RECOVERY
COVID-19 CARE INSTRUCTIONS

You have been enrolled into our COVID-19 Care Management Program
Our goal is to make sure you have all the resources and support necessary to stay healthy. You have been enrolled in this program because you have tested positive for COVID-19 or are presumed positive for COVID-19. 

Our team will be reaching out to you throughout this program in a cadence depending on your level of symptoms.
About The Program

About our COVID Care Program

We provide a nurse-driven COVID Care program for patients who have, or have been exposed to, COVID-19 by delivering support and education through the symptomatic and recovery phases of COVID-19.

Supportive services offered through COVID Care Program

  • Symptom monitoring and management
  • Family and social guidance
  • Local resources for financial and food support
  • Mental Health support
  • Referrals to specialists for additional support
  • Transmission reduction
  • Assist in rehab and recovery from COVID-19
  • And ultimately, the return to optimal health

Expected communication frequency and length of the program

This is a flexible program that is personalized to individual patient’s needs. The frequency of follow-up will be discussed with patients based on their symptoms and risk factors. This may change as the patient’s condition changes.

Caring For Someone With COVID-19

Below are guidelines you can follow  if you are caring for someone with COVID-19 in order to protect yourself and others around you.

  1. Protecting yourself when caring for someone who is sick 
    1. When possible, select a caregiver who is not at higher risk for severe illness from COVID-19. High risk individuals include those who are >65 years of age, diagnosed with chronic lung disease, moderate to severe asthma, heart conditions, or someone immunocompromised. 
    2. Use a separate bedroom and bathroom, if possible. 
    3. If you share a space make sure the room has good airflow by opening a window or turning on a fan to increase air circulation. 
    4. Avoid having unnecessary visitors. 
    5. Eat in separate rooms, if possible. 
    6. Wash all dishes and utensils used by a person who is sick  with gloves. You can wash dishes with soap and hot water or in a dishwater. Wash your hands after taking off your gloves. 
    7. Avoid sharing any dishes, cups/glasses, silverware, towels, bedding, or electronics with a person who is sick. 
  2. When to wear a cloth face cover or gloves 
    1. If you are sick you should wear a cloth face covering when you are around other people at home or when you go out 
    2. This covering can help prevent the spreading of the virus to others by keeping respiratory droplets contained. 
    3. If you are caring for someone who is sick you should wear gloves when you touch or come in contact with blood, stool, or body fluids like saliva, mucus, vomit and urine. Otherwise, gloves are not necessary for the general public. In fact, it could even serve to further spread illnesses.
    4. As a caregiver you may wear a cloth face covering when caring for a sick person but it is unknown how protective the effects are. 
    5. Remember to clean your hands often. 
  3. Clean and disinfect your home
    1. It is important to clean and disinfect “high-touch” surfaces and items every day like tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks and electronics. 
    2. You can clean the area or item with soap and water if dirty and then use a household disinfectant that is EPA-registered. 
    3. Be sure to follow the instructions when using household disinfectants to ensure it is effective. 
    4. If using a separate bedroom and bathroom, clean the area when it is soiled to help minimize your contact with the sick person. 
    5. If the person who is sick feels able, they can be given their own personal cleaning supplies to clean their bedroom and bathroom when using separate rooms. 
    6. If sharing a bathroom the person who is sick should clean and disinfect after each use. If they cannot, the caregiver should wait as long as possible before entering the bathroom and clean and disinfect before use. 
    7. When washing laundry, wear disposable gloves when handling dirty laundry
    8. You can wash dirty laundry from a person who is sick with other people’s items.
    9. Wash according to the label instructions and use the warmest water setting possible.
    10. Remove gloves and wash your hands right away. 
    11. Dry laundry on hot if possible and wash hands after putting clothes in the dryer.
    12. Clean and disinfect hampers and wash your hands after. 
  4. Trash 
    1. Make sure you are using a lined trash can. 
    2. Use gloves when removing garbage bags and handling disposing of trash and wash hands afterwards. 
    3. If possible, dedicate a lined trash can for the person who is sick.
  5. Provide support
    1. Help the person who is sick drink lots of fluids and rest. 
    2. Help them with grocery shopping, filling prescriptions and getting other needed items. If possible, consider having items delivered. 
    3. Take care of their pets and limit contact between the person who is sick and their pets when it is possible. 
  6. Warning Signs 
    1. When caring for a patient who is sick have their doctor’s phone number on hand. 
    2. Call their doctor if the person is getting worse.FOR EMERGENCY WARNING SIGNS OF COVID-19 CALL 911 RIGHT AWAY 
      1. Difficulty breathing or shortness of breath 
      2. Persistent pain or pressure in the chest 
      3. New confusion or inability to wake up 
      4. Bluish lips or face 
  7. Monitor your own health 
    1. As a caregiver you should monitor your own health for COVID-19 symptoms.
    2. If you are having trouble breathing, call 911. 
    3. More information surrounding caring for someone at home can be found at the following website:

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.htm

Covid-19 Rehab

An important factor in recovering from COVID-19 is staying active and working through catered exercises that help you maintain a strong level of fitness. Below you will find specific instructions for an exercise regimen that will continue to strengthen your muscles and expand your lung capacity. 

  1. Preface to Exercise
    1. Pulmonary rehabilitation is a program of exercises that helps you improve your shortness of breath, increase your exercise capacity, and improve quality of life. These exercises include breathing exercises to strengthen the muscles of your chest as you recover from your lung infection and muscle strengthening exercises which address the weakness and muscle loss that can occur after a lengthy hospital stay.
    2. Home-based exercise therapy can be just as effective as an in-person hospital based program. Especially if you have already consulted one of our physical medicine staff. 
    3. If you are unsure about your participation in exercise, speak with your healthcare provider first or before beginning an exercise regimen. These exercises are meant to be performed alone, so do not proceed if you do not feel well enough to exercise.
    4. If your physician suggests speaking with a physical therapist before you begin exercising, please reach out to our team of physical therapists, by calling or sending a portal message. Additionally, you may also schedule an appointment.
    5. Walking. During your recovery period, we encourage you to walk to improve your overall conditioning.
      1.  Week 1: 10 minutes, 4 times per day
      2. Week 2: 15minutes, 3 times per day
      3. Week 3: 20 minutes, 2 times per day
    6. Positioning – Spending a long time laying down or in your bed leads to deconditioning and other medical problems. We recommend sitting upright as much as you can during the day, walking around your space as tolerated,and changing positions regularly. Some patients have an easier time breathing on their stomachs with a pillow under their chest, which can open up different parts of the lungs.
    7. Monitoring – You may have a pulse oximeter or can purchase one to help monitor your oxygen levels. Check and log your heart rate and oxygen level before, during, and after exercises to monitor how your body is responding to your exercises. We recommend keeping a log or journal of what your heart rate and oxygen levels are during these exercises.  If you can talk during exercise, you are most likely not overexerting. Normal oxygen saturation is 96-100% and it should not go below 88% during exercise. Stop exercising and rest if you see a drop in your oxygen saturation below 88%.

      Please contact your MD/NP if you are concerned about your oxygen saturation level or if you feel unwell during or after exercising.
  2. Exercise Precautions
    1. BEGIN this exercise program after discharge from the clinic.
    2. STOP exercise immediately if you get chest pain, palpitations, exhaustion, dizziness/lightheadedness, shortness of breath or difficulty breathing.
    3. Keep your mask on when exercising if there are others around you.
Exercise Program Instructions
General Instructions
  1. The 8 exercises in each Phase are the same, but the amount of time you will spend exercising will increase as you progress.
  2. Perform all exercises with your Pulse Oximeter monitoring your oxygen level and heart rate. Your goal is to complete each exercise of each phase with your oxygen level never dropping below 88% – so check it often during the exercise program. Stop if it drops below 88%, and contact your MD/NP or physical therapist.
  3. Perform all exercises with a phone nearby, or when someone else is in the home, in the event that you do not respond well and develop symptoms.
  4. Recommended equipment for this exercise program below includes:
    • Pulse oximeter
    • Incentive spirometer
    • Chair
    • Stabilizing surface to support your balance, such as a table, countertop, or dresser.
  5. If you have any questions or concerns, please consult with a MD/NP or physical therapist at any point – We are here for you!

Phase 1

Complete each exercise and rest in-between each exercise.

Perform this circuit of exercises from start to finish one time , but repeat the circuit up to four times per day. As a suggestion, perform one set of exercises separated by a time period of 2-3 hours between each set, for a total of four times per day. Perform this for 7 consecutive days.

Phase 2

Complete each exercise and rest in-between each exercise.

Perform this circuit of exercises two times consecutively, up to 2 times per day. As a suggestion, perform one set of exercises in the morning and one in the afternoon, for a total of two times per day. Perform this for 3 consecutive days . On the fourth day of this week, take a rest from the exercise program

Phase 3

Complete each exercise and rest in-between each exercise, as prescribed.

Perform this circuit of exercises three times consecutively, up to 2 times per day. As a suggestion, perform one set of exercises in the morning and one in the afternoon. Perform this for 3 consecutive days .

EXERCISE
Diaphragmatic Breathing
1 Minute
Lie on your back with your head on a pillow and a pillow under the knees, or your knees may be bent. Put one hand on your chest and one hand on your belly. Breathe deeply through your nose, allowing your chest and belly to expand, and out through your mouth. Perform for 1 minute. Then, rest for 30 seconds

Incentive Spirometer Exercise
5 Minutes
Sit as tall as you can, with your shoulder blades pinched back, and your chest out. Breathe out
completely, then with an incentive spirometer, slowly breathe in to your maximum inhalation, and slowly breathe out. Perform for 1 minute. Then, rest for 30 seconds.

Sit to Stand Squats
30 sec
Start by scooting toward the front of the chair. Next, lean forward at your trunk, reach forward with your arms and rise to a standing position.
Lower your arms as you stand up.

Use your arms as a counter-balance by reaching
forward when sitting down. Repetitively stand-up and sit-down for 30 seconds at a comfortable pace. Rest in a seated position for 30 seconds.

Standing Marching
30sec
While standing, draw up your knee with control, pause with your knee in the air for 2 seconds, then set it down and then alternate to your other side. Use one arm or both arms for support, if needed for balance and safety. Continue alternating each side continually for 30 seconds. Rest in a seated position for 30 seconds.

Seated Arm Reaches
30 sec
In a seated position, begin by positioning your arms like the picture on the right, with your thumbs next to your opposite front pockets. Bring your arms up and across your body, turning your palms towards your face while slightly arching your back. End with your thumbs pointing backwards. Return your arms to the starting position and repeat. Continue this movement for 30 seconds. Rest for 30 seconds.

Standing Heel Raises
30 sec
While standing, hold onto the back of a chair or wall for safety, raise up on your toes as you lift your heels off the ground as high as you can. Pause for 2 seconds. Lower your heels to the ground with control. Continually repeat this full
motion, up and down for 30 seconds. Rest for 30 seconds.

Sidestepping
30 sec
Stand straight. Take a lateral step to one side. Follow with your other leg. Maintain your balance. Maintain proper posture and breathing. Repeat for the length of your counter or dresser, or ~5 steps to one direction. Repeat going in the other direction. Continue sidestepping back and forth for 30 seconds total. Rest for 30 seconds.

Wall Pushups
30 sec
Start with your hands on the wall and elbows and trunk straight. Slowly bend your elbows, lowering yourself towards the wall. Then slowly push away from the wall. Your hands should never be higher then the level of your shoulders. Repeat this exercise for 30 sec. Rest for 30 sec.

Returning To Work FAQ
  1. What should my employer practice prior to returning to work?
    1. Pre-Screen: Employers should measure the employee’s temperature and assess symptoms prior to them starting work. Ideally, temperature checks should happen before the individual enters the facility.
    2. Regular Monitoring: As long as the employee doesn’t have a temperature or symptoms, they should self-monitor under the supervision of their employer’s occupational health program.
    3. Wear a Mask: The employee should wear a face mask at all times while in the workplace for 14 days after last exposure. Employers can issue facemasks or can approve employees’ supplied cloth face coverings in the event of shortages.
    4. Social Distance: The employee should maintain 6 feet and practice social distancing as work duties permit in the workplace.
    5. Disinfect and Clean work spaces: Clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment routinely.
  2. Should I wear a mask or face covering when I return to work?
    1. Yes, you should wear a mask when you will be going to public spaces. Wear a cloth face covering like a bandana, scarf, or home-sewn mask if you can’t find a mask. Use a cotton or cotton-blend cloth with a minimum of 2 layers. Clean your mask or cloth face covering every day.
    2. If you are going outdoors or in your car, it is not necessary to cover your face when you are isolated from others.
    3. There is currently a lot of discussion about whether we should only be wearing a mask when experiencing signs of illness. We have recently learned that people can spread COVID-19 via exhaling or talking without having any signs of illness.
    4. Wearing a mask or face covering is a step everyone should take to stay safe from being exposed to COVID-19.
  3. Can I go out to lunch with my coworker?
    1. Employees should physically distance when they take breaks together. Stagger breaks and don’t congregate in the break room, and don’t share food or utensils.
  4. What should I do if an employee comes to work with COVID-19 symptoms (fever, cough, or shouldness of breath)?
    1. Employees who have symptoms when they arrive at work or become sick during the day should immediately be separated from other employees, customers, and visitors and sent home. Employees who develop symptoms outside of work should notify their supervisor and stay home.
    2. Sick employees should follow CDC-recommended steps. Employees should not return to work until they have met the criteria to discontinue home isolation and have consulted with a healthcare provider and state or local health department.
    3. Employers should not require sick employees to provide a COVID-19 test result or healthcare provider’s note to validate their illness, qualify for sick leave, or return to work.
  5. What should I do if an employee is suspected or confirmed to have COVID-19?
    1. In most cases, you do not need to shut down your facility. But do close off any areas used for prolonged periods of time by the sick person:
    2. Wait 24 hours before cleaning and disinfecting to minimize potential for other employees being exposed to respiratory droplets. If waiting 24 hours is not feasible, wait as long as possible.
    3. During this waiting period, open outside doors and windows to increase air circulation in these areas.
    4. Follow the CDC cleaning and disinfection recommendations:
      1. Clean dirty surfaces with soap and water before disinfecting them.
      2. To disinfect surfaces, use products that meet EPA criteria for use against SARS-Cov-2 the virus that causes COVID-19, and are appropriate for the surface.
      3. Always wear gloves and gowns appropriate for the chemicals being used when you are cleaning and disinfecting.
      4. You may need to wear additional personal protective equipment (PPE) depending on the setting and disinfectant product you are using.
      5. In addition to cleaning and disinfecting, employers should determine which employees may have been exposed to the virus and need to take additional precautions:
      6. Most workplaces should follow the Public Health Recommendations for Community-Related Exposure.
      7. Critical infrastructure workplaces should follow the guidance Implementing Safety Practices for Critical Infrastructure Workers Who May Have Had Exposure to a Person with Suspected or Confirmed COVID-19.
      8. Sick employees should follow CDC-recommended steps. Employees should not return to work until they have met the criteria to discontinue home isolation and have consulted with a healthcare provider and state or local health department.
      9. If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA).
  6. If employees have been exposed but are not showing symptoms, should I allow them to work?
    1. Employees may have been exposed if they are a “close contact” of someone who infected, which is defined as being within 6 feet of someone who has COVID-19 for a total of 15 minutes or more over a 24-hour period starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated:
      1. Potentially exposed employees who have symptoms of COVID-19 should self-isolate and follow CDC recommended steps.
      2. Potentially exposed employees who do not have symptoms should remain at home or in a comparable setting and practice social distancing for 14 days.
    2. All other employees should self-monitor for symptoms such as fever, cough, or shortness of breath. If they develop symptoms, they should notify their supervisor and stay home.
  7. What should I do if I find out several days later, after an employee worked, that they were diagnosed with COVID-19?
    1. If it has been less than 7 days since the sick employee used the facility, clean and disinfect all areas used by the sick employee following the CDC cleaning and disinfection recommendations.
    2. If it has been 7 days or more since the sick employee used the facility, additional cleaning and disinfection is not necessary. Continue routinely cleaning and disinfecting all high-touch surfaces in the facility.
    3. Other employees may have been exposed to the virus if they were in “close contact” (within approximately 6 feet or 2 meters) of the sick employee for a prolonged period of time.
      1. Those who have symptoms should self-isolate and follow CDC recommended steps.
      2. In most workplaces, those potentially exposed but with no symptoms should remain at home or in a comparable setting and practice social distancing for 14 days.
      3. Critical infrastructure workers should follow Implementing Safety Practices for Critical Infrastructure Workers Who May Have Had Exposure to a Person with Suspected or Confirmed COVID-19. A critical infrastructure worker who is symptom-free and returns to work should wear a face mask at all times while in the workplace for 14 days after last exposure. Employers can issue facemasks or can approve employees’ supplied cloth face coverings in the event of shortages.
    4. Employees not considered exposed should self-monitor for symptoms such as fever, cough, or shortness of breath. If they develop symptoms, they should notify their supervisor and stay home.
  8. When should an employee be suspected or confirmed to have COVID-19 return to work?
    1. Sick employees should follow steps to prevent the spread of COVID-19 if you are sick. Employees should not return to work until they meet the criteria to discontinue home isolation and have consulted with a healthcare provider and state or local health department.
  9. What should I do if an employee has a respiratory illness?
    1. Employees who appear to have COVID-19 symptoms, such as fever, cough, or shortness of breath, upon arrival to work or become sick during the day with COVID-19 symptoms should immediately be separated from other employees, customers, and visitors and sent home.
    2. CDC has a symptom self-checker chatbot called Clara that employers and employees may find helpful. It has a series of questions and recommends what level of medical care, if any, the user should seek. It is not intended to provide diagnosis or treatment.
Grounding Techniques

After a trauma, it’s normal to experience flashbacks, anxiety, and other uncomfortable symptoms. Grounding techniques help control these symptoms by turning attention away from thoughts, memories, or worries, and refocusing on the present moment. 

5-4-3-2-1 Technique Using the 5-4-3-2-1 technique, you will purposefully take in the details of your surroundings using each of your senses. Strive to notice small details that your mind would usually tune out, such as distant sounds, or the texture of an ordinary object.

  1. What are 5 things you can see? Look for small details such as a pattern on the ceiling, the way light reflects off a surface, or an object you never noticed. 
  2. What are 4 things you can feel? Notice the sensation of clothing on your body, the sun on your skin, or the feeling of the chair you are sitting in. Pick up an object and examine its weight, texture, and other physical qualities. 
  3. What are 3 things you can hear? Pay special attention to the sounds your mind has tuned out, such as a ticking clock, distant traffic, or trees blowing in the wind. 
  4. What are 2 things you can smell? Try to notice smells in the air around you, like an air freshener or freshly mowed grass. You may also look around for something that has a scent, such as a flower or an unlit candle. 
  5. What is 1 thing you can taste? Carry gum, candy, or small snacks for this step. Pop one in your mouth and focus your attention closely on the flavors. 

Categories:

Choose at least three of the categories below and name as many items as you can in each one.  Spend a few minutes on each category to come up with as many items as possible. 

MoviesCerealsCarsCities
CountriesSports TeamsFruits & VegetableTV Shows
BooksColorsAnimalsFamous People
For a variation on this activity, try naming items in a category alphabetically. For example, for the fruits & vegetable category, say “apple, banana, carrot,” and so on.

Body Awareness

The body awareness technique will bring you into the here-and now by directing the focus to sensations in the body. Pay special attention to the physical sensations created by each step.

  1. Take 5 long, deep breaths through your nose, and exhale through puckered lips. 
  2. Place both feet flat on the floor. Wiggle your toes.  Curl and uncurl your toes several times. Spend a moment noticing the sensations in your feet. 
  3. Stomp your feet on the ground several times.  Pay attention to the sensations in your feet and legs as you make contact with the ground. 
  4. Clench your hands into fists, then release the tension.  Repeat this 10 times. 
  5. Press your palms together.  Press them harder and hold this pose for 15 seconds.  Pay attention to the feelings of tension in your hands and arms. 
  6. Rub your palms together briskly. Notice the sound and the feeling of warmth. 
  7. Reach your hands over your head like you’re trying to reach the sky.  Stretch like this for 5 seconds. Bring your arms down and let them relax at your sides. 
  8. Take 5 more deep breaths and notice the feeling of calm in your body. 

Mental Exercises

Use mental exercises to take your mind off uncomfortable thoughts and feelings. They are discreet and easy to use at nearly any time or place.  Experiment to see which works best for you. 

  1. Name all the objects you see. 
  2. Describe the steps in performing an activity you know how to do well.  For example how to shoot a basketball, prepare a favorite meal, or tie a knot. 
  3. Count backwards from 100 by 7.
  4. Pick up an object and describe it in detail.  Describe its color, texture, size, weight, scent, and any other qualities you notice. 
  5. Spell your full name, and the names of three other people, backwards. 
  6. Name all your family members, their ages, and one of their favorite activities.
  7. Read something backwards, letter-by-letter. Practice for at least a few minutes. 
  8. Think of an object and “draw” it in your mind, or in the air with your finger. Try drawing your home, a vehicle, or an animal. 

© 2018 Therapist Aid LLC Provided by TherapistAid.com

Smoking Cessation
  1. COVID-19 is a virus that weakens the respiratory system and if not managed properly can lead to further respiratory complications. Smoking places a patient at higher risk of respiratory complications when testing positive for COVID-19. It is imperative that you reduce your smoking or quit all together to reduce your risk. Below you will find coping strategies to help you adjust. 
  2. Manage Your Stress:
    1. Breath deeply 10 times
    2. Take a walk or exercise
    3. Engage in a pleasurable activity
    4. Listen to soothing music
    5. Use a relaxation app
    6. Use prescribed medications
  3. Focus Your Thinking On
    1. Your personal reasons for quitting
    2. Your health & benefits of quitting
    3. Negatives of resuming smoking
    4. The fact that smoking now will only have quitting later more difficult
    5. Urges will pass if resisted
    6. How your life will be different as a nonsmoker
    7. Someone that you love that makes quitting worthwhile
    8. Wanting versus needing to smoke
    9. Money saved by quitting (about $2,000/year for a pack-a-day smoker)
  4. Things to Do
    1. Do an activity to distract yourself
    2. Talk to someone and get support
    3. Get away from smoking triggers
    4. Drink water
    5. Chew sugarless cinnamon gum
    6. Squeeze a stress ball
  5. Control Your Environment
    1. Get rid of cigarettes from your home
    2. Remind everyone that you quit
    3. Avoid places where others smoke
    4. Get rid of all smoking paraphernalia
    5. Change your routines

For more COVID-19 information, please visit covid19.partners.crossoverhealth.com