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MINISTRY OF HEALTH
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SOCIALIST REPUBLIC OF VIETNAM
Independence – Freedom – Happiness
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No. 1242/QD-BYT
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Hanoi, May 18, 2022
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DECISION
GUIDELINES ON POST COVID-19
REHABLITATION AND SELF-MANAGEMENT OF RELATED ILLNESSES
MINISTER OF HEALTH
Pursuant to Law on Prevention and Control of Infectious
Diseases in 2007;
Pursuant to the Law on Medical Examination and Treatment in
2009;
Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of
the Government on functions, tasks, powers, and organizational structure of the
Ministry of Health;
Pursuant to Resolution No. 38/NQ-CP dated March 17, 2022 of
the Government on COVID-19 Control Program;
At request of Director of Department of Medical Service
Administration, Ministry of Health.
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Article 1. The Guidelines on post COVID-19 rehabilitation and
self-management of related illnesses are attached hereto.
Article 2. The Guidelines on post COVID-19 rehabilitation and
self-management of related illnesses apply to people recovering from COVID-19
infection at home and grassroots health personnel.
Article 3. Assign Health Departments of provinces and
central-affiliated cities, and health authorities to direct implementation
hereof for the general public and medical establishments assigned to manage and
advise on the general public's health following a recovery from COVID-19.
Article 4. This Decision comes into effect from the day of signing.
Article 5. Chief of Ministry Office, Chief of Ministry Inspectorate,
Directors of Departments affiliated to Ministry of Health; Chairpersons of
Steering Committees for COVID-19 Control of provinces and cities; directors of
hospitals and institutes affiliated to Ministry of Health; directors of Health
Departments of provinces and central-affiliated cities; heads of medical sector
are responsible for implementation of this Decision./.
PP. MINISTER
DEPUTY MINISTER
Nguyen Truong Son
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(Attached to Decision No. 1242/QD-BYT
dated May 18, 2022 of Minister of Health)
Compilation director:
Assoc. Prof. PhD Nguyen Truong Son
Deputy Minister of Health
Chief editor:
Assoc. Prof. PhD Luong Ngoc Khue
Director of Department of Medical Service Administration,
Ministry of Health
Participants in compilation and appraisal:
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Vice Director of Department of Medical Service
Administration, Ministry of Health
Assoc. Prof. PhD Tran Trong Hai
Chairperson of the Vietnam Rehabilitation Association
Prof. PhD. Cao Minh Chau
General Secretary of Vietnam Rehabilitation Association
Specialist Level 2 MD. Nguyen Trung Cap
Vice Director of National Hospital of Tropical Diseases
Assoc. Prof. PhD Truong Tuyet Mai
Vice Director of National Institute of Nutrition
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Vice Director of the Central Rehabilitation Hospital
PhD. Tran Ngoc Nghi
Director of Division of Rehabilitation and Expertise,
Department of Medical Service Administration
Specialist Level 1 MD. Nguyen Thi Thanh Lich
Vice Director of Division of Rehabilitation and Expertise,
Department of Medical Service Administration
Assoc. Prof. PhD Luong Tuan Khanh
Director of Rehabilitation Center, Bach Mai Hospital
Assoc. Prof. PhD Do Dao Vu
Vice Director of Rehabilitation Center, Bach Mai Hospital
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Head of Emergency Department, Bach Mai Hospital
PhD. Pham Thi Cam Hung
Vice Principal of Hai Duong Medical Technical University
BMed. Specialist Level 2 MD. Tran Quoc Dat
Head of Rehabilitation Department, Friendship Hospital
PhD. Nguyen Trong Hung
Director of Department of Adult Nutrition Counseling -
National Institute of Nutrition
Specialist Level 2 MD. Vu Thi Thu Huong
Director of Department of Examination and Treatment,
National Hospital of Tropical Diseases
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Director of Rehabilitation Department, Cho Ray Hospital
BMed. Le Huy Cuong
Director of Rehabilitation Department, Central
Rehabilitation Hospital
BMed. Nguyen Thu Phuong Anh
Director of Department of Exploration - Rehabilitation,
National Lung Hospital
BMed. Nguyen Minh Hanh
Principal Official, Department of Rehabilitation and
Expertise, Department of Medical Service Administration
Specialist Level 1 MD. Ho Quang Hung
Vice Director of Rehabilitation Department, Cho Ray
Hospital
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Head of C6 Department - Heart Institute - Bach Mai
Hospital
MD. Pham Thi Le Quyen
Respiratory Center, Bach Mai Hospital
MD. Bui Van Loi
Institute of Mental Health, Bach Mai Hospital
Editor secretaries:
BMed. Nguyen Thu Phuong Anh
Director of Department of Exploration - Rehabilitation,
National Lung Hospital
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Principal Official, Department of Rehabilitation and
Expertise, Department of Medical Service Administration
MD. Nguyen Thi Dung
Principal Official of Department of Rehabilitation and
Expertise, Department of Medical Service Administration
BMed. Nguyen Thanh Hoa
Principal Official of Department of Rehabilitation and
Expertise, Department of Medical Service Administration
MD. Do Duc Tuan
Principal Official of Department of Rehabilitation and
Expertise, Department of Medical Service Administration
GUIDELINES
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Who is this document for?
This document provides guidelines on post COVID-19
rehabilitation and self-management of related illnesses for adults. This
document can be used in combination with guidance of health workers.
This document is compiled by care, treatment, rehabilitation
experts after consulting recovered COVID-19 patients on the basis of documents
of World Health Organization (WHO). Despite being indigestible, advice given
under reference documents is based on evidence. There are a lot of details
regarding post COVID-19 recovery that remain obscure and more and more evidence
will come to light.
COVID-19 can cause health problems and long-term symptoms
that impact daily activities. In some cases, these symptoms may last more than
12 weeks and have now been referred to as post COVID-19 conditions, also known
as long COVID-19 or post COVID-19 conditions. Regular symptoms will improve
over time. This document provides practical recommendations to allow readers to
manage these regular symptoms. If these symptoms worsen or do not improve over
time, physical examination by health workers is required.
You can read this document in each section, starting with
sections related to symptoms that you wish to improve the most.
In addition, health workers can make adjustments to advice
given under the document to best suit your situations. Advice under this
document does not replace personal rehabilitation program or advice which you
personally receive from health workers.
Your family and friends can help you recover so it’s in your
best interests to share this document with them.
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“Warning sign". When to contact a health worker for
emergency aid
Managing breathlessness
Exercising
Conserving energy and managing fatigue
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Managing problems relating to swallowing
Nutrition and problems relating to sense of smell and
sense of taste
Managing problems with attention, memory, and thinking clearly
Managing problems with stress, mood, depression, and sleep
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Returning to work
Symptom diary
“Warning sign". When to contact a health worker for
emergency aid
Medical complications may occur during post COVID-19 recovery
and require emergency medical care. You must immediately contact health workers
when:
- You
have difficulty breathing when performing light activities and the condition
does not improve with positions described in pages 2-3; or
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- You
fee chest pain, fast heart rate, or dizziness in some positions or throughout
the exercise or physical activities, or
- Confusion
worsens or you have difficulty talking or understanding speech; or
- You
feel changes to feeing and motion on your face or limb(s), especially when
these symptoms are unilateral and/or anxiety or mood worsens, or you are having
self-harm thoughts.
Managing breathlessness
Managing breathlessness
- Cause
of breathlessness: damage to lungs, heart, or muscle weakness.
- Breathlessness
usually occurs as a result of physical exertion
- Upon
experiencing breathlessness: Remain calm, cease all physical exertion, take appropriate
positions to ease breathlessness, practice diaphragmatic breathing: inhale
before physically exerting, exhale while physically exerting.
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Positions to ease breathlessness: combine breathing
practices with these positions to ease breathlessness.
Taking a prone position
Lying on your side propped up by pillows, supporting your
head and neck, with your knees slightly bent
Forward lean sitting
Forward lean sitting (no table in front)
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While standing, lean forwards onto a windowsill or other
stable surface.
Lean with your back against a wall and your hands by your
side. Have your feet about 30 cm away from the wall and slightly apart.
Breathing techniques
* Diaphragmatic breathing or belly breathing helps
relax and ease breathlessness
- Lie
or sit in a comfortable position, put one hand on your stomach, relax and
focus on your breathing.
- Slowly
breathe in through your nose, your stomach will rise along with your hand.
- Hold
your breath for 1-2 seconds. Later repetitions will require you to hold your
breath for as long as possible.
- Breathe
out through your mouth while sinking your stomach.
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* Paced breathing
Think about breaking the activity down into smaller parts
to make it easier to carry out without getting so tired or breathless at the
end Example when taking the stairs.
- Breathe
in through the nose and take one step up the stairs
- Breathe
out through the mouth and take another step up.
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Staying indoors or in hospital as a result of COVID-19
infection for a long time will reduce physical strength and muscle. Exercising
helps improve physical strength and muscle. However, exercising must be safe
and monitored for other symptoms of COVID-19 infection.
You may feel tired or “exhausted” or “laborious” despite
little effort. This phenomenon is called “post-exertional malaise”. This
symptom typically occurs for several hours following physical and mental
exertion. It commonly takes at least 24 hours to physically recover,
reenergize, and regain focus, sleep, and memory.
If you experience “post-exertional malaise”, avoid physical
exercises or exerting activities while maintaining energy. If you do not
experience exertional malaise, you can increase exercise intensity gradually. You
can refer to the Borg - CR 10 scale to increase exercise intensity.
This scale is an objective tool for assessing the perception
of intensity that you will feel when exercising, from 0 (no exertion) to 10
(most exertion).
Borg - CR 10 rating varies from person to person and from
time to time for the same activity. For example, by walking, you may experience
a rating of 1 (very light) while another person may experience a rating of 4
(little exertion) or you may experience another rating on another day. You will
write down your daily activities and give Borg - CR 10 ratings for those
activities in order to monitor your situations and gradually increase your
intensity.
Stages of exercise
Exercises shall be divided into 5 stages with each stage
must be maintained for at least 7 days before moving onto a higher intensity
stage. If you feel increasing fatigue after exercising, reduce intensity and/or
move back to a lighter intensity stage.
If you experience chest pain or dizziness, stop immediately
and contact health workers.
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Preparation activities (Borg - CR 10 rating from 0 - 1)
Perform breath control exercises, walking, muscle stretching
exercises, and balancing exercises.
You can stretch muscle while standing or sitting. Each
stretch should be done slowly and kept in position for 15-20 seconds.
If your Borg - CR 10 rating of the exercises
increases by 1, you must stop exercising at this stage.
Reach your right arm up to the ceiling and then lean over
to the left slightly; you should feel a stretch along the right side of your
body. Repeat for the other side.
Put your arm out in front of you, keep your arm straight,
and bring it across your body at shoulder height, using your other hand to
squeeze your arm to your chest so you feel a stretch around your shoulder.
Repeat on the opposite side.
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Stand with your feet apart and leaning forwards onto a
wall or something sturdy. Keep your body upright and step one leg behind you.
With both feet facing forwards, bend your front knee, keeping your back leg
straight and your heel on the floor. You should feel a stretch in the back of
your lower leg. Repeat on the opposite side.
Stand up and hold onto a chair. Bend one leg up behind
you, and if you can reach it, use the hand on the same side to hold your
ankle or the back of your leg. Take your foot up towards your bottom. Repeat
on the opposite side.
Stage 2
Low-intensity activities (Borg - CR 10 rating of 2-3)
Walking, chores, or light gardening.
If you complete the exercises with ease (Borg - CR 10 rating
of 2-3), you can increase daily exercise duration by 10 - 15 minutes. You will
have to maintain this exercising stage for 7 days without feeling exhausted
before moving onto the next stage. If your Borg - CR 10 rating of the exercises
is higher than 3, you should stop exercising at this stage.
Stage 3
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Jogging, going up and down the stairs, running, bowing,
resistance training, and focusing on upper body. If your Borg - CR 10 rating of
the exercises is higher than 5, you should stop exercising at this stage.
Strengthening exercises for your ARMS
Biceps exercise
Hold a weight or water bottle in each hand with your palms
facing forwards. Gently lift the forearms, bringing the weights up and down.
You can do this exercise sitting or standing.
Wall push off
Stand 20 cm away from the wall and face the wall, place
your one hand flat against the wall at shoulder height. Slowly lower your
body towards the wall by bending your elbows, then gently push away from the
wall again, until your arms are straight. Repeat for the other side.
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Hold a weight in each hand, with your arms by your sides
and your palms facing inwards, raise both arms out to the side, up to your
shoulder level (but not higher), and slowly lower back down.
Strengthening exercises for your LEGS
Sit to stand
Sit with your feet hip-width apart. With your arms by your
side or crossed over your chest, slowly stand up, hold the position for the
count of 3, and slowly sit back down onto the chair
Knee straightening
Sit in a chair with your feet together.
Straighten one knee and hold your leg out straight for a
moment, then slowly lower it. Repeat with your other leg. Increase the time
holding your leg out straight to a count of 3.
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Squats
Stand with your back against a wall or other stable
surface and your feet slightly apart. Move your feet about 30 cm away from
the wall. Slowly bend your knees a short distance; your back will slide down
the wall. Keep your hips higher than your knees
Pause for a moment before slowly straightening your knees
again.
Heel raises
Rest your hands on a stable surface to support your
balance, but do not lean on them. Slowly rise up on to your toes, and slowly
lower back down again.
Stage 4
Moderate-intensity activities for motor and coordination
functions (Borg - CR 10 rating of 5 - 7)
Running, cycling, swimming, dancing.
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Stage 5
Returning to regular exercising (Borg - CR 10 rating of 8 -
10)
You can resume your regular sports and activities.
Do not exercise if you feel pain If you feel pain such as
chest pain or nausea or dizzy during exercise, stop immediately until you have
consulted health workers.
Conserving energy and managing fatigue
Fatigue is one of the most commonly seen symptoms during
recovery from COVID-19 and described as a feeling of being overwhelmed or
physically and mentally exhausted.
Physical fatigue: if you feel physical fatigue, you will find your body heavy
and light physical exercises to be energy-consuming.
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Fatigue causes you to feel exhausted after completing daily
tasks. You may wake up feeling as fatigued as before you go to sleep. The level
of fatigue you experience can change on a weekly, daily, or hourly basis. You
do not feel motivated to do anything and/or feel exhausted even with the
simplest tasks and find it difficult to explain your exhaustion to your family,
friends, and colleagues.
Help other people understand your fatigue and how it affects
you can create a huge difference in how you deal with and manage your fatigue.
Pacing
Pacing is a key strategy to help you avoid injury while
managing your activities without worsening current symptoms. You should develop
a flexible plan which allows you to stay within your current capacity and avoid
being overloaded. After which, your level of activity can be gradually
increased in a controlled manner as soon as your energy level and symptoms
improve.
By adjusting the pace of your activities yourself, you can
make sure that:
- You
are controlling the parameters set forth for yourself.
- These
parameters fit your current capacity.
- You
are exposing your physical and mental attributes to these demands on a regular
basis and in a controlled manner in order to assist your gradual recovery.
The first step is to think of how many activities can you
perform without being exhausted or relapsing. It is important not to compare
yourself to other people or your previous self. Thereby you can create a basic
number of tasks or activities which you can carry out safely on a daily basis.
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If you feel low on energy, you should save energy for the
most important tasks. You should identify necessary tasks in your day - meaning
you should define tasks that you “must” do, tasks that you “want” to do, tasks
that you can do at a later time, and tasks that you can ask for help from other
people.
Planning
When planning for your day or week, it is best to evenly
distribute activities instead of cramming everything in one day. Carry out
energy-consuming activities whenever your energy level is at the highest. Can
any activity be rearranged so that you do not have to complete everything at
the same time? For example, can you just clean one room instead of the whole
house at once?
Planning for rest and relaxation to help you “recharge” is
as important as planning for your activities. Plan for multiple rests in a day
if necessary.
Keeping an activity diary or daily timetables will help you
adjust your pace and prioritize what you must do and want to do. You may have
to try several times in order to find the best direction. As soon as you find
your correct pace, it is important that you must keep your pace consistent for
a definite amount of time before increasing your activity intensity.
Examining and counseling fatigue management
If fatigue persists after you have adjusted your pace and
prioritized activities, clearly affects your health and daily tasks, and is
accompanied by symptoms such as (1) Fatigue after exertion lasting longer than
24 hours; (2) Difficulty staying asleep; (3) Reduced memory or concentration
capacity; (4) Muscle pain, multiple joint pain without inflammation, soreness;
Sore throat or mouth ulcer; headache, you should seek appropriate specialist
consultation for diagnosis and treatment. In addition, if you feel persistent
fatigue after COVID-19 infection while having chronic diseases relating to
cardiovascular (coronary artery disease, heart failure, etc.), internal
diseases (diabetes, chronic kidney disease, chronic obstructive pulmonary
disease, etc.) or cardiovascular, pulmonary, etc. complications during COVID-19
infection, you should immediately seek appropriate specialist consultation for
examination.
Managing problems with your voice
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COVID-19 may cause sore throat, coughing, and feeling of
mucus in your throat thus you feel the need to frequently clear your throat. Your
voice may also be weak, out of breath, or hoarse, especially when you were
previously ventilated (having a breathing tube) in the hospital. You may feel
that your throat/upper respiratory tract is more sensitive to the environment
than it was before the infection. For example: you may cough or feel throat
tightness or breathless if you are exposed to a strong scent. If your symptoms
do not relieve over time, please consult healthcare specialists.
Advice for voice problems
- Stay
well hydrated. Sip water throughout the day to keep your vocal cord flexible
and functional.
- Straining
your voice, raising your voice, or screaming may strain your vocal cord. Whispering
may cause your vocal cord to slack.
- Steam
inhalation for 10 - 15 minutes helps moisturize the vocal tract.
- Gastroesophageal
reflux disease may cause your throat to sore or irritate and thereby affecting
your vocal cord and altering your voice, so you should avoid certain food and
eating late at night.
- Quit
smoking and imbibing.
- Use
other forms of communication, such as writing, texting, or gestures if talking
is difficult or uncomfortable.
Advice for persistent coughing
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- Try
sucking on low-sugar boiled sweets
- Practice
“Coughing relief exercises”. Whenever you feel like coughing, close your mouth
and cover your mouth with your hands (TO EASE the coughing). At the same
time, SWALLOW with effort. HOLD your breath - stop momentarily. Once you
start breathing again, breathe in and breathe out through your nose GENTLY.
- If
you cough at night due to gastroesophageal reflux, lie on one side or prop your
head (neck) up with pillows.
Managing problems relating to swallowing
You have difficulty swallowing food and beverages. This
condition occurs because the muscles involved in the swallowing process have
been weakened. For people who were previously ventilated in hospital, breathing
tubes may cause bruises and swelling of the tongue, throat, vocal cord,
epiglottis. You should be careful to avoid choking which can lead to aspiration
pneumonia. Aspiration occurs if food/beverages go down "the wrong pipe”
and into your airway or lungs.
If you have difficulty swallowing, the following advice may
come in handy:
- Sit straight up whenever you eat or drink. Do not eat or drink while lying.
- Keep a straight (sitting, standing, walking) posture for at least 30 minutes
after eating.
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- Focus on your meal, have your meal in a quiet place Refrain from talking while eating or
drinking to prevent the opening of airway or choking or food and drink from
going down the wrong pipe into bronchus and lungs.
- Make sure that your mouth cavity is empty before taking another bite or
another sip. If necessary, swallow one more time.
- Have many small meals in the day if you feel tired when you are full.
- If you cough or choke while eating or drinking, seek advice from a medical
professional since the food or drink may go down your airway.
- Keep your mouth cavity clean by brushing your teeth and drinking
enough water.
Nutrition and problems relating to sense of smell and
sense of taste
COVID-19 can affect appetite and nutrition and cause some
people to lose weight due to skipping meals or gain weight due to inactivity. Thus,
a balanced, reasonable, and healthy diet is required in order to improve
and recover health.
- Make
sure that you have enough food, have all 3 primary meals, eat even when you
feel tired and do not want to eat. If your intake amount is small, divide into
smaller meals in order to have sufficient nutrition.
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- If
you feel tired or do not feel like eating or do not eat enough, you should
drink milk and energy-rich, protein-rich supplements for 1-3 times/day. Vulnerable
individuals such as the elderly, people with underlying medical conditions,
pregnant women, breastfeeding women, small children, etc. must eat properly to
prevent malnutrition.
- For
people with underlying medical conditions, adhere to prescription drug and
advised diet suitable for their conditions and nutrition situation.
- Drink
a lot of water, 6-8 glasses every day on average. Refrain from drinking soft
drinks, alcoholic beverages, stimulants, etc.
- Restrict
salty food, fat, and sugar:
+ Have less than 5g of salt every day (equivalent to 1
teaspoon)
+ Have less than 50g of sugar every day (equivalent to 12
teaspoons).
+ Total fat should be less than 30% of total food intake. Opt
for unsaturated fat in fish, avocado, peas, and vegetable oil instead of
saturated fat (fat, butter, etc.) and trans fat (confectionery, fried oil,
etc.).
- Ensure
food safety, only consume cooked food and drink. Read food label carefully
before use.
- Receive
nutrition advice from health workers.
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- Brush
your teeth twice every day.
- Sniff
fragrant herbs (lime, rose, clove, eucalyptus, etc.) for 20 seconds every time
for 2 times per day.
- Use
herbs and spices such as chili, lime juice, and other kinds to enhance the
flavor. However, these components should be used with care as they can worsen
gastroesophageal reflux in some people.
Managing problems with attention, memory, and thinking
clearly
While recovering from COVID-19, you may suffer from a series
of difficulties relating to your thinking capacity (hereinafter referred to as
“cognition”). These difficulties may include problems with memory, attention,
information processing, planning, and organization. These conditions are also
referred to as “brain fog” phenomenon. The brain fog phenomenon usually worsens
due to fatigue, meaning the more fatigue you feel, the more difficulty you will
have with your thinking capacity.
The important thing is you and your family should be aware
of whether or not you encounter these difficulties since they can affect your
relationship, daily activities, your return to work or education. If you face
any of difficulties above, the following advice might be helpful:
- Reduce distraction: try working in a peaceful environment without distractions. You
can use earplugs if necessary. If you feel distracted while reading text, mark
sections of the text with paper or your fingers.
- Complete activities whenever you feel less tired: Whenever your tasks require thinking
capacity, save these tasks for when you feel less tired. For example, if you
feel tired as the day goes on, finish your work in the morning.
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- Set reasonable goals and objectives: Something clear and attainable will
help you stay motivated. Set realistic and attainable goals for yourself. For
example: Read 5 pages each day.
- Prepare timetable: Establish your daily and weekly timetables. It might come in
handy if you make plans in advance. It might also come in handy if you record
or divide tasks into manageable parts.
- Reward yourself: Whenever you achieve your goals, reward yourself - starting
with something simple, having a cup of tea or coffee, watching television, or
going on a walk.
- Do one activity at a time: Do not feel the urge or try to
receive too much information at the same time, as doing so can lead to errors
in information processing.
- Prompt yourself: Use lists, notes, diaries, and calendars to help your memory
and habits.
- Brain exercise: try new hobbies, solve puzzles, crossword puzzles, memory
exercises, or read to help you think. Start with challenging but
manageable brain exercises and increase the difficulty whenever you can. Doing
so is important as it helps keep you motivated.
- In addition, some solutions for improving physical conditions and
strategies for reducing stress can improve brain fog condition such as: taking
sufficient and quality sleep, exercising, relaxing; thinking positively, having
reasonable diet, avoiding psychotropic substances such as alcohol, stimulants,
etc.
Managing problems with stress, mood, depression, and sleep
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Relaxing
Relaxing helps you conserve the limited energy that you have
during recovery from COVID-19. This helps you control anxiety and improve your
mood. Examples regarding relaxing techniques are mentioned below.
Grounding technique
Breathe gently and ask yourself:
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What are the 4 things I can touch?
What are the 3 things I can hear?
What are the 2 things I can smell?
What is the one thing I can taste?
Think and answer these questions to yourself slowly, one
question at a time, and spend at least 10 seconds to focus on each question.
The important thing to remember is that your symptoms are a
part of the recovery process. Anxiety and thoughts about your symptoms can make
you feel worse. For example, if you focus on your headache, you may feel your
headache worsen.
Relaxation techniques
Find a quiet place, gentle lighting but not too bright, lie
flat with your limps stretched out and in a complete relaxed state. Whisper and
think to yourself “completely still” while paying attention to your breath. You
can repeat until you feel comfortable or enter a sleep state.
In addition, an important thing to remember is that symptoms
are usually related: the increase of one symptom can lead to the increase of
another. If you feel tired, your ability to focus will be affected, and then
your memory will be affected followed by more anxiety and you will feel more
tired. As you can see, it becomes a loop. You only have to improve one symptom
to improve another.
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- Sleep quality
+ Try to return to a regular sleeping and waking time, using
alarms to remind you;
+ You or your family/caregivers can ensure that your
environment is free from things that might disturb you, such as too much light
or noise.
+ Try to stop using electronic devices such as mobile phones
and tablets one hour before you go to sleep;
+ Do not use or minimize the use of substances that effect
your sleep such as: alcohol, coffee, tobacco, or other psychotropic substances;
+ Try to use relaxation technique to sleep.
- Alternative relaxation techniques: Examples on relaxation techniques
include meditation, focusing on images, herbal bath therapy, Tai chi, Yoga, and
music.
- Staying socially connected is important for your mental
wellbeing. Talking with others can help to reduce the stress.
- Eating healthily and gradually returning to your daily
activities or hobbies are the best ways to improve your mood.
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- Spend
more time to relax, you can choose tasks that you feel excited (listening to
music, gardening, etc.)
- Spend
time exercising, play sports, and doing appropriate physical training. If you
do not exercise, you should start forming the habit of doing so.
- Remain
calm about health information and select credible information sources.
- Share
with relatives and seek help from mental health professionals upon experiencing
prolonged fatigue, anxiety, or excessive boredom, or lose interest to
everything, or experience extended period of poor sleep quality, or have
negative thoughts.
Managing pain
Pain is a common symptom of people recovering from COVID-19.
The pain may occur in localized area (joint pain, muscle pain, headache, or
abdominal pain) or in a generalized area or spread across the body. Prolonged
pain (that lasts longer than 3 months) may affect your sleep, lead to insomnia,
various degrees of fatigue, mood, reduced ability to focus or work. If you
experience localized pain, such as chest pain with pain severity increases when
you work, you can consult health workers.
Advice on pain management
- For
joint pain, muscle pain, or body pain, you can take over-the-counter pain
relief such as paracetamol or ibuprofen after meal.
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- It
might be difficult to completely remove persistent pain. Aiming towards
controlling the pain will allow you to operate and sleep better and potentially
engage in daily essential activities.
- A
good sleep will help relieve the pain. Time your use of pain relief together
with sleeping time will help if the pain affects your sleep.
- Listening
to relaxing music or meditating can help reducing pain.
Arranging daily activities is an effective tool in
managing your pain. Light exercises help the body to release a substance
called endorphin which relieves pain.
- Be
assured that pain is a common symptoms and overcoming the pain is analogous
to breaking the loop of pain. You can overcome light pain but you should not
exert yourself, as doing so will cause you to feel more pain and fatigue
(post-exertional malaise).
Returning to work
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What you need to pay attention to upon returning to work:
- Take
time off until you feel strong enough.
- Discuss
your health conditions with your employers.
- If
you feel strong enough to return to work, consult health workers and
occupational health workers where you work for permission.
- Review
your work responsibilities and assess whether you can handle everything or just
a part of the work.
- Discuss
plans for returning to work to employers, including the gradual increase of
workload in a definite period (also known as “phased return to work”) and
regularly revise these plans. This helps prevent repetition of symptoms and
reduces the need for paid leave. Once you have returned to work, you may adjust
your work pace such as starting time and finishing time, work from home or
light tasks.
- Employers
should assist employees’ phased return to work as it may take several weeks or
months, depending on employees’ symptoms and nature of the work.
- If
you cannot meet your work demands, consider changing tasks or work.
- If
you think your health conditions may affect your work in the long term, consult
health workers and employers in order to make necessary adjustments based on
policies of the government and legal demands.
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Symptom diary
Please specify whether the symptom occurs before or after
COVID-19 in the first column
In the subsequent columns, give a rating of 0-3 for
each symptom (with 0 being no problem, 1 being mild problem, 2 being
moderate problem, 3 being serious or life-changing problem)
Put your rating on a weekly basis in order to determine
whether your symptoms are improving or worsening.
Symptoms
Do the symptoms occur after
COVID-19?
Yes/No
Day
Day
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Day
Day
Day
Rating
0-3
Rating
0-3
Rating
0-3
Rating
0-3
Rating
0-3
Rating
0-3
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Do you have cough/throat irritation/voice problems?
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Do you feel any change to your sense of smell or sense
of taste?
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Do you have difficulty swallowing soft or hard
food?
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Do you feel tired during the day?
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Are you in pain (joint pain/muscle pain/headache/abdominal
pain)?
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Do you feel your heart beating rapidly whenever you
move or do activities?
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Do you feel dizzy whenever you move or do
activities?
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Do you have difficulty sleeping?
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Do you feel anxious?
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Do you feel frustrated?
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Do you have difficulty communicating (in terms of
looking for appropriate words)?
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Do you have difficulty performing daily personal tasks such
as showering or dressing up?
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Do you have difficulty taking care of family
members or communicating with friends?
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Other symptoms (specify)-
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Other symptoms (specify)-
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Other symptoms (specify)-
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Reference:
1. Ministry
of Health, 2020, Guidelines on rehabilitation for severe acute respiratory
syndrome caused by SARS-CoV-2 (COVID-19) (Attached to Decision No. 1719/QD-BYT
dated April 15, 2020 of Minister of Health).
2. Ministry
of Health, 2021, Decision No. 5904/BYT-KCB dated December 29, 2021 on
commissioning and promulgating videos guiding rehabilitation for severe acute
respiratory syndrome caused by SARS-CoV-2 (COVID-19).
3. “Support for rehabilitation: self-management after
COVID-19-related illness, second edition; 2021. License: CC BY-NC-SA 3.0 IGO”.