In the early hours of Christmas morning, Lance Hoddinott was pulled from restless sleep with a raging temperature.
"I knew instantly what it was," said Hoddinott. "My Christmas present this year was COVID-19."
Although he took all the precautions and followed safety guidelines to the letter, Hoddinott contracted the disease that ultimately sent him to hospital on New Year's Eve as an unrelenting fever morphed into a shortness of breath. After four days on oxygen, Hoddinott began to improve, and after a week he was sent home.
Hoddinott is recovering — but after eight months and counting, some symptoms continue to linger, including fatigue and brain fog.
"Normally I read between 30 and 60 books a year. This year I've only read three because I can't concentrate anymore," he said. "The question that came to my mind was, 'Is this going to be my new normal?'"
There is a subsection of people who have recovered from COVID-19 but, like Hoddinott, are left dealing with a list of afflictions, said Doug Gross, professor in the Department of Physical Therapy and director of the Rehabilitation Research Centre at the University of Alberta. Now, a team led by Gross has received $152,000 from the Canadian Institutes of Health Research to explore rehabilitation needs and access to services for people with long COVID.
"We don't know much about the group of people who develop long COVID, but we know they have a lot of complicated symptoms that can be difficult to treat," said Gross.
"The old-fashioned techniques of physical retraining and building muscles have been tried, and quite often they fail — in fact, a little bit of exercise can sometimes really lead to setbacks. We are learning that pacing and strategies for conserving energy may be more effective."
What researchers know about this post-viral struggle is that about 10 per cent of people who get COVID-19 battle any number of symptoms such as fatigue, shortness of breath and post-exertional malaise, heart palpitations, aches, an inability to concentrate, anxiety or depression for 12 weeks or longer.
Part of this study will determine what access patients have to care, and how best to help overcome those barriers. The study will involve rehabilitation researchers from the U of A and across Canada, in collaboration with respiratory specialists in Edmonton and Calgary.
Early work on rehabilitation
In the early months of 2020, when the entire world was focused on the acute management of COVID-19, physical therapy professor Geoff Bostick said survivors who were clear of the disease but remained in the clutches of its symptoms were the ones who generated the push to get the condition recognized even when the medical community was doubtful.
"I don't think there's ever been a condition that has basically been defined and labelled by the people who are affected by it rather than by the medical community, and now the medical community is trying to catch up," he said.
Still, the U of A rehabilitation medicine researchers' involvement dates back to the early days of the pandemic when more than 50 researchers from around the world came together to create a series of briefing papers through World Physiotherapy, including Safe Rehabilitation Approaches for People Living With Long COVID: Physical Activity and Exercise.
"This briefing paper provides guidance to physiotherapists around the world on how to safely approach rehab and physiotherapy care for patients with long COVID that would inform what we're doing in our student clinic," said Mark Hall, a U of A physical therapy professor and, along with Bostick and Gross, one of six U of A researchers called on to inform the safe rehabilitation briefing paper.
Putting patients on the path to full recovery
Earlier this year, the Faculty of Rehabilitation Medicine was approached by physiotherapists at the Misericordia Hospital in Edmonton who were concerned there was no clear pathway for COVID-19 patients to go from hospital to rehabilitation.
Part of the problem, said Bostick, are the multiple branches of rehabilitation each patient may need to access. For instance, physiotherapy would be involved to help with strength and endurance and to help retain proper breathing; occupational therapy would be needed to help with depression, anxiety and sleep disturbances; and speech therapy would be necessary in cases where speech has become impaired.
"This is such a new thing, especially the post-exertional malaise. I think there's a lot of people who just need support trying to navigate their disability in a context where there's not a lot known about it or a lot of resources available," said Bostick.
Some of that support is coming from physical therapy master's students at the Corbett Hall Student Physical Therapy Clinic, supervised by Bostick, who have ramped up their efforts to help patients find a way out of long COVID.
"This is new territory; we're not used to flying blind," said Bostick. "In the beginning, we were really concerned about making sure that patients weren't having a negative experience, so we were really cautious about trying to figure out who's the right candidate.
"Our clinic prides itself on trying to meet gaps in the community. Obviously this is a huge gap, so we're just really keen to help but need to be cautious as well."
