What To Do If You Get COVID Again

Melissa Seifried   MScPT
Registered Physiotherapist
Director of Long COVID Rehabilitation
updated Mar 1, 2024

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In our Long COVID Rehabilitation program, the patients we work with may have only been infected with the SARS-COV-2 virus once. Some are perhaps infected twice or more. A small group of patients have developed Long COVID symptoms after vaccination without confirmed SARS-COV-2 infection.

As the world tries to move on from this pandemic, this much is abundantly clear: it is not over for many people still living with persistent symptoms. We now know that the risk of developing Long COVID increases with the number of repeat infections.(1)

Our healthcare professionals are often asked by patients who are rehabilitating from Long COVID how to prevent reinfection and what to do if they contract COVID-19 again. The first line of defence is to continue to practice good hygiene strategies including hand washing, masking in public places and avoid interacting with individuals who are symptomatic. But if you do find yourself testing positive again, here are some practical tips to manage the acute phase:

 

Reducing The Spread

Stay home: Home-based recovery is suitable when people test positive for COVID-19 and are asymptomatic or have only mild symptoms and they are not in a high-risk category (for example, older people or people with underlying conditions, such as cardiovascular or chronic lung diseases)(2)

Reduce the risk of spread within your household: wearing respirator masks (N95 or KN95), practicing good hand hygiene, sleeping in a separate room, limiting contact with family members and opening the windows where appropriate to increase air circulation are all recommended strategies to avoid contracting or passing along the virus within your household.(3)

 

Managing Symptoms

Rest

You should be taking time off work in the acute phase. If your symptoms are mild, you may consider working reduced hours part time. Please note that if you do work remotely, the cognitive load of your work could drain your energy and impact recovery. It is important to sleep if your body is asking for it. Resting in a comfortable position and reducing sensory inputs (including screens when able) will ensure your nervous system is not overwhelmed in this acute phase.

You can practice some breathing exercises if you are experiencing shortness of breath or tachycardia (racing heart). https://www.youtube.com/watch?v=5ux5rwDQT8U. Coherent breathing can be used if you are experiencing a sensation of “fight or flight” or increased anxiety and is characterized by even inhales and exhales through the nose into the belly.(4)

Manage Fever

In the case of a high fever or a fever that causes discomfort, your doctor or Nurse Practitioner may recommend nonprescription medication, such as acetaminophen (Tylenol, etc) or Ibuprofen (Advil, Motrin IB, etc). Use these medications according to the label instructions or as recommended by your healthcare provider.

Stay Hydrated

Drinking water and clear liquid beverages are important, even if you do not feel thirsty. When you are dehydrated, your respiratory secretions thicken and are hard to secrete from your lungs. Signs of dehydration include increased thirst, fever, dark coloured urine, reduced urine output, dry mouth, increased resting heart rate, tiredness and confusion. Drink 2-4oz every 15 minutes you are awake, and a larger amount of water after you awake from sleep. Some other tips to stay hydrated include:

• Use a variety of liquids to avoid taste fatigue
• Keep liquids within arms reach
• If you are vomiting or have diarrhea, ensure you are taking an oral rehydration solution like gatorade or pedialyte.(5)

Eat a High Calorie/High Protein Diet

Although you may not have an appetite or food may not taste good, it is critical to keep eating. Your body needs caloric intake to maintain its metabolic functions and body weight. You can use this calculator to calculate your caloric needs to maintain your current weight:https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/calorie-calculator/itt-20402304.

You should consider increasing your caloric input during the period of acute infection.
If the taste and smell of food is interfering with your intake, consider cold or room temperature food, eating with plastic utensils if food tastes metallic, choosing less sweet foods or adding flavouring like salt and pepper to plain foods.(5)

Antivirals

You can speak with your doctor regarding the use of antivirals like Paxlovid in the acute phase. A recent JAMA analysis of case studies (published in Dec 2023) found that Paxlovid did not diminish effects of Long COVID in certain monitored subjects, nor did it decrease the intensity of Long COVID in subjects vaccinated before or after infection.(7) However, taking Paxlovid within 5 days of acute onset of Sars-COV-2 infection has been shown to reduce the severity of symptoms and duration of the acute phase.(8) Common side effects of Paxlovid are generally mild and can include dysgeusia (altered taste), diarrhea, hypertension, myalgia, vomiting and headache.(9)

If you decide to pursue a course of Paxlovid, please speak with your primary case physician or Pharmacist to ensure you meet the eligibility requirements and it is not contraindicated with any other medications you are currently taking. The primary avenue to obtain it would be your family doctor, then a Pharmacist.

The CanTreatCOVID study is based at MAP Centre for Urban Health Solutions at St. Michael’s Hospital and supported by the Canadian Institutes of Health Research, Health Canada and Public Health Agency of Canada. Registering for this study can give you quick access to a Paxlovid prescription as well: https://cantreatcovid.org/.

Other Medications

Metformin has been identified as a potential therapeutic agent in the treatment of acute Sars-COV-2 infection because of its possible action against the proteins that are involved in translation, its antiviral activity in vitro, and its anti-inflammatory and antithrombotic activities.(12) Data from some recent studies have suggested that patients who were receiving Metformin as treatment for diabetes at the time of their COVID-19 diagnosis had a lower risk of hospitalization and developing Long COVID.(11) Please speak with your primary care physician for more information.

 

Recognizing When to Call 911

You should call 911 or an emergency care facility if you experience any severe symptoms, including:

• Difficulty breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake up or stay awake
• Bluish lips or face6

 

Resuming Activity and Exercise

If you were exercising before contracting COVID-19 again, you should ensure you are monitoring your biometric data to ensure you are safe to resume. Here are some guidelines:

1)  Your daily lowest resting heart rate (RHR) is back in your normal range consistently
2)  Your fatigue levels have returned to baseline levels
3)  Your heart rate behaves normally on exertion – i.e. increases appropriately and decelerates appropriately upon cessation of activity. A good test of this is the 2-minute recovery test described here: https://my.clevelandclinic.org/health/articles/23490-heart-rate-recovery

It is best to speak with your Physiotherapist before resuming exercise, especially exercise in anaerobic zones. They can help you scale back and build up your tolerance incrementally following reinfection to ensure a safe and smooth recovery.

 

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10454552/
2. https://www.who.int/westernpacific/news-room/feature-stories/item/eight-steps-to-help-with-safe-home-based-recovery-for-covid-19
3. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/how-to-care-for-person-with-covid-19-at-home-advice-for-caregivers.html
4. https://www.choosingtherapy.com/coherent-breathing/
5. https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/COVID19/COVID19%20Patient%20Nutrition%20Paper.pdf
6. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/diagnosed-with-covid-19-what-to-expect
7. https://jamanetwork.com/journals/jama/article-abstract/2813149
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9880690/
9. https://covid19-sciencetable.ca/wp-content/uploads/2022/06/NirmatrelvirRitonavir-Paxlovid-What-Prescribers-and-Pharmacists-Need-to-Know-with-Appendix_20220606.pdf
10. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00299-2/fulltext
11. https://www.frontiersin.org/articles/10.3389/fmed.2021.704666/full
12. https://www.covid19treatmentguidelines.nih.gov/therapies/miscellaneous-drugs/metformin/