol
- Try gentle steaming with hot water (nothing added to it). Breathe in and out gently through your nose or mouth. The steam should not be so hot that it brings on coughing
- Avoid persistent, deliberate throat clearing if you can and, if you can’t prevent it, make it as gentle as possible. Taking small sips of cold water can help to supress the urge to cough
- Chew sugar free gum or suck sugar free sweets/lozenges to promote saliva flow to lubricate the throat and reduce throat clearing. Avoid medicated lozenges and gargles, as these can contain ingredients that may irritate the lining of the throat
- Avoid smoking or vaping
- Talk for short periods at a time. Stop and take a break if your voice feels tired
- Always aim to use your normal voice. Don’t worry if all that comes out is a whisper or a croak; just avoid straining to force the voice to sound louder
- Don’t choose to whisper; this does not ‘save’ the voice; it puts the voice box under strain
- Avoid attempting to talk over background noise such as music, television or car engine noise, as this causes you to try to raise the volume, which can be damaging
- If you are experiencing reflux, speak to your GP as this can further irritate the throat
- Reduce risk of reflux by sitting upright for about 30 minutes after a meal and eating little and often.
Changes to communication
Emerging evidence suggests a proportion of people with COVID-19 also present with changes to communication associated with neurological impairments. You may experience:
- Agitation and confusion
- Impaired consciousness
- Acute cerebrovascular events e.g. stroke or encephalopathy, myopathy/neuropathy and hypoxia (lack of oxygen to the brain)
- Delirium that may persist
- Dysarthria – changes to the clarity of your speech
- Dysphasia – changes to your ability to find words, form sentences, read or write
- Dyspraxia – changes to how your brain sends messages to your mouth to form sounds or words
- Dysphonia – changes to voice (see above)
- Cognitive-communication disorders e.g. changes to memory or planning
Things you can try:
- Speak slowly and with increased effort if your speech is not clear
- Try other methods if speaking is challenging e.g. writing it down, gesture
- Try to maintain a routine to reduce unexpected conversations if needed
- Look after your voice following the advice (page 18)
- Ask for help from your household with remembering information if needed
- If you are experiencing fatigue, try to limit effortful communication. This can be supported by routine, a familiar person who will know your wants/needs and using alternative methods of communication where possible
This advice has been adapted from a publication produced by the British Laryngological Association in May 2020 and a publication produced by the Royal College of Speech and Language Therapists in May 2020
Support from social services
If you require assistance with activities of daily living, you can contact your local authority for a community care assessment. A care needs assessment will be conducted to assess your requirements. The assessment will look at your limitations, difficulties and current support.
The assessment criteria have four levels (low, moderate, substantial and critical). People with substantial and critical are most likely to get support. Those needing assistance with personal care are likely to be put into either of these levels. These services are means tested. Disability living allowance, personal independent payments and attendance allowance are often taken into account as part of the financial assessment.
Helps with extra costs is you have a disability severe enough that you require someone to help you. To find out more information and to apply go to www.gov.uk
Personal Independence Payment (PIP)
PIP helps you with some of the extra costs if you have a long term ill health or disability. It has replaced the disability living allowance. To apply you need to call the department of Work and Pensions. For more information and the number to call go to www.gov.uk
Council tax reductions/housing benefits
If you are on low income you may be entitled to council tax support. For more information go to www.gov.uk
Winter Fuel Payment
If you are elderly you could qualify for winter fuel payment. This is money to help pay for your heating bills. For more information go to www.gov.uk
Blue badges help people with disabilities or long term health conditions, park closer to their destination. You have to fit certain eligibility criteria. For more information please go to www.gov.uk
For help on applying for benefits and further help please contact citizens advice for further information on what benefits you are entitled to and how to apply.
Smoking tobacco products increase your risk of infection due to the harm caused to your immune system and lungs
- Smoking is linked with poorer outcomes in COVID-19
- It’s never too late to stop
- By stopping you can see benefits within 24 hours.
For further support and advice contact your GP, call the One Your Surrey-Quit Smoking Service on 01737 652168 or email email@example.com or more information can be found at https://www.nhs.uk/better-health/quit-smoking/
Spending time in hospital or being ill at home with COVID-19 can result in a significant reduction in muscle strength, particularly in your legs. This can be for a number of reasons, but mainly due to inactivity.
It’s not harmful to get out of breath when doing physical activity, this is a normal response.
However, if you are too breathless to speak, slow down until your breathing improves.
Try not to get so breathless that you have to stop immediately. Remember to pace your activities.
Do not overdo it – try to increase your activity levels slowly
Try to use the breathing techniques talked about at the beginning of this booklet to help control your breathing whilst you exercise. You may require a referral to a physiotherapist or the Pulmonary Rehabilitation Team.
When you are doing physical activity, it is ok to feel moderately breathless
When you’ve been seriously ill, you may feel differently about things and you may not want to do things you used to enjoy. You may:
- not feel like seeing lots of people at once
- find it difficult to concentrate
- find it hard to follow a TV programme.
Your concentration will get better and your memory will usually improve
What if my symptoms do not improve?
The length of time that it takes to recover from COVID-19 varies from person to person, for some it will be days, others weeks or months. The more severe your symptoms, the longer it might take for you to return to what is normal for you.
Post COVID-19 support for patients and families Including a list of useful websites and leaflets
Asthma UK and The British Lung Foundation have set up a support hub to provide information and dedicated support for people why have been diagnosed with COVID-19 and their family members. This can be accessed at: www.post-covid.org.uk
- The Samaritans: www.samaritans.org
- Support group for: www.icusteps.org
- The British Lung Foundation: www.blf.org.uk/
- Talking Therapy at: www.mindmattersnhs.co.uk/surrey
- Information and support for mental health: www.mind.org.uk
- Access to online CBT therapy www.iesohealth.com/surrey
Association of Chartered Physiotherapists in Respiratory Care – Leaflets
- How To Cope With Being Short of Breath – Breathing Exercises
- How to Cope With Being Short Of Breath – Positions
- Secretion Clearance: The Active Cycle of Breathing Techniques
- Energy Conservation
The British Lung Foundation (2020)
The Association of Chartered Physiotherapists in Respiratory Care
Homerton University Hospital NHS Foundation Trust