Rehabilitation from COVID-19

An Integrated Traditional Chinese and Western Medicine Protocol

Wenguang Xia, Xiaolin Huang, Chanjuan Zheng

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000377224
• Edition: 1
• Topic: Medicina
• Subtopic: Medicina alternativa y complementaria

The COVID-19 pandemic is unlike anything the world has ever seen before. Its reach is wide, and its effects have been debilitating. Understanding this particular strain of the coronavirus and knowing the best ways to recover are more important than ever.

Rehabilitation from COVID-19: An Integrated Traditional Chinese and Western Medicine Protocol contains basic knowledge about COVID-19, including its etiology, pathogenesis, and treatment both in traditional Chinese medicine and Western medicine. It also includes relative assessment and rehabilitation targeting residual dysfunctions due to COVID-19, such as pulmonary dysfunction, mental disorders, and malnutrition, among others.

Key Features

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• Presents a new concept of CRN (COVID-19 Rehabilitation Unit) that will protect patients and medical workers

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• Emphasizes special management of rehabilitation procedures under COVID-19 conditions

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• Includes home-based rehabilitation tactics

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• Provides assessment scales to help patients self-evaluate

Based on clinical experience from experts, this text has been compiled by those on the frontline against COVID-19 in Wuhan. Rehabilitation from COVID-19 is an informative collection that will be helpful to patients and medical workers alike.

Chapter 1

Clinical Basis of COVID-19

COVID-19 is an acute infectious disease caused by the novel coronavirus. It is mainly transmitted by respiratory droplets and can also be transmitted by contact. The clinical symptoms are mainly fever, dry cough, fatigue, and gradual dyspnea. Severe cases may develop into acute respiratory distress syndrome. The World Health Organization (WHO) has officially named the disease COVID-19. This disease is a new infectious and highly contagious disease.

1.1 Etiology

2019-nCoV is an RNA virus that is widely found in humans and animals. It belongs to the coronavirus family of the nest virus order and belongs to the β genus of coronavirus. The coronavirus genus has an envelope. The particles are round, oval, or pleomorphic, with a diameter of 60 nm–140 nm. Its genetic characteristics are obviously different from those of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Current research has shown that it is most similar to the bat SARS-like coronavirus (bat-SL-CoVZC45) of the Chinese chrysanthemum bat, with nucleotide homology reaching more than 85%. It shares approximately 78% and 50% homology to SARS virus and MERS virus, respectively, which once brought grave disasters to China.

How does the 2019-nCoV work? The spike protein (S protein) on the surface of the virus enters the host cell by interacting with specific receptors on the cell surface. Then it enters the cell through membrane fusion and releases its genome into the cytoplasm. The virus mainly binds to angiotensin-converting enzyme 2 (ACE2) via the S protein on its surface. During fusion, the S protein undergoes structural rearrangement to fuse the viral membrane with the host cell membrane, thereby infecting human respiratory epithelial cells. It has a higher affinity than SARS-CoV and, therefore, is more infectious.

When isolated and cultured in vitro, 2019-nCoV can be found in human respiratory epithelial cells in about 96 hours, while it takes about 6 days to isolate and culture in Vero E6 and Huh-7 cell lines.

The physicochemical properties of COVID-19 are mainly understood from studies on SARS-CoV and MERS-CoV. The virus is sensitive to ultraviolet rays and heat and can be effectively inactivated by 56°C for 30 minutes, ethyl ether, 75% ethanol, chlorine-containing disinfectant, peracetic acid, chloroform, and other lipid solvents; however, chlorhexidine cannot kill the virus effectively.

1.2 Epidemiology

1.2.1 Source of Infection

It is currently believed that the source of infection is mainly COVID-19 patients, with an incubation period of 1–14 days, mostly 3–7 days. There are very few cases with an incubation period of more than 14 days, but the longest can even reach 24 days. Infected yet asymptomatic patients and patients who do not show obvious clinical symptoms due to weak immune system stress response or their own physical characteristics do carry the virus and can infect others. Because there are no clinical symptoms, asymptomatic infected persons are not easily detected, and even the patients themselves are not aware of the infection, which is difficult to control and get them isolated in time, thus it could easily cause large-scale transmission.

1.2.2 Route of Transmission

Transmission through respiratory droplets and close contact are the main route of transmission. There is a possibility of aerosol transmission in a relatively closed environment when exposed to high concentrations of aerosols for a long period of time. Because 2019-nCoV can be isolated in feces and urine, attention should be paid to the aerosol or contact transmission caused by feces and urine pollution to the environment. The possibilities of other routes of transmission require further research.

1.2.2.1 Respiratory Droplet Transmission

Respiratory droplet transmission is the main mode of the transmission of 2019-nCoV. The virus is spread through droplets produced when patients cough, sneeze, and talk, and those who are susceptible will be infected after inhalation.

1.2.2.2 Close Contact Transmission

2019-nCoV can also be transmitted through indirect contact with infected patients. Indirect contact transmission means that people come into contact with the droplets containing the virus through touching the surface of objects, and then touch their mouth, nose, eyes, and other mucous membranes, resulting in infection.

1.2.2.3 Fecal–Oral Transmission

Fecal–oral transmission occurs when bacteria or viruses found in the stool enter the human respiratory tract and digestive tract and thus infect people. Whether there is a fecal–oral transmission route for 2019-nCoV is to be determined. It is also believed that the virus in feces may be transmitted by aerosol formed by droplets containing the virus, which also requires further investigation.

1.2.2.4 Aerosol Transmission

Aerosol transmission refers to when the respiratory droplets lose water in the air, and the leftover proteins and pathogens form nuclei or dust that float far away in the form of aerosols, causing long-distance transmissions, and the range of transmission can vary from tens of meters to hundreds of meters.

1.2.2.5 Mother-to-Child Transmission

At present, a case has been reported in which the mother was a confirmed COVID-19 patient, and the throat swab for viral nucleic acid detection showed positive for the 30-hour-old infant, suggesting that 2019-nCoV may cause neonatal infection through mother-to-child transmission, and there is vertical mother-to-child transmission; however, preliminary evidence suggests that infection in the third trimester of pregnancy does not cause vertical transmission.

Other studies suggest that the urinary system might also be a potential route for COVID-19 infection. It has been proven through scientific experiments that the virus will not spread through skin penetration.

1.2.3 Susceptible Groups

As it is a new infectious disease, the mass population generally has no resistance. In terms of age, the ability to resist the virus is no different for people of all age groups, and everyone is susceptible under suitable conditions. The probability of infection increases among the elderly and people with underlying diseases. Children and pregnant and lying-in women are vulnerable to 2019-nCoV infection.

1.2.4 Mortality Rate

On the whole, COVID-19 spreads faster than SARS, with high risk and low mortality rate, but its mortality rate of severe patients is higher than that of SARS and MERS.

1.3 Pathogenesis

COVID-19 is a systemic multiorgan injury disease, with the lung as the main target organ. Its pathophysiological mechanisms involve inflammation, fever, hypoxia, water, electrolytes, acid–base balance disorder, shock, and other basic pathological processes. Excessive activation of immune cells, excessive oxidative stress caused by cytokine storm, and hypoxemia may be the common pathophysiological basis for COVID-19 to cause acute respiratory distress syndrome (ARDS), septic shock, and multiple organ failure leading to death.

1.3.1 Excessive Inflammatory Response and Cytokine Storm

ACE2 is the binding receptor of 2019-nCoV, and the specific mutation of base T at the 501st site of the genome of 2019-nCoV enhances its ability to bind to human ACE2. ACE2 is widely expressed in various tissues of the human body, and it is most abundant in alveolar epithelium, small intestinal epithelium, and vascular endothelial cells. However, most COVID-19 patients are characterized by pulmonary manifestations with a few having diarrhea, suggesting that the lungs are the main target organ of 2019-nCoV.

After entering the cell, the virus can induce the release of cytokines, such as monocyte chemoattractant protein 1 (MCP-1), granulocyte-macrophage colony-stimulating factor (GM-CSF), and macrophage colony-stimulating factor (M-CSF), which can be activated by binding to the corresponding receptors on the macrophage surface. Activated macrophages can recruit a large number of mononuclear phagocytes on the one hand, and initiate a specific immune response on the other hand, and at the same time produce and relea...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Contents
• Foreword
• Preface
• About the Editors
• Editorial Board of COVID-19 Rehabilitation Diagnosis and Treatment Guidance of Integrated Traditional Chinese and Western Medicine
• 1 Clinical Basis of COVID-19
• 2 Diagnosis and Treatment of COVID-19
• 3 Dysfunctions of COVID-19
• 4 Assessment for Rehabilitation of COVID-19
• 5 Modern Rehabilitation Techniques for COVID-19
• 6 Traditional Chinese Medicine Rehabilitation Treatment Techniques for COVID-19
• 7 Diagnosis and Treatment Model of the COVID-19 Rehabilitation Unit
• 8 Management of COVID-19 Rehabilitation Nursing
• 9 Clinical Rehabilitation of COVID-19
• 10 Psychological Rehabilitation of COVID-19
• 11 Assessment and Treatment for Malnutrition of COVID-19 Patients
• 12 Community- and Home-Based Rehabilitation of COVID-19
• Appendices: Related Rating Scales
• Index