People infected with the novel coronavirus
Guidelines for Health Management Professionals in Recovery
(First Edition)
This guideline collects the opinions of experts and scholars in different fields, summarizes relevant clinical experience, and aims to help and guide the self-health management of patients in the recovery stage of the novel coronavirus. If you have been infected with the novel coronavirus and are recovering, please read this guide carefully and follow it to be the first person responsible for your own health.
1, applicable population
According to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial ninth Edition) and expert advice, a person infected with novel coronavirus has entered the recovery period when he/she meets any of the following criteria and other symptoms are significantly improved: 1. Nucleic acid test was negative for two consecutive times, and Ct value was ≥35. 2. The antigen test results were negative for three consecutive days; 3. After 7 days of home isolation, the fever has subsided for more than 24 hours without the use of antipyretic drugs.
2. Main health problems and rehabilitation suggestions during convalescence
According to the WHO's "Guidelines for Individual Recovery from COVID-19", combined with clinical observation and population survey, people in the convalesce stage of COVID-19 infection currently have the following health problems: shortness of breath, limited physical activity and exercise, decreased physical strength and fatigue, hoarseness and cough, swallowing problems, smell and taste problems, anxiety, depression and sleep problems, and body pain.
(1) Rapid breathing (shortness of breath)
Shortness of breath is common after COVID-19 infection. Advice for shortness of breath: Try a variety of positions to relieve shortness of breath to determine which one works. Prone position: Lying flat on your stomach (stomach) can help relieve shortness of breath; To sit at a table, leaning forward above the waist, with your head and neck resting on a pillow on the table and your arms resting on the table, or to sit in a chair and lean forward with your arms resting on your knees or on the arms of the chair; To lean forward on a ledge or other stable supporting surface while in a standing position; Back leaning position: Back against a wall, hands at your sides, feet about 30cm away from the wall, legs apart. In addition, be aware of the following situations that require prompt medical attention: significant shortness of breath after light activity, which cannot be improved by any posture to relieve shortness of breath; The degree of shortness of breath changes at rest and cannot be improved with any breathing control technique; Experiencing chest pain, a racing heart, or dizziness during certain poses, activities, or exercises; Weakness appears in the face, arms and legs, especially on one side of the body.
(2) cough
Cough is an important defensive reflex of the body, which is conducive to clearing respiratory secretions and harmful factors. Advice for cough problems: General mild cough can not be treated. If phlegm is excessive or difficult to cough up, acetyl cysteine, ambroxol hydrochloride, eucalyptus pina capsules, carboxymesteine and other expectorants can be taken. If the cough is mainly dry cough, you can take dextromethorphan, compound methoxamine capsules, antihistamines, etc. In traditional Chinese medicine, if accompanied by pharyngeal pain or cough (especially dry cough), no other symptoms, you can take Jing Prevention of sepsis powder, Yinqiao powder, Sangju drink, in order to heat and produce fluid, moisten the lung and relieve cough, you can also use gua Sha and other traditional Chinese medicine external treatment. If the cough is severe, interferes with daily work or sleep, or lasts for more than 3 weeks, it is recommended to seek medical attention.
(3) Fatigue
Feeling weak or fatigued, with no obvious relief after rest, is the most frequently reported symptom during the recovery period from COVID-19 infection. Suggestions on the problem of fatigue: maintain the rhythm of daily life, determine the priority order of activities, and make a reasonable work plan. Symptoms are mild without dyspnea, routine treatment of basic diseases can be appropriate at the same time to supplement qi drugs, such as lily, platycodon and other drugs to tonify lung qi and promote qi machinery. If you have difficulty breathing, go to the hospital. External treatment of traditional Chinese medicine such as soaking can be used. Take 3 pieces of ginger (about the size of a one-yuan coin) plus 5 grams of mogwort and 5 grams of salt, boil for 10 minutes, add water to above the ankle joint, control the temperature at 40-43℃, maintain the temperature for about 30 minutes, once a day. To slightly sweat is appropriate, do not sweat profusely. If you have heart disease, the soaking time needs to be halved, not too long. If you have difficulty breathing, go to the hospital.
(4) insomnia
Symptoms such as difficulty falling asleep, short sleep duration, light sleep and dreaminess may occur during recovery from COVID-19. Advice for insomnia: Have a regular bedtime and wake up time. Make sure your environment is free from distractions such as excessive light or noise; Try to stop using devices like phones and tablets an hour before bed; Reduce nicotine (e.g. smoking), caffeine and alcohol intake as much as possible; Try relaxation techniques that help you fall asleep, such as meditation, mindfulness-based stress reduction therapy, mindfulness or bathing, aromatherapy, tai chi, yoga and music. Traditional Chinese medicine can also be used to soak the method.
(5) Pain
In the process of infection and recovery from COVID-19, pain symptoms such as bone and joint pain, muscle soreness and sore throat are common. Advice for pain problems: For joint, muscle or general pain, analgesics such as paracetamol or ibuprofen can be taken with meals. For sore throat, can use golden throat health, mint lozenges and other drugs to treat. A good night's sleep can help relieve pain symptoms. Listening to relaxing music or meditation can also help relieve pain. Pacing your daily activities is one of the keys to managing pain. External treatment of traditional Chinese medicine such as hot compress and scraping can also be used. If you have obvious chest pain, go to a medical institution immediately.
(6) palpitation
During the recovery phase of the novel coronavirus infection, some patients have the symptoms of palpitation and palpitation. At this time, it is recommended to pay attention to more rest, adjust daily work and rest, and keep enough sleep. At the same time, they should strengthen their own nutrition and take in more food rich in protein and vitamins to improve the body's resistance to disease. If palpitation symptoms are obvious, beats per minute last more than 100 times, less than 60 times, or irregular beats occur, it is necessary to be alert to the occurrence of viral myocarditis, it is recommended to go to the hospital for examination in time to find out the cause and take measures.
(7) Sound problems
COVID-19 infection can cause sore throat, irritating cough and a build-up of phlegm in the throat, requiring frequent clearing of the throat. Weak voices, breathing or hoarseness may also occur, especially after being on a ventilator in the hospital. Advice for sound problems: Drink plenty of water, a few times throughout the day, to try to keep your voice as normal as possible. Don't strain your voice. Don't speak in a whisper volume, as this can strain the vocal cords, and try not to speak or shout loudly. Inhaling steam (from a cup of boiling water after covering your head with a towel) for 10-15 minutes will relieve dryness and moisturize your vocal tract. It is recommended to stop smoking.
(8) Swallowing problems
When you have trouble swallowing food and drink, the muscles that help you swallow may be weakened. Advice for swallowing problems: Sit up straight when eating or drinking, and never eat or drink lying down. Stay upright (sitting, standing, walking) for at least 30 minutes after eating. Experiment with different textures, either by choosing soft, smooth or moist foods, or by cutting solid foods into very small pieces to eat. Eat slowly and don't Wolf down your food. Pay attention when eating or drinking. Try to eat in a quiet place. Avoid talking while eating or drinking. Make sure there is no food in your mouth before eating or drinking. Swallow once if necessary. If you feel tired after eating a full meal, eat smaller meals more often throughout the day. Keep your mouth clean by brushing your teeth and drinking water. If you cough or choke while eating or drinking, consult a medical professional as food or drink may stray into the lungs.
(9) decreased sense of smell and taste
If a loss of smell or taste occurs, the following are recommended: Brush your teeth twice a day to ensure oral hygiene. Practice olfactory training, including smelling lemons, roses, cloves or eucalyptus for 20 seconds twice a day. Try adding herbs and spices to your food, such as lemon juice and fresh herbs. Most cases of reduced sense of smell and taste recover within a month of infection with the novel coronavirus.
3. Psychological adjustment and nutritional support during convalescence
(1) Psychological adjustment during the recovery period
It is natural to experience feelings of fear, nervousness and anxiety during the process of COVID-19 infection and recovery. To overcome fear, tension and anxiety, you can start from the following aspects:
1. Keep a regular schedule, ensure adequate sleep, moderate exercise, reading, listening to music, etc., and ensure a healthy diet. Do not use denial, withdrawal, over-dependence on others, blame, blame, temper, impulse and other bad coping methods, especially do not try to smoke or drink to relieve tension.
2. Make positive psychological adjustment, communicate with others, encourage each other, provide psychological support to each other and divert attention.
3. Breathing relaxation training, aerobic exercise, mindfulness meditation, meditation and other ways to adjust the mood.
(2) Nutritional support during convalescence
Can eat a small number of meals, pay attention to the diet should be fixed time, food diversity, reasonable collocation. Keep the variety of food, pay attention to both meat and vegetables, thick and fine mix; Eat more fresh vegetables, fruits, soybeans, milk, cereals; Eat fish, poultry, eggs, lean meat, preferably fish, shrimp, poultry and lean meat, eat less fat meat, light diet is not greasy. Avoid eating spicy and stimulating food, fried greasy food. Make sure you drink plenty of water, preferably plain water, and few or no sugary drinks.
Rational use of medicinal diet for food cultivation and diet therapy, combined with the winter climate characteristics, recommend the use of Sydney Luo Han fruit water, corn beard orange peel water, white radish honey water, walnut scallion and white ginger soup, pear soup, yam, winter melon and lotus seed porridge, Coix seed poria yam porridge and other traditional Chinese medicine dietary therapy.
4. Matters needing attention in daily life
During the recovery period of COVID-19 infection, although nucleic acid and antigen test results have turned negative, the body has not yet recovered to the pre-disease level, and it takes 1-2 weeks or even longer to complete remission. At this stage, in terms of personal protection, daily life, daily exercise, return to work and other aspects, we should follow the principle of step by step and do according to our ability, and gradually recover as usual.
(1) Matters needing attention in daily life
1. The current high incidence of respiratory diseases in winter cannot rule out the risk of the combined epidemic of novel coronavirus infection with influenza, common cold and other respiratory diseases in winter and spring. Therefore, the standard of self-protection should not be lowered due to "Yang Kang". Practice good hand hygiene at all times, especially after touching suspected contaminants or public surfaces with high frequency contact.
2. Get adequate nutrition, regular sleep and good sleep. Diet should pay attention to the intake of high protein nutritious food. Smoking, drinking habits, especially some risk factors, smoking, drinking will aggravate the underlying diseases. Recommend "Yangkang" after the best to quit smoking, limited alcohol. For "Yangkang" after poor appetite, or have a taste disorder, it is recommended to eat less and more meals. Diabetic patients should maintain regular diet to avoid large fluctuations in blood sugar.
3. After the acute fever has subsided, you can take a bath if physical strength permits, but you should avoid sauna. Be sure to avoid cold when taking a bath, pay attention to the appropriate indoor temperature, bath water temperature should not be too high.
(2) Matters needing attention in daily exercise
1. On the basis of regular daily living, adequate nutrition and sleep, start with low-intensity activities, such as walking, eight sections of the tapestry, simple daily housework, etc. If there is no obvious discomfort, the intensity of activities can be increased gradually over several weeks, such as walking up and down stairs, brisk walking, jogging, cycling, swimming, dancing until the normal state of activity before the disease.
2. In case of chest pain, palpitation, dizziness and other uncomfortable symptoms during exercise, stop exercising immediately and seek medical attention if necessary. For hospitalized rehabilitation patients, patients with original cardiopulmonary diseases and patients with remaining symptoms such as fatigue, chest tightness, dyspnea, strenuous exercise or heavy work should be avoided within 2 weeks. Low-intensity exercise can be maintained for at least 1-2 weeks, and then higher intensity exercise can be carried out after the body gradually ADAPTS to it.
(III) Matters needing attention when returning to work
1. At the beginning of returning to work, start from light work and gradually return to the normal workload and working state, avoid stress, overtime work, stay up late and other behaviors.
2. Take a 20-30 minute lunch break if possible.
3. Due to individual differences in physical fitness, age, illness and other conditions, the recovery time will also be different, so the recovery work is gradual and the intensity is based on not feeling tired.
5, home disinfection suggestions
After COVID-19 patients enter the recovery period, ventilation should be strengthened indoors, and disinfection of key areas and used items should be done on the basis of cleanliness and hygiene. Physical disinfection methods such as sun exposure and heat are preferred. Chemical disinfectant can be used to wipe the surface of the home environment. Use disinfectants such as chlorine-containing disinfectants, quaternary ammonium salt disinfectants, and hand disinfectants, or use alcohol or quaternary ammonium salt disinfection wipes.
(1) Disinfection methods for different objects
1. Indoor air. Open Windows regularly every day for ventilation to keep indoor air circulation. If there is no natural ventilation conditions, exhaust fans and air conditioning systems can be used for mechanical ventilation.
2. Object surface. Clean the surfaces of tables, chairs, furniture, doorknobs, faucets, and other objects with contaminants, and then use 500mg/L chlorine-containing disinfectant, or choose a less irritating quaternary ammonium salt disinfectant, and wipe clean after 30 minutes with water. Mobile phones, remote controls, mice and other small items can be wiped and disinfected with alcohol wipes.
3. Surfaces such as floors and walls that may be contaminated. If there are any contaminants, clean them up and then disinfect them. Use 500mg/L chlorine-containing disinfectant to wipe or spray them. The disinfection time is not less than 30 minutes.
4. Dining (drinking) set. First wash and then disinfect. The first choice is to boil and disinfect for 15 minutes, or soak 500mg/L chlorine-containing disinfectant for 15 minutes, and then rinse with clean water.
5. Clothing, bedding, towels and other textiles. It can be boiled and disinfected for 15 minutes or washed with hot water and kept at 56℃ or above for 30 minutes. It can also be soaked with 1000mg/L quaternary ammonium salt disinfectant or other clothing disinfectant for 30 minutes and then cleaned according to routine. Fabrics that cannot be washed can be left at room temperature for 7-10 days.
6. Mop, rag and other sanitary utensils. Should be dedicated to the area, avoid cross, after use with 1000mg/L chlorine-containing disinfectant for disinfection, after 30 minutes of use, rinse with water, dry storage.
7. Bathroom. After the toilet seat and surrounding areas can be cleaned, wipe and disinfect with 1000mg/L to 2000mg/L disinfectant containing effective chlorine; use 500mg/L disinfectant containing effective chlorine to wipe and disinfect frequently touched parts such as toilet door handles, faucets, washbasin surfaces, etc. After 30 minutes of use, wipe with clean water to enhance toilet exhaust.
8. Refrigerators and frozen foods. If the frozen food stored in the refrigerator is contaminated, it is recommended to dispose of it as garbage; If you need to eat it, you can also cook it thoroughly and then eat it. Take good personal protection during the processing of the food, wear a mask, gloves and strict hand hygiene. If the inside of the refrigerator is contaminated, it is recommended to disinfect the refrigerator by referring to the "object surface" method after the temperature returns to normal temperature.
9. Household garbage. Garbage should be collected and cleaned in a timely manner. It is recommended that after double-layer plastic bags are tightly wrapped, the outer surface of garbage bags should be sprayed and disinfected with chlorine-containing disinfectant containing 500mg/L-1000mg/L effective chlorine, and then transported to the garbage drop point.
10. Other items. Items not suitable for disinfection, such as books and valuables, can be sealed and stored at room temperature for 5-7 days.
(2) Precautions related to disinfection
1. Disinfectant should be used and mixed on the spot. Take a chlorine-containing disinfectant with an effective chlorine content of 5% as an example: When preparing 500mg/L, take one part of disinfectant and add 99 parts of water to mix; When preparing 1000mg/L, add one part of disinfectant to 49 parts of water and mix well.
2. Disinfectants, especially chlorine-containing disinfectants, have certain irritants. Personal protection should be paid attention to when preparing and using them, and it should prevent splashing into eyes. At the same time, disinfectant has a certain corrosive, pay attention to reach the disinfection time with clean water to wipe, to prevent damage to the articles.
3. Disinfectant should be used alone, not mixed with other chemical components. Before use, carefully read the disinfection product manual, and use correctly according to the range, method, concentration and time of use specified in the manual.
4. Home disinfection should be scientific and standardized, avoid excessive disinfection, do not directly use disinfectants to disinfect the human body, do not disinfect indoor air under human conditions, do not use alcohol to disinfect the air, do not carry out large area disinfection.
5. Keep disinfectants in a cool and dark place, out of reach of children.
6. Health guidance for key groups
(1) The elderly
1. The elderly often still have a certain degree of fatigue after nucleic acid or antigen turns negative, even for several weeks. If you feel tired, please try to rest as much as possible, try to adjust the pace of daily work, do not do too many things at once.
2. If energy permits, please ask your elderly friends to gradually restore your daily work and rest, and make a daily schedule for yourself, including sleep, meals, activities, etc.
3. Exercise safely and without fatigue to restore strength and endurance. If walking is difficult for you, consider exercising in bed or a chair, starting with stretching and gradually increasing the amount of activity, such as housework, walking, tai chi, Baduanjin, etc. When you first start exercising, start with 5-10 minutes, then add one minute each day, and if you are worried about falling, do it when you have family or friends with you. If you experience dizziness, chest pain, or difficulty breathing during or after exercise, stop, rest, and consult your doctor.
4. Drink 1500-2000ml water every day, three meals a day, can be appropriate to add meals. It is recommended to keep a daily food log to help you know if you are eating healthily.
5. Stay socially connected. Talk to loved ones and those you trust by phone, video, or other means of communication as often as possible throughout the day.
6. Try to think of three happy thoughts each day, try to repeat the words "relax" and "calm" while breathing deeply, try to avoid negative or unhealthy thoughts; If stress, worry, fear and sadness interfere with daily activities for several days, contact your doctor for psychosocial support.
7. List emergency contact numbers such as nearby medical facilities, psychosocial support helplines, family doctors, family members, friends, etc.
8. When an elderly person with underlying diseases gets infected with COVID-19, the underlying diseases will get worse. For example, the elderly with hypertension may have unstable blood pressure after infection, the elderly with diabetes may have unstable blood sugar after infection, the elderly with cerebrovascular disease may have cerebral infarction or bleeding risk after infection, and the elderly with COPD may have cough and increased dyspnea after infection. After nucleic acid or antigen detection, the elderly turn negative, but the aggravated underlying disease may not be stabilized, so it is necessary to closely monitor blood pressure, blood sugar, oxygen saturation, etc. If the instability lasts for a long time, please go to the hospital in time to adjust the treatment plan of the underlying disease.
(2) Pregnant women
1. No matter what age of pregnancy, pregnant women should pay attention to rest within 1-2 weeks after recovery from COVID-19 infection and take appropriate exercise, but the intensity and duration of exercise should not be too high and should not be too long. Do a good warm up before exercise, exercise before and after the appropriate hydration. If there is threatened abortion, placenta previa and other inappropriate exercise should follow the doctor's advice.
2. Ensure reasonable and adequate nutritional intake throughout the pregnancy.
3. Keep a happy and stable mood, and do not worry too much about the adverse effects of the novel coronavirus infection on the fetus. Currently, it is believed that the vertical transmission of the novel coronavirus will cause intrauterine infection of the fetus, and generally will not lead to abnormalities.
4. Regular pregnancy tests should be conducted, and pregnant women in the second and third trimesters should monitor fetal movements by themselves. If you have abnormal fetal movement, abdominal pain, abdominal discomfort, vaginal bleeding and other symptoms should go to the hospital immediately.
(3) Children and adolescents
Generally speaking, most children and adolescents infected with the novel coronavirus have a good prognosis, showing a self-limited course of disease, and the chance of serious complications and sequelae is very low. Parents should first keep a calm mind, understand the natural course of COVID-19 infection and not be overly anxious.
Continue to take good precautions and develop good hygiene habits.
(1) Do not take children and teenagers to crowded places, poorly ventilated rooms or long contact with others. Wear a mask when going out (children over 3 years old) and keep a distance from others as much as possible.
(2) Indoor ventilation should be done when staying at home for a long time. Try to choose ventilation when children and teenagers go out for activities, or separate ventilation for each room.
(3) Family members should wash their hands, face, change clothes and contact with children after going out and coming home. If you have a respiratory infection in your home, isolate yourself from your children and wear a mask.
(4) Guide children and teenagers to develop good hygiene habits, washing hands before eating, after using the toilet, after sneezing, coughing and cleaning nose, after going out and returning.
2. Develop good living habits and enhance your resistance.
(1) Regular rest and sleep enough. Go to bed and wake up on time, sleep at least 12 hours a day for children up to age 1, 11 hours before kindergarten, 10 hours in kindergarten, at least nine hours a day for primary school students, and eight hours a day for middle school students.
(2) Step by step, exercise. After recovering from the novel coronavirus infection, it is recommended to gradually increase outdoor activities and physical exercise, the intensity of which is appropriate for children to not feel uncomfortable.
(3) Three regular meals and a balanced diet. Not partial food, not picky food, develop healthy eating habits.
(4) Others: reasonable clothing, pay attention to mental health.
3. Treat convalescent symptoms correctly. Some children and teenagers can cough for a while after being infected with the novel coronavirus. If the general situation is good, does not affect daily life, do not need special treatment, usually do not advocate the application of antitussive medicine. However, if the child originally had bronchial asthma, allergic rhinitis, cough for more than 3 weeks and still does not recover, mainly cough at night, also need to seek medical attention in time.
4. Parents should be alert to congenital heart disease, chronic lung disease, neurological disease, severe malnutrition, tumor, obesity, diabetes or genetic disease, immune deficiency or long-term use of immunosuppressants, premature infants or newborns and other high-risk groups. If the child has high fever for more than 3 days, shortness of breath, lethargy, persistent chest tightness or chest pain, or the condition worsens, he or she should seek medical attention in time.
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