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”.