My COVID Recovery

Managing trouble breathing or shortness of breath

The following strategies and exercises have been shown to help improve breathlessness. You can pick and choose which ones work best for you based on the reason why you are feeling breathless.

Relaxed breathing

Also known as diaphragmatic breathing, this can help you to relax and get control of your breathing. This is helpful when you are feeling anxious. This is also helpful to build your breathing strength after you have been unwell for some time.

• Sit in a comfortable and supported position.
• Put 1 hand on your chest and the other on your stomach (belly).
• If it helps you to relax, close your eyes. If this does not help you to relax, keep them open and focus on your breathing.
• Slowly breathe in through your nose (or your mouth, if you are not able to breathe through your nose). Then breathe out through your mouth. You may need to purse your lips when breathing out if you have been told to do this in the past.
• As you breathe, you should feel the hand on your stomach rise more than the hand on your chest.
• Try to use as little effort as possible. Keep your breaths slow, relaxed, and smooth.

Paced breathing

This may help you control your breathing when you are doing activities that take more effort or make you breathless (such as making your bed, climbing stairs, etc.).

• Break the activity down into smaller parts. This will make it easier to do without getting too tired or breathless.
• Breathe in before you make the 'effort' of the activity, such as before you climb up a step.
• Breathe out while making the effort, such as climbing up a step.
• It may help to breathe in through your nose and out through your mouth.

Different positions

These positions may help you breathe easier. Try each one to see what helps you most.

• High (raised) side lying:  Lie on your side. Place pillows under your body to support your head and neck. Slightly bend your knees.
  
• Forward lean sitting with table: Sit in front of a table with a pillow on it. Lean forward from your waist. Rest your head and neck on the pillow. Rest your arms on the table. Note: You can also try this without a pillow.
  
• Forward lean sitting without table: Sit in a chair. Lean forward to rest your arms on your lap or the armrests of the chair.
  
• Forward lean standing: Stand up straight. Then lean forward onto a stable surface (like a windowsill or table).
  
• Standing with back support: Stand with your back towards a wall and your hands by your sides. Place your feet about 1 foot away from the wall and slightly apart. Then lean against the wall.
  

Use a Symptom Tracker to record how you are feeling over time.

There are other breathing exercises that can help to decrease breathlessness which you may also find helpful. These can be found under the Resources and Supports tab above.

Resources and supports

Some of this material, including images, has been adapted from an original work Support for Rehabilitation Self-Management after COVID-19 Related Illness. Geneva: World Health Organization (WHO); 2020. Licence: CC BY-NC-SA 3.0 IGO. This adaptation was not created by WHO. WHO is not responsible for the content or accuracy of this adaptation. The original edition shall be the binding and authentic edition.

References

Neuroscience, Rehabilitation & Vision Strategic Clinical Network. Post COVID Task Force.(2021). How to Support Your Recovery and Rehabilitation after COVID-19. British Columbia: Provincial Health Services Authority. http://www.phsa.ca/health-info/post-covid-19-care-recovery

NHS England.(2021). Breathlessness. Your COVID Recovery. Retrieved July 9, 2021, from https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/breathlessness/

Post-COVID-19 Interdisciplinary Clinical Care Network (n.d.). Managing Breathlessness in Post COVID--19 Recovery. Alberta: Alberta Health Services. https://www.saot.ca/wp-content/uploads/2021/03/if-ppih-covid-19-support-recovery-rehabilitation-after-covid-19.pdf

Professional Practice Coordinators, IPPL, Central Zone (2021). Supporting your recovery from COVID-19. Patient & Family Guide. Halifax: Nova Scotia Health Authority. https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2219.pdf

World Health Organization(2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Ofice for Europe. https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness

Managing your cough

Try these strategies:

To manage a dry cough

• Drink plenty of fluids. They can make a scratchy throat feel better and keep mucus thin, so it is easier to cough up.
• Raise your head with an extra pillow if coughing keeps you awake at night.
• When possible, limit, reduce or avoid smoking and exposure to second-hand smoke. Smoke can irritate your lungs and make you cough more. This is very important when you have an illness that can affect your breathing, like COVID-19.
• Take cough medicine if you have a dry, hacking cough, as it may help to stop your coughing. This should only be used for a short time.
  • Talk with your pharmacist before using cough medicine as it could interfere with other medications you may be taking.
  • Children under 6 years old should not use cough medicine.
• Soothe a sore throat by sucking on throat lozenges or plain, hard candies.
  • Do not give lozenges to children under 6 years old.

To manage a productive cough (coughing up mucus or phlegm)

• Controlled coughing comes from deep in your lungs. It loosens mucus and moves it through your airways.
• If you have been prescribed an inhaler or medication to help your cough, take it before trying controlled coughing.
• To do controlled coughing:
  • Sit on the edge of a chair with both feet flat on the floor.
  • Lean forward a little and relax.
  • As you inhale (breathe in) slowly through your nose, fold your arms over your stomach.
  • As you exhale (breathe out) through your mouth, lean forward. Push your arms against your stomach.
  • Cough 2 or 3 times as you exhale with your mouth slightly open. Make the coughs short and strong. Gently push on your stomach with your arms as you cough. The first cough brings mucus through your lungs. The next coughs bring it up and out.
  • Inhale again, slowly and gently through your nose. Do not take quick or deep breaths through your mouth. This can block the mucus coming out of your lungs. It can also cause uncontrolled coughing.
  • Rest. Repeat as needed.

Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

Some of this material has been adapted from an original work Support for Rehabilitation Self-Management after COVID-19 Related Illness. Geneva: World Health Organization (WHO); 2020. Licence: CC BY-NC-SA 3.0 IGO. This adaptation was not created by WHO. WHO is not responsible for the content or accuracy of this adaptation. The original edition shall be the binding and authentic edition.

References

NHS England.(2021). Cough. Your COVID Recovery. Retrieved July 9, 2021, from https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/cough/

Professional Practice Coordinators, IPPL, Central Zone (2021). Supporting your recovery from COVID-19. Patient & Family Guide, WC85-2219. Nova Scotia: Nova Scotia Health Authority. https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2219.pdf

World Health Organization(2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Ofice for Europe. https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness

Managing fatigue

Try these strategies:

Plan to rest

Planning to rest before you start to feel exhausted can help your recovery. Stopping only when you feel exhausted can lead to more fatigue. Planned rests can lower your need for longer periods of rest (often called a "crash").
For example: If you are exhausted and usually have to nap by 2 p.m. daily, consider planning to rest by 1 p.m. each day.

Rest effectively

A rest should be a break for your body, brain, senses, and emotions. A rest should either give you energy or pause the drain of energy.
Think of a cell phone -- in order to have battery power, you need to plug it in to recharge, turn it off so the battery stops draining, or close some apps or programs so that the battery does not drain as quickly. A rest is your time to recharge.
Consider how and where you rest. Do you need a quiet or dark room? Is your brain resting as well as your body?

Do-Rest-Do

Break your activities into smaller parts. Complete 1 part, followed by a rest. This “Do – Rest – Do” plan can help you complete a task with less frustration, support your recovery, and help you do more throughout the day. You can spread parts of an activity throughout the day, or do them over a number of days.
For example:

• Clean the sink 1 day, and the toilet the next day.
• Gather the dirty laundry 1 day. Do the washing and drying the next day.
• Do 20 to 30 minutes of computer work, then rest.
• Chop the vegetables for supper earlier in the day, then rest before cooking.

Time of day

Each of us has a time of day when our energy level is highest. This is true, even when you have fatigue. For most people, this is the time of day when their brain and body work best. Use your best hours each day for your most important or challenging tasks.

For example:

• If you want to have quality time with a friend or family member, plan your visit during your best time of day. You may choose to meet for coffee on the deck at 10 a.m., instead of an evening visit).
• If you have to complete a form that needs concentration, plan to work on the form for short periods during your "best time of day".

Consider the environment

Your surroundings will change how much energy you need to do an activity. Think of the amount of energy needed to have a one-on-one conversation in a quiet room, compared to a busy or loud environment. 

Reduce stimulation

Try to lower stimulation by:

• Wearing a baseball hat when shopping in a store with bright or fluorescent lights.
• Lowering background noise, like a TV or radio, when you need to concentrate.
• Moving to a quiet, calm environment when reading an information pamphlet about your health.

Think about your body

Poor posture and position use more energy. They can also increase your risk of pain and injury. Consider how to lift, reach, and work safely.

For example:

• Sit while folding laundry.
• Use a speaker phone to avoid holding your cell phone to your ear.
• Carry small grocery bags instead of lifting large, heavy bags.

Use tools and equipment

Tools and equipment can help save energy.
For example:

• Sit while cooking.
• Use an automatic can opener.
• Use an electric mixer instead of mixing by hand.
• Sit while showering.
• Set up automatic bill payments or reminders.

Be kind to yourself

You may not be able to do as much as usual because your health has changed. This is OK. Take it slow and do not try to do too much.

Other people may expect you to feel better or be able to do more than you are ready for. This can be stressful. You may feel angry, sad, frustrated, scared or discouraged. This can affect both your physical and mental health.

Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Integrated Chronic Care Services(2020).Welcome to the Integrated Chronic Care Service (ICCS).Patient & Family Guide,WX85-2060. Nova Scotia: Nova Scotia Health Authority.https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2060.pdf

NHS England(2021). Fatigue. Your COVID Recovery. Retrieved July 9, 2021 from https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/fatigue/

Managing trouble concentrating, brain fog, or memory problems

Try these strategies:

Do one thing at a time

Multitasking (doing more than 1 thing at a time) requires more energy to complete a task. For example, you may be able to follow a recipe when alone, in silence. But, you may struggle to remember the next step of the recipe if you are having a conversation while you cook.

Paying attention to details and sensory experiences (what you see, hear, smell, feel and taste) can help.

For example:

• Notice the smell or feel of your soap while doing dishes.
• When you are thinking about something else, bring your thoughts back to what you are doing in the moment. Notice the colour of the grass, the softness of the sheet you are folding, or the feel of the paper you are writing on.

Set up your environment to help you succeed

Remove distractions and avoid too much stimulation. Noise, lights, clutter, and other people moving or being active nearby can make it harder to think and remember.

For example:

• Turn off the TV while having a conversation.
• Find a quiet place to read.
• When using the computer or social media, only open 1 task or website at a time.
• Go to a quiet room, when trying to plan an appointment.

Use your brain and body without overdoing it

Keeping both your brain and body active can help you recover after having COVID-19. This can be hard if you have fatigue or brain fog. Add cognitive activities slowly over time. Start by doing activities you are familiar with that are not too challenging. Plan to do a cognitive task for a short time. This can help you keep your brain active without making your symptoms worse.

For example:

• Start by reading a short article or listening to an audio book.
• Plan to work on a crossword puzzle for no more than 5 to 10 minutes, then rest.
• Plan to rest before and after a medical appointment that requires focus, learning and attention.
• See the Symptoms That Get Worse After Physical Activity page of this website for suggestions to safely start physical activity.

Avoid feeling overwhelmed

It can be stressful to have trouble with concentrating, brain fog and memory. It can be overwhelming to plan, understand, organize and start a task. You cannot think clearly when you are overwhelmed. To avoid this, break down activities into small steps.

For example:

• Do not write a grocery list, drive to the store and buy groceries all at once.
• Write a list a day or 2 before you plan to shop. Start by listing and fruits and vegetables you need to buy, followed by a break. Add meat and proteins to the list next.
• Then drive to the grocery store and shop on a different day.

Remember to adjust your expectations during your post-COVID recovery. You may not able to do as much each day, as you could before having COVID-19. Set realistic goals and expectations based on your current energy and cognitive abilities.

Use supports, tools and reminders

Use supports, tools and reminders that make thinking and remembering easier. These supports may include lists, timers, calendars, reminders on your phone and extra help from family and/or friends.

Use lists, notes and alerts (like a phone alarm) to remind you of things you need to do. Accept offers of support and let people know what they can help you with (like shopping, carpooling, cooking or errands).

Calm your brain

Our brains work best when our bodies, thoughts and emotions are calm. There are many strategies to help with relaxation and lowering stress, while improving your focus and ability to pay attention and think more clearly. These calming approaches include mindfulness, meditation practices, gentle stretching, yoga, reflective journalling, breathing practices and other self-soothing activities.

Learning how to manage your emotions is an important step in your physical recovery. Not only can it lower stress, anxiety, heart rate and blood pressure, it can improve concentration and memory, and lower brain fog. When your brain is relaxed, your body is relaxed.

Consider your "brain battery"

Your brain is always working, but some activities use more brain power than others. Activities that need longer periods of focus or learning can be especially challenging when recovering from COVID-19. Prioritize tasks to make sure you have the brain energy you need to do the most important tasks each day. Plan to do these  tasks when you feel best. This may be after a rest, early in the morning or on a certain day of the week. Remember to plan a brain break after doing a cognitive activity.

Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Integrated Chronic Care Services(2020).Welcome to the Integrated Chronic Care Service (ICCS). Patient & Family Guide,WX85-2060. Nova Scotia: Nova Scotia Health Authority.https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2060.pdf

NHS England(2021). Memory and concentration. Your COVID Recovery. Retrieved July 9, 2021, from https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-mind/memory-and-concentration/

Royal College of Occupational Therapists(2020). A quick guide for occupational therapists: Rehabilitation for people recovering from COVID-19. https://www.rcot.co.uk/files/guidance-quick-guide-occupational-therapists-rehabilitation-people-recovering-covid-19-2020

World Health Organization(2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Ofice for Europe. https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness

Managing stress, anxiety and worry

Try these strategies:

• Many people find they are able to manage their anxiety with stress management, relaxation techniques, exercise, and getting enough sleep. A health care provider may also recommend cognitive behavioural therapy, exposure therapy, and/or medication.
• Self-management tools are available. Try these free, online, 24/7 resources that are safe, confidential, and reliable:
  • Mental Health and Addictions Tools | Nova Scotia Mental Health and Addictions
• Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Mayo Clinic Staff.(2018). Anxiety Disorders. Mayo Clinic. Retrieved July 9, 2021 from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

Managing sadness or depression

Try these strategies:

• Talk to your primary health care provider. Your symptoms may be related to your COVID-19 diagnosis. You can also call the Mental Health and Addictions Intake Line for an assessment:
  • Phone (toll-free): 1-855-922-1122
• It may help to reach out to friends and family for support, take part in physical activity, get enough sleep, and eat well.
• Most people with depression feel better with professional help, medication, psychotherapy, or both.
• Self-management tools are available. Try these free, online, 24/7 resources that are safe, confidential, and reliable:
  • Mental Health and Addictions Tools | Nova Scotia Mental Health and Addictions
• Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Collier, S.(2021).Could COVID-19 infection be responsible for your depressed mood or anxiety? Harvard Health Publishing. Retrieved July 9, 2021, from https://www.health.harvard.edu/blog/could-covid-19-infection-be-responsible-for-your-depressed-mood-or-anxiety-2021041922391

Nasserie, T., Hittle, M.,& Goodman, S.N..(2021). Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19 A Systematic Review.JAMA Network Open, 4(5):e2111417. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780376

Ries, J. (2020, November 12). People with COVID-19 more likely to develop depression, anxiety, and dementia. Healthline.  Retrieved July 9, 2021, fromhttps://www.healthline.com/health-news/people-with-covid-19-more-likely-to-develop-depression-anxiety-and-dementia

Taquet, M., Luciano, S., Geddes, J.R., & Harrison P.J. (2020). Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62,354 COVID-19 cases in the USA. The Lancet Psychiatry, 8(2), 130-140. https://doi.org/10.1016/S2215-0366(20)30462-4

What causes depression?(2019, June 24). Harvard Health Publishing. Retrieved July 9, 2021 from https://www.health.harvard.edu/mind-and-mood/what-causes-depression

Managing withdrawal from friends and activities

Try these strategies:

• Visit Nova Scotia Health’s Mental Health and Addictions website to learn more, including online self-management tools and resources for social anxiety and depression isolation:
  • Withdrawal from Friends and Activities
• Learn more about post-COVID related anxiety and depression including causes, when to seek help, management and resources on this website:
  • Feeling Sad or Depressed  
  • Feeling Stressed, Anxious or Worried
• Use a Symptom Tracker to record how you are feeling over time.

Managing trouble sleeping

Try these strategies:

Keep a regular sleep schedule

Try to go to sleep and wake up at the same time each day, even on weekends. It can help to nap when recovering from COVID-19, but napping for too long or late in the day can affect your sleep at night. If you nap, try to do it earlier in the day. Do not nap within 4 hours before your bedtime. If napping makes it hard for you to fall asleep at night, take short naps (no more than 20 to 40 minutes) or rest instead of napping. Everyone is different, and you may have to try different sleep strategies to find what is right for you.

Changing your schedule takes time

An illness like COVID-19 can affect your body’s rhythms and routines, including sleep. There may be even more greater effects after a long illness or hospital stay. If your sleep schedule is “mixed up”, there is hope. Start slowly and be patient. Change your bedtime and wake-up time by no more than 15 to 30 minutes a day. Stay at the new time for 2 to 3 days, before shifting by another 15 to 30 minutes.

For example:

• If you are going to bed between 2 and 2:30 a.m., try falling asleep at 1:45 a.m. Go to sleep at 1:45 a.m. for 2 to 3 days, then shift to 1:30 a.m.

Consider your environment

Your environment can affect the quality of your sleep. Try the following:

• Spend time outside in natural daylight each day.
• Keep the room cool. Most people sleep better in a cool room than in a warm room.
• Limit noise and light in the room.
• Limit screen time (smartphone, tablet, TV, etc.) for 1 hour before you go to sleep.

See the Resources and supports tab for more ideas on how to get a more restful sleep.

Increase your activity during the day

When you have fatigue and are not sleeping well, you may feel tired, but not be able to sleep. Being more active throughout the day can help. Slowly add a bit more activity each day. Activities can be physical, social or mental. Remember: do not do too much.

For example:

• Talk on the phone with a friend.
• Go for a short walk.
• Complete a puzzle or play a card game.

Slow down before bedtime

To fall asleep, our bodies and brains must slow down. Make a plan to help calm your body and brain before bedtime. Start 2 hours before you plan to go to sleep. Do not eat or do intense (hard) exercise, difficult tasks or activities that cause emotional distress during this time. Calming strategies (like meditation, gentle stretching or yoga, journalling and deep breathing) can help.

Limit frustration

You cannot force yourself to sleep. If you are having trouble falling asleep, or are waking up overnight, it can be frustrating to lay in bed trying to sleep. This frustration can make it harder to sleep. If you are not able to fall asleep after 30 to 45 minutes:

• Get out of bed.
• Try doing something quiet or calming.
• Do not turn on bright lights or do activities that need a lot of effort (like exercise or brain puzzles).
• Try a calm, quiet activity (like reading, listening to music or cuddling with a pet).

Ask yourself why you cannot sleep

• Are nightmares waking you up?
• Are you waking up feeling breathless?
• Is pain making it hard to fall asleep?

Many things can affect your sleep. Understanding these can help you, your family, and your health care team find the best ways to work toward better sleep. Using medication(s) and/or supplements for a short time may help.

Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Action for M.E.(n.d.).Managing your symptoms: Sleep Management. https://www.actionforme.org.uk/get-information/managing-your-symptoms/sleep-management/

Integrated Chronic Care Services(2020). Welcome to the Integrated Chronic Care Service (ICCS).Patient & Family Guide,WX85-2060Nova Scotia: Nova Scotia Health Authority.https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2060.pdf

Mayo Clinic(2021). Sleep disorders.Clinical Guidelines - Long COVID-19 Retrieved Dec 10, 2021, from https://www.ohsu.edu/sites/default/files/2021-04/Long-COVID-19-Clinical-Guidelines-English-April-21-2021.pdf/

NHS England(2021). Sleeping well. Your COVID Recovery. Retrieved July 9, 2021, from https://www.yourcovidrecovery.nhs.uk/your-wellbeing/sleeping-well/

World Health Organization(2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Office for Europe.https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness

Managing loss of appetite

Try these strategies:

• Try eating 6 small meals throughout the day instead of 3 large meals.
• Try eating larger amounts when you are feeling well.
• Try to eat something every 2 to 3 hours, even if you do not feel hungry.
• Drink fluids between meals as much as possible. If you fill up on fluids at mealtimes, you may not be able to eat enough.
• Try to eat foods with protein (like nuts, seeds, cheese, Greek yogurt, milk, tuna, chicken or lean meats).
• Do not use foods labelled "low fat" or "low calorie".
• Consider using an oral (by mouth) nutritional supplement (like Boost^® or Ensure^®).
• Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Alberta Health Services. (2021, February). Post-COVID-19: Nutrition for Recovery and Rehabilitation (Adults). Government of Alberta. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-post-covid-19-nutrition-for-recovery-and-rehab-adults.pdf

Managing nausea and vomiting

Try these strategies:

• Eat small meals or snacks often.
• Do not let your stomach get very empty. This can make nausea worse.
• To lower the risk of vomiting, do not eat too much at once. This will help to prevent your stomach from getting too full.
• Try to drink fluids between meals.
• If the smell of food bothers you:
  • Try eating cold or room temperature foods. Warm and hot foods have a stronger smell.
  • If the smell of food cooking makes your nausea worse, try foods that do not need to be cooked (like sandwiches, smoothies, vegetables with dip, crackers and cheese, etc.).
  • Ask someone to help prepare your meals and wait somewhere else while they cook.
• Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Alberta Health Services. (2021, February). Post-COVID-19: Nutrition for Recovery and Rehabilitation (Adults). Government of Alberta. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-post-covid-19-nutrition-for-recovery-and-rehab-adults.pdf

Zhang, T., Liu, D., Tian, D., & Xia, L. (2020). The role of nausea and vomiting in COVID-19: Did we miss something? Elsevier Public Health Emergency Collection, PMCID:PMC7568482. doi: 10.1016/j.jmii.2020.10.005

Managing the loss of smell or taste

Try these strategies:

• Try new flavours, foods, and drinks. They may have a taste you enjoy.
• Try new recipes.
• Eat what tastes good, even if it is the same food every day.
• Eat small meals and snacks throughout the day.
• If your mouth is dry, it can affect how food and drinks taste. Good mouth care is important.
  • If your mouth feels dry, brush your teeth and rinse with water.
  • Do not use regular mouthwash. Only use mouthwash recommended for dry mouth.
• Drink lots of fluids, including with meals.
• If you have a bad taste in your mouth between meals, try sugar-free candy or mints, or chew sugar-free gum .
• Consider using smell training (also called olfactory training) to help regain your sense of smell. Smell training is the process of smelling four different odors, twice per day for 3 months. You can learn more about this in the following document:

If the smell of cooking food is affecting your appetite:

• Try cooking with a microwave or barbeque outside.
• Ask family or friends to help make your meals.
• Use a kitchen fan or open a window.
• Order take-out or buy pre-cooked meals.

If food has no taste:

• Sour and tart foods (like lemon, lime and vinegar) can help to stimulate (encourage) your taste buds. This may make it easier for you to taste the rest of your food.
• Eat foods with more flavour, or flavour them yourself (marinate meat, use condiments like barbeque sauce, salad dressing, ketchup, soy sauce, etc.).
• Try using herbs and spices like mint, thyme, garlic, basil, parsley, oregano, ginger, cinnamon, salt, and pepper when preparing food.
• Include foods with different colours and textures.

If food tastes metallic:

• Use glass cookware, if possible.
• Use plastic utensils (fork, spoon, knife) or chopsticks instead of metal utensils.
• Eat foods that are cold or room temperature. Heating food causes it to have a stronger flavour.
• Eat foods with mild flavours (like chicken, turkey, salmon, tuna, tofu). Try drinks with mild flavours (like dairy products and dairy-free alternatives such as soy or coconut milk).
• Do not eat red meat.
• Eat fresh or frozen food instead of canned foods.

Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Addison, A. B., Wong, B., Ahmed, T., Macchi, A., Konstantinidis, I., Huart, C., Frasnelli, J., Fjaeldstad, A. W., Ramakrishnan, V. R., Rombaux, P., Whitcroft, K. L., Holbrook, E. H., Poletti, S. C., Hsieh, J. W., Landis, B. N., Boardman, J., Welge-Lüssen, A., Maru, D., Hummel, T., & Philpott, C. M. (2021). Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction. The Journal of allergy and clinical immunology, 147(5), 1704–1719. https://doi.org/10.1016/j.jaci.2020.12.641

Alberta Health Services. (2011, June). Eating well when you have taste and smell changes. Government of Alberta. https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-eating-well-when-you-have-taste-and-smell-changes.pdf

BC Cancer. (2020). Food Ideas to Help with Taste and Smell Changes. http://www.bccancer.bc.ca/nutrition-site/Documents/Patient%20Education/Food-ideas-to-cope-with-taste-and-smell-changes.pdf

Greenhalgh, T., Sivan, M., Delaney, B., Evans, R., & Milne, R. (2022). Long covid - an update for primary care. BMJ;378:e072117 http://dx.doi.org/10.1136/bmj-2022-072117

Lechien, J., Chiesa-Estomba, C., Beckers, E., Mustin, V., Ducarme, M., Journe, F., Marchant, A., Jouffe, L., Barillari, M., Cammaroto, G., Circiu, M., Hans, S., Saussez, S. (2021). Prevalence and 6-month recovery of olfactory dysfunction: a multicentre study of 1363 COVID-19 patients. Journal of Internal Medicine. https://doi.org/10.1111/joim.13209

Speth, M.M., Singer-Cornelius, T., Oberle, M., Gengler, I., Brockmeier, S.J., & Sedaghat, A. (2020). Mood, anxiety and olfactory disfunction in COVID-19: Evidence of central nervous system involvement? The Laryngoscope, 130(11), 2520-2525. https://doi.org/10.1002/lary.28964

Yaylacı, A., Azak, E., Önal, A., Aktürk, D. R., & Karadenizli, A. (2022). Effects of classical olfactory training in patients with COVID-19-related persistent loss of smell. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 1-7. Advance Online Publication. https://doi.org/10.1007/s00405-022-07570-w

Managing diarrhea and constipation

Try these strategies:

To manage diarrhea:

• Try to drink 1-3 litres of fluids a day. Water is best.
• Do not drink juice, pop or other sweetened drinks. These can make diarrhea worse.
• Sports drinks can help to replace electrolytes. Choose low sugar versions. 
• Do not drink caffeinated drinks like coffee, tea or pop. 
• Avoid sugar alcohols (like xylitol, erythritol, sorbitol and maltitol) which can be found in sugar-free gum and candies.
• Eat foods that contain soluble fibre (like oats, barley, avocadoes, legumes, sweet potatoes, broccoli, Brussels sprouts and most fruits). Psyllium fibre is a soluble fibre that can be sprinkled on yogurt or hot cereals.

To manage constipation:

• Try to drink 2 to 3 litres of fluids a day. Water is best.
• Include high fibre foods like fruit, vegetables, whole grains and legumes (peas, beans, lentils) at meals and snacks.
• Choose whole grain breads, cereals, pasta and rice.
• Eat 1/4 cup of nuts or seeds a day, as a snack or added to a salad.
• Try adding 1-2 tbsp of ground flaxseed or wheat bran to your food. This can be mixed into yogurt, hot cereal, applesauce, pasta sauce or stews.

Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Alberta Health Services. (2021, February). Post-COVID-19: Nutrition for Recovery and Rehabilitation (Adults). Government of Alberta. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-post-covid-19-nutrition-for-recovery-and-rehab-adults.pdf

Managing headaches

Try these strategies:

• Healthy changes can help to lower and manage your symptoms. Take care of yourself:
  • Get enough sleep.
  • Eat healthy, regular meals.
  • Do not smoke.
  • Drink less alcohol.
  • Lower your caffeine.
• Slowly add exercise to your daily routine, if you are able. Gentle stretching and movement may help to lower your symptoms.
• Try a gentle movement class.
  • Nova Scotia Health offers many online classes (like Mindful Movement).
• Track your symptoms. Take note if certain situations affect how often or how bad your headaches are.
• Avoid extreme temperature changes. For example, stay inside somewhere cool on hot, humid days.
• Try over-the-counter headache medication, if needed.
• Rest and relaxation can help to calm you and manage pain. Try spending time in a peaceful, quiet space and focusing on your breathing.

Resources and supports

References

Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group. (2020). Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603–605. doi:10.1001/jama.2020.12603

Centers for Disease Control and prevention. (2021, April 8). Post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html

Marshall, M. (2020). The lasting misery of coronavirus long-haulers. Nature, 585, 339-341. https://doi.org/10.1038/d41586-020-02598-6

Mazza, M. G., Palladini, M., De Lorenzo, R. (2021). Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: Effect of inflammatory biomarkers at three-month follow-up, Brain, Behavior, and Immunity. Brain, Behavior, and Immunity, 94, 138-147. https://doi.org/10.1016/j.bbi.2021.02.021

Nova Scotia Health Authority. (2021). Care and supports for patients with post-acute/Long COVID-19. Rapid Review May 26, 2021.https://library.nshealth.ca/ld.php?content_id=35919290

Poncet-Megemont, L., Paris, P., Tronchere, A. (2020). High prevalence of headaches during COVID-19 infection: a retrospective cohort study. Headache, 60(10), 2578-2582. https://doi.org/10.1111/head.13923

Professional Practice Coordinators, IPPL, Central Zone (2021). Supporting your recovery from COVID-19. Patient & Family Guide; WC85-2219. Halifax: Nova Scotia Health Authority. https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2219.pdf

Managing chest pain, tightness or angina

Try these strategies:

• Use a Symptom Tracker to record how you are feeling over time.
• Take care of yourself:
  • Get enough sleep.
  • Eat healthy, regular meals.
  • Do not smoke.
  • Drink less alcohol.
  • Lower your caffeine.
• Talk to your primary health care provider about adding physical activity to your daily routine.
• Talk with your primary health care provider about medication(s) to help lower chest pain from inflammation.
• Talk to your primary health care provider about whether taking part in a cardiac (heart) rehabilitation (rehab) program is right for you. This might be an appropriate option for you.
• Sign up for a program to learn how to overcome daily challenges, take action and live a healthy life. Nova Scotia Health offers a variety of wellness programs including Your Way to Wellness.
  • Visit www.healthyNS.ca to see available programs and register.

Resources and supports

References

Greenhalgh, T., Knight, M., Buxton, M. & Husain, L. (2020). Management of post-acute COVID-19 in primary care. BMJ, 370. doi: https://doi.org/10.1136/bmj.m3026

Public Health Ontario. (2021, April 19)..Persistent Symptoms and Post-Acute COVID-19 in Adults – What We Know So Far.. Retrieved May 10, 2021 from https://www.publichealthontario.ca/- /media/documents/ncov/covid-wwksf/2020/07/what-we-know-covid-19-long-term-sequelae.pdf

Royal Australian College of General Practitioners. (n.d.). Caring for adult patients with post-COVID-19 conditions. https://www.racgp.org.au/clinical-resources/covid-19-resources/other-health-issues/caring-for-adult-patients-with-post-covid-19  

Managing joint or muscle pain

A slow gradual return to movement is one of the best ways to help reduce joint or muscle pain. Try these movement strategies:

When lying down:

• Change your position often. For example, lie in a different position every 30 minutes you are lying down.
• 3-5 repetitions of slow movements using your arms or legs while lying down can be a good place to start. Examples of these movements can be found in this hand-out entitled Mobility Matters - Bed Exercises Anyone Can Do.

When sitting:

• Once you are able to get out of bed, do not sit or lie in one position for long periods of time.
• Change your position often. For example, lie in a different position every 30 minutes that you are sitting or lying down. This will help prevent stiffness.
• 3-5 repetitions of slow movements with your arms or legs while sitting can be helpful. Examples of these movements can be found in this hand-out entitled Mobility Matters - Chair Exercises.
• Think about tasks that will encourage you to change position.
  • For example, get up to use the washroom, grab a drink of water from the kitchen or look out a window.
• Gentle movement and flexibility (stretching) exercises are a relaxing way to start moving your joints and muscles again. This can help you manage your pain.
• Try a gentle movement class. Nova Scotia Health offers many online classes (like Mindful Movement).
  • Visit www.healthyNS.ca to see what is available and to register.
• Some people find that heat or ice can help manage their joint or muscle pain. If you want to try this:
  • Always keep a damp cloth between your skin and the hot/cold pack.
  • Do not apply heat or ice for longer than 15 to 20 minutes at a time.
  • Be careful not to fall asleep with a heat source or an ice pack on your skin.
  • Make sure you can feel the heat (from the heating pad) or cold (from the ice pack) on your body.
  • Make sure that your skin returns to normal temperature before applying heat or cold again.
• Talk to your primary health care provider or pharmacist about taking over-the-counter pain medicine, if that is something that you are considering doing.
• Use a Symptom Tracker to record your muscle and joint pain symptoms over time.

When standing/walking:

• Think about tasks that will encourage you to change position.
  • For example, get up to use the washroom, grab a drink of water from the kitchen or look out a window.
• Gentle movement and flexibility (stretching) exercises are a relaxing way to start moving your joints and muscles again. This can help you manage your pain.
  • Try a gentle movement class. Nova Scotia Health offers many online classes. A good first class is Mindful Movement.
  • Visit www.healthyNS.ca to see what is available and to register.
  • Not ready for a class? Try the exercises found in this hand-out entitled Mobility Matters - Standing Exercises.

Other strategies can also help you with your joint and muscle pain. For example, some people find that heat or ice can help manage their joint or muscle pain. If you want to try this:

• Always keep a damp cloth between your skin and the hot/cold pack.
• Do not apply heat or ice for longer than 15 to 20 minutes at a time.
• Be careful not to fall asleep with a heat source or an ice pack on your skin.
• Make sure you can feel the heat (from the heating pad) or cold (from the ice pack) on your body.
• Make sure that your skin returns to normal temperature before applying heat or cold again.

There are medications that may also help with your pain. Talk to your primary health care provider about taking over-the-counter pain medicine if that is something that you are considering doing.

Use a Symptom Tracker to record your muscle and joint pain symptoms over time.

When your pain is unresolved or persistent:

Pain is complicated, and there are many reasons why you may have pain. If your pain does not feel like muscle pain, or if you have tried the strategies listed above and you continue to have pain, please reach out to a physiotherapist, occupational therapist or your primary health care provider for more guidance.

Resources and supports

• Out-patient physiotherapy:
  • To access private physiotherapy services you can call your local physiotherapy clinic. A list of clinics can be found by calling 211 or online at: https://www.physiotherapyns.ca/find-a-physio
  • For information on access to publicly funded outpatient physiotherapy in Nova Scotia visit www.nshealth.ca/service-details/physiotherapy

References

Neurosciences, Rehabilitation & Vision Strategic Clinical Network,& Allied Health Professional Practice and Education, Health Professions Strategy and Practice(2021, March 23rd). Symptoms: Joint and muscle pain. After COVID-19. MyHealth.Alberta.cahttps://myhealth.alberta.ca/after-covid/symptoms/joint-and-muscle-pain

NHS England (2021). Musculoskeletal, shoulder and back pain. Your COVID Recovery. https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/musculoskeletal-shoulder-and-back-pain/

Managing symptoms that get worse after physical activity

The following are some strategies that may help you manage your symptoms that get worse after physical activity. You may need to try one or all of the strategies. For more ideas, please click on the Resources and Supports tab above.

Add activity slowly over time

• Start with activities you can do while sitting.
• Once you are no longer experiencing an increase in your symptoms, it is time to move on to easier activities, like self-care (showering, dressing), making meals, light chores (like doing the dishes or folding laundry), gentle stretching and breathing exercises.
• If you are struggling with self-care activities, it may be too early to start physical activity.
• When self-care activities do not make your symptoms worse, you are ready to start adding physical activity slowly over time.
• If you are struggling with being more active, a personal exercise plan created by a physiotherapist or other qualified health care provider may help.
• Talk to your primary health care provider for more support.

Monitor your effort

• It may help to monitor how hard you are working (also called your exertion or effort level).
• The Rate of Perceived Exertion (RPE) is a scale from 0 to 10. It measures how hard you are working based on your breathing and how hard your muscles are working.
  • 0 means nothing at all, or very little effort.
  • 10 means working very, very hard.
• When you go back to physical activity, start between 1 and 3 on the RPE scale. 
• Monitor your symptoms while you exercise and after you finish exercising. Notice how you feel for 12 to 48 hours (up to 2 days) after you are active. If you are exhausted (very tired) or if any of your other symptoms get worse, you may be working too hard. Try to lower your level of effort and keep monitoring your symptoms.
• When you are able to exercise between a 1 and 3 RPE scale without increasing your symptoms, you may be ready to gradually increase your activity or the time you spend doing the activity.  
• Use a Symptom Tracker to write down how many minutes of exercise you did. Also write down the RPE and any changes in your symptoms.
• Do not push yourself to the point that you feel exhausted or have more symptoms. Pushing yourself and overdoing it can slow your recovery.
• If you have been advised to check your oxygen levels, and you have been given a pulse oximeter, use it to check your oxygen saturation (O2 sats %) before, during and after your activity. Do this for the first several weeks. Not everyone will need to do this.

Pace yourself

• Pacing means balancing activities with rest to prevent your symptoms from getting worse.
• Slowly add to your activity over time. Be careful and pace yourself. Start with low-intensity activities like walking. Start with as much time as you are able. Even a few minutes is a good start. Be patient and do not expect to be able to do as much as you did before having COVID-19.
• Listen to your body and notice how you feel for 12 to 48 hours (up to 2 days) after you are active. If you are exhausted (very tired), you may be doing too much. Rest for 1 to 2 days between activities.
• Use a Symptom Tracker to record your physical activity and symptoms over time.

Remember, everyone’s recovery is different. Be kind to yourself.

Resources and supports

References

BonES Lab. (2021).A Focus on Breath.. Retrieved Dec 10, 2021 from https://www.youtube.com/watch?v=5ux5rwDQT8U

Johns Hopkins Activity and Mobility Promotion (2021). Mobility Matters: Recovering from COVID-19. Baltimore: Johns Hopkins Medicine. https://www.hopkinsmedicine.org/physical_medicine_rehabilitation/education_training/amp/everybodymoves/covid-resources.html

Post-COVID-19 Interdisciplinary Clinical Care Network (n.d.). Managing Breathlessness in Post COVID--19 Recovery. Alberta: Alberta Health Services. https://www.saot.ca/wp-content/uploads/2021/03/if-ppih-covid-19-support-recovery-rehabilitation-after-covid-19.pdf

Professional Practice Coordinators, IPPL, Central Zone (2021). Supporting your recovery from COVID-19. Patient & Family Guide. Halifax: Nova Scotia Health Authority. https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2219.pdf

World Health Organization (2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Ofice for Europe. https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness

World Physiotherapy (2021a). Information sheet 3: Fatigue and post-exertional symptom exacerbation. London, UK: World Physiotherapy. https://world.physio/toolkit/world-pt-day-2021-information-sheets-english

World Physiotherapy (2021b). World Physiotherapy Response to COVID-19 Briefing Paper 9. Safe rehabilitation approaches for people living with Long COVID: physical activity and exercise. London, UK: World Physiotherapy. https://world.physio/sites/default/files/2021-06/Briefing-Paper-9-Long-Covid-FINAL-2021.pdf

Managing loss or grief

Try these strategies:

• It can help to talk about your loss, get support from family and friends, or join a bereavement group.
• Talk to your primary health care provider to find out if your grief is related to your symptoms after having COVID-19.
• Call the Mental Health and Addictions Intake Line for an assessment:
  • Phone (toll-free): 1-855-922-1122
• Try the free self-management tools available here:
  • Mental Health and Addictions Tools - Nova Scotia Health
• Use a Symptom Tracker to record how you are feeling over time.

Resources and supports

References

Centre for Addiction and Mental Health.(n.d.).Loss, grief, and healing. https://www.camh.ca/en/health-info/mental-health-and-covid-19/loss-grief-and-healing

Johnson, K.(2007). Grief - Complicated? Or not?.Visions Journal, 3(3), 14-15 https://www.heretohelp.bc.ca/visions/trauma-and-victimization-vol3/grief-complicated-or-not

Managing hair loss

There is no treatment for hair shedding caused by a fever, illness, or stress. It normally gets better on its own, after 6 to 9 months.

If you are not sure what is causing your hair to shed, or it is not getting better over time, talk with your primary health care provider. You can also call 811 for advice from a registered nurse.

Resources and supports

Learn more about stress and how to manage it: Feeling stressed, anxious, or worried

References

American Academy of Dermatology Association. (2022). Can COVID-19 cause hair loss?. https://www.aad.org/public/diseases/hair-loss/causes/covid-19#:~:text=Temporary%20hair%20loss%20is%20normal,loss%2C%20it's%20actually%20hair%20shedding

Government of Alberta. (2022).. Types of hair loss. https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=ug2799&lang=en-ca#ug2799-Bib

Provincial Health Services Authority. (2022).. Hair loss in post COVID-19 recovery. http://www.phsa.ca/health-info-site/Documents/post_covid-19_Hair_Loss.pdf

Sharquie, K., Jabbar, R.I.(2021). COVID-19 infection is a major cause of acute telogen effluvium. Irish Journal of Medical Science. Aug 31, 1-5.https://doi.org/10.1007/s11845-021-02754-5