When Charlie Coulton regained consciousness after 42 days in intensive care fighting Covid-19 — half of that time on a ventilator — he wondered if he had woken up in a science fiction film.
Surrounded by nurses and doctors wearing full protective suits, masks and gloves, and drowsy from sedatives and painkillers, the 65-year-old widower was weak and struggling to breathe.
‘There were tubes up my nose, in my throat and bleeping monitors — I didn’t know if any of it was real,’ says Charlie, a retired bakery worker from Plymouth, who lives alone.
He had called for an ambulance in March after suffering a persistent cough, high temperature and breathing problems. Initially admitted to the Covid-19 ward at Derriford Hospital, Charlie was moved to the intensive care unit (ICU) within three days.
When Charlie Coulton regained consciousness after 42 days in intensive care fighting Covid-19 — half of that time on a ventilator — he wondered if he had woken up in a science fiction film
‘My last memory was of being taken to ICU and told I needed a ventilator as my breathing was so bad and my blood oxygen levels so low.’
He later learned his heart stopped three times while he was on the ventilator, and he’d also had emergency kidney dialysis after developing sepsis.
‘They nearly lost me several times, but I have no memory of it,’ he says.
After the disease cleared, he was taken off the ventilator but still struggled to breathe and constantly coughed up mucus. Charlie lost 2 st while in hospital and was so weak he couldn’t even get out of bed.
Doctors warned him the recovery could take up to 18 months, although with rehabilitation therapy he would soon be back on his feet. ‘But it was my lungs I was most concerned about — as they said they were badly damaged and full of mucus.
‘I was shocked when I saw the CT scan — there were lots of areas of white, meaning my lungs had been damaged. I had fibrosis [scarring of the lungs] which I’ve since learned is permanent.’
But treatment from a specialist respiratory physiotherapist has helped set him on the long road to recovery
But treatment from a specialist respiratory physiotherapist has helped set him on the long road to recovery.
Charlie’s experience is not unique. It’s estimated up to 60 per cent of patients hospitalised with Covid-19 could face lasting lung damage — including breathlessness and fatigue.
Until recently, the work of respiratory physiotherapists has gathered little attention, but they could hold the key to helping Covid patients recover lung function and quality of life.
They start working with patients even when they are in intensive care on ventilators, using manual manipulation techniques to help clear mucus. Further on in a patient’s recovery they may teach them breathing techniques and gradually build up their exercise tolerance, lung capacity and muscle strength using, for example, an exercise bike.
But the Chartered Society of Physiotherapy (CSP) is warning there may not be enough of these specialists to cope with the extra workload from the pandemic — which would leave Covid patients unable to get the care they need.
Charlie’s experience is not unique. It’s estimated up to 60 per cent of patients hospitalised with Covid-19 could face lasting lung damage — including breathlessness and fatigue
The specialists are physiotherapists who have had postgraduate training in helping patients recover lung function after being on ventilators and CPAP masks, which also assist breathing.
There are an estimated 2,000 in the UK, and they normally care for patients with chronic lung diseases and cardiac and neurodegenerative conditions, such as motor neurone disease, which affects muscle function in the lungs.
Even before Covid-19 struck, the CSP estimates the UK was 4,000 physiotherapists short and, now demand is even higher, ‘it’s hard to know how many more we will need’, says a spokesman.
Hospital audit data, based on patients treated up to mid-May, shows that 62 per cent (29,854) of those admitted with Covid-19 may need ongoing rehab for breathlessness, muscle weakness and other lung conditions.
NHS guidance out last week stated that 30 per cent of Covid-19 patients may need long-term care for lung problems. And a CSP survey found one in four rehabilitation physiotherapists thought Covid patients were not getting the rehabilitation needed after intensive care.
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The chief executive of the CSP, Professor Karen Middleton, told Good Health: ‘We know patients are much more likely to make a full recovery if rehabilitation begins in hospital and continues seamlessly at home.
‘It is tragic to think that thousands of people have fought off Covid-19 only to find themselves struggling with multiple conditions due to a lack of aftercare.
‘Rehabilitation services have been under-resourced for decades and now, more than ever, we need quality community rehabilitation to be prioritised.’
Physios are being redeployed to work with Covid patients, supervised by respiratory physiotherapists. But access to community rehabilitation care is patchy, says the CSP, which wants a national strategy to ensure uniform rehabilitation services across the UK to cope with the legacy of Covid-19.
And the problem will only worsen over time. ‘Those with very frail lungs don’t have much exercise tolerance, so they get breathless on minimal exertion,’ says Ema Swingwood, chair of the Association of Chartered Physiotherapists in Respiratory Care.
‘Further down the line some of these patients may need oxygen support long-term at home.’
It’s not simply about treating patients with obvious damage, she adds. ‘In some patients the damage may not be apparent at first, but may become obvious in a few years as fibrosis progresses.
EXERCISES TO TRY IF YOU’RE BREATHLESS
These have been specially designed to ease breathlessness by physiotherapists and nurses at Lancashire Teaching Hospitals NHS Trust.
- LEAN FORWARD: When you feel short of breath, one of these positions may help control your breathing. They can be used at the same time as the control exercises (see next bullet points).
Sit with your forearms on your knees, relaxed, and lean forward. Or, if standing, you can lean forward or backwards, supported by a wall and with your feet slightly apart. Or lie on your side with your shoulders and head raised on pillows, knees slightly bent. Repeat as often as needed.
- BREATHE THROUGH YOUR NOSE: This can help reduce the effort of breathing. Sit in a relaxed position with your arms supported and breathe in and out through your nose (if easier, breathe out through your mouth). As you exhale, try to let go of stress and gradually slow your breathing. Repeat once an hour.
- ‘STACK’ YOUR BREATH: This helps to keep your lungs flexible and can make you cough more productively. Leave an hour after eating or drinking and stop if you experience chest pain.
Breathe out fully. Then take a small breath in and hold. Repeat until you feel you can’t take any more air into your lungs, and hold for two to five seconds. Exhale all air out of your mouth. Repeat once an hour. Stop if your breathing pattern alters outside this exercise and contact your GP.
‘This is because the lungs may never fully recover and any early stage fibrosis may worsen.’
Disorders, such as hyperventilating (over-breathing) and a chronic cough, may worsen, too.
Physiotherapists are also concerned about Covid patients they don’t know about because they weren’t admitted to hospital.
‘People could be isolated at home, struggling with breathlessness,’ says Ema Swingwood.
‘All these patients need follow-up rehabilitation if they are to regain their previous quality of life and/or get back to work.’
Rachael Moses, a respiratory physiotherapist and associate director of rehabilitation at London’s Royal Brompton Hospital, believes at least half of Covid-19 hospital admissions may need ongoing rehabilitation.
‘Some post-Covid patients are falling through the net,’ she says. ‘Many were moved out of hospital, where they were getting a lot of rehab, quickly due to the infection risk. What rehab they get in the community is a postcode lottery.
‘Some of these patients won’t manage the stairs at home or go back to work if they don’t get the follow-up care.’
Charlie Coulton credits his ongoing recovery to respiratory physiotherapists. ‘Each day I had to pedal an exercise bike at the end of my bed and learn how to breathe in through my nose and out through my mouth,’ he says.
‘They helped me to shower — it took 50 minutes the first time as I was so weak — and walk upstairs to improve my exercise tolerance. It was so difficult, but they made me believe it was possible.’
Charlie was discharged six weeks ago, after two weeks recovering on a ward. He’s since had home visits from respiratory physiotherapists.
‘When I was first home I struggled to walk upstairs — I had to stop on each step and was exhausted from coughing all day and night.
‘I’m much better, but I am still breathless and fatigued, though I only cough in the morning now.
‘It’s a long road back to where I was before, when I easily walked 10,000 steps a day.’