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What is Long COVID?                                           

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Where do I find help?

Long COVID

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There are currently no recognized causal therapies for Long COVID. The available therapies are based on experience with other diseases and are symptom oriented. The focus is on alleviating the symptoms. Discuss the treatment options with your family doctor and work out an individual treatment plan together. Furthermore, you should check whether your health insurance company also offers a counselling service or accompaniment for Long COVID sufferers: While you as a CSS-insured person benefit from personal support by the <a href="https://www.css.ch/en/private-customers/my-health/advice/health-coach.html" target="_blank" rel="noopener">health coaches</a>, <a href="https://www.sanitas.com/en/magazine/living-together-today/long-covid-symptoms-and-treatment.html" target="_blank" rel="noopener">Sanitas</a> and <a href="https://www.helsana.ch/en/blog/body/illnesses/long-covid.html" target="_blank" rel="noopener">Helsana</a> offer informative articles on the topic of Long COVID.
The Directory contains both <a href="https://altea-network.com/en/blog/complementary-medicine" target="_blank" rel="noopener">conventional and complementary medical offers</a>. In general: Altea does not guarantee the quality and success of the treatments and therapies.
Providers must meet the following requirements to be included in the Directory:
<ul>
<li>In the case of medical services, there must be a specific offer for Long COVID within the framework of compulsory health insurance (KVG).</li>
<li>In the case of complementary medical therapies,&nbsp;<a href="https://www.emr.ch/fr/label_de_qualite" target="_blank" rel="noopener">EMR recognition</a>&nbsp;or&nbsp;<a href="https://www.asca.ch/?lang=fr" target="_blank" rel="noopener" data-anchor="?lang=fr">ASCA recognition</a>&nbsp;of the therapist and the therapy offered is mandatory.</li>
</ul>
The offers can be filtered by Canton, location and symptom and searched for keywords.

Register your offer!

Become part of the register

The Directory provides an overview of treatments and therapies. However, the first point of contact is always the family doctor's office.

Long COVID: clinics, therapies, rehabilitation

Returning to work
Accompanying COVID patients in the workplace is a challenge even for experienced employers since recovery varies and there is still little experience in dealing with the topic. The measures that can be used to support the return to work are correspondingly diverse and individual. However, it has been shown that practicing a profession is usually successful if certain factors are considered.
In collaboration with the REHA Bellikon &ndash;&nbsp;<a href="https://www.rehabellikon.ch/centre-of-expertise-for-occupational-integration/" target="_blank" rel="noopener">Centre of expertise for occupational integration</a>,&nbsp;<a href="https://long-covid-info.ch/" target="_blank" rel="noopener">Long COVID Schweiz</a>&nbsp;and&nbsp;<a href="https://www.sulserpartner.ch/" target="_blank" rel="noopener">Sulser &amp; Partner AG</a>&nbsp;(case management and professional reintegration) we have developed some tips to support employers.

Three general tips for supporting employees with Long COVID:
<ol>
<li>Less is more: Plan the return to work together with the affected person. Design individual and flexible working models. Distribute more demanding tasks over different days.</li>
<li>Maintain relationships: Structure conversations clearly and create a benevolent, appreciative atmosphere.</li>
<li>Relieve yourself with professional help:&nbsp;Due to the complex health conditions of those affected and the necessary coordination with social insurance, it is worth delegating support to professional coaching or case management.</li>
</ol>
&nbsp;
Here you find three PDFs with detailed information and tips on this topic:
<ul>
<li><a title="Altea VM Work Employers Tips RKB Kbe EN v2" href="https://adm.altea-network.com/assets/7b27b7c6-34d9-4eff-b4a7-60856ec73d03?download" target="_blank" rel="noopener">Three tips to support employees with Long COVID</a> (REHA Bellikon)</li>
<li><a title="Altea VM Work Employers Part1 V1" href="https://adm.altea-network.com/assets/c94b2f01-572f-4829-996d-bec8ad1404fa?download" target="_blank" rel="noopener">Back to work &ndash; Part 1</a>: Understanding employees suffering from Long COVID (Long Covid Schweiz and Sulser &amp; Partner AG)</li>
<li><a title="Altea VM Work Employers Part2 V1" href="https://adm.altea-network.com/assets/a59bf8b0-5078-4acc-8f08-85c38debdc9b?download" target="_blank" rel="noopener">Back to work &ndash; Part 2</a>: Practical advice for employers when employees with Long COVID return to work (Long Covid Schweiz and Sulser &amp; Partner AG)</li>
</ul>

Tips for employers

Returning to work
Every COVID infection is different and dealing with the disease is very individual. Therefore, the way back to work is very different depending on the symptoms and performance and depending on the job. Progress in performance is not always visible. However, you can make your return to work early and successful, especially if you allow yourself enough time and get helpful support.
Please read the&nbsp;<a title="Altea VM Work Patients RKB Kbe EN v2" href="https://www.altea-network.com/media/5x1cgeop/altea_vm_work_patients_rkb_kbe_en_v2.pdf">tips for LC affected people</a>, by REHA Bellikon,&nbsp;<a href="https://www.rehabellikon.ch/centre-of-expertise-for-occupational-integration/">Centre of expertise for occupational integration</a>.

Three general tips for those affected:
<ol>
<li>Don't go beyond your limits: If you put too much strain on yourself or too soon, so-called "<a href="http://altea-network.com/en/vademecum/fatigue/#pem-post-exertional-malaise" target="_blank" rel="noopener">crashes</a>" occur that require long recovery times and prevent the stabilization of initial successes. Therefore, work closely together with specialists from therapy and integration or from your company to gradually build up your ability to work.</li>
<li>Take breaks: Listen to your body and take breaks outside of normal hours if you need them.</li>
<li>Let yourself be accompanied professionally: Let yourself be accompanied on your way back to work by a professional job coach or case manager, who will be made available to you by the health insurance company or the IV.</li>
</ol>

Tips for affected people

Going back to work can be very different depending on the symptoms and occupation and can be a challenge for both employees and employers.

Work

Work | Altea Network

Tips favorising a smooth&nbsp;return to work

Shortness of breath, dry cough, irritable cough
The active breathing cycle helps with&nbsp;dry cough and irritable cough. This exercise is also used for&nbsp;breath awareness&nbsp;and&nbsp;breath training. The active breathing cycle improves your lung ventilation and gently loosens the produced secretion so that you can cough it up. In addition, this exercise can reduce energy-sapping coughing attacks.
Repeat the three-step active breathing cycle&nbsp;several times a day for about 10 minutes. Suitable positions for this exercise are sitting and the side or prone position. The supine position is&nbsp;not&nbsp;suitable, as the lower lung areas are poorly ventilated in this position.
The active breathing cycle takes place in three phases:
<ul>
<li>Phase&nbsp;1: breathing control, perceive breathing</li>
<li>Phase 2: deep breathing</li>
<li>Phase 3: Huffing (or forced expiratory technique)</li>
</ul>
Please read the&nbsp;detailed information about the active breathing cycle&nbsp;(in German, EN version follows shortly).
You can find more information in a&nbsp;<a href="https://www.youtube.com/watch?v=qpzJmjtir08" target="_blank" rel="noopener" data-anchor="?v=qpzJmjtir08">video</a>&nbsp;that shows the active breathing cycle and in a&nbsp;<a href="https://www.youtube.com/watch?v=0Mer-1UeCOA" target="_blank" rel="noopener" data-anchor="?v=0Mer-1UeCOA">video</a>&nbsp;explaining "huffing" (in Dutch).
In a short video, the physio team of the B&uuml;rgerspital Solothurn shows and explains the&nbsp;<a href="https://www.youtube.com/watch?v=NVNhNvT-Bio" target="_blank" rel="noopener" data-anchor="?v=NVNhNvT-Bio">breathing exercise for breath awareness and breath deepening</a>. For more languages (incl. Spanish, Turkish, Serbian, Arabic, etc. click on&nbsp;<a href="https://www.solothurnerspitaeler.ch/uebungen-physiotherapie/" target="_blank" rel="noopener">"Atemtherapie (inkl. bei Covid-19)" and then scroll down until&nbsp; "Teil 3: Aktiver Zyklus Atemtechnik (ACBT)")</a>.

Active breathing cycle

Air hunger, fast breathing, exhaustion
Body positions that facilitate breathing help when you&nbsp;breathe faster than usual&nbsp;or if you&nbsp;feel hungry for air, but also if you find it&nbsp;difficult to breathe in deeply&nbsp;or if you&nbsp;feel exhausted.
In all postures that make breathing easier,&nbsp;leaning on the arms&nbsp;calms and lightens&nbsp;the breath. This happens for two reasons: first, the support reduces the weight of the shoulder girdle and, second, the auxiliary respiratory muscles can better help with inhalation.
The simultaneous implementation of the <a href="/en/vademecum/breathing/#pursed-lip-breathing" target="_self" data-anchor="#pursed-lip-breathing">pursed lip breathing</a> technique also supports the calming of the breath.
The following applies to all body positions that facilitate breathing:&nbsp;inhale slowly and deeply through your nose and slowly exhale using the pursed lips. Remain in the posture that relieves breathing until your breathing calms down.

The exercises can be done while sitting or standing.&nbsp;
Sitting:&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="26" aria-setsize="-1" data-aria-posinset="1" data-aria-level="1">Coach seat&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1">Sitting at the table&nbsp;</li>
</ul>
Standing:&nbsp;&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="27" aria-setsize="-1" data-aria-posinset="1" data-aria-level="1">Goalkeeper position&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="27" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1">Support against the wall&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="27" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Support on a railing or piece of furniture&nbsp;</li>
</ul>
&nbsp;
In the PDF you will find&nbsp;illustrated instructions for the individual exercices. (in German, the EN translation follows shortly) 
In a&nbsp;<a title="Positions to ease breathing video" href="https://www.youtube.com/watch?v=CGJYKzd7fUI" target="_blank" rel="noopener" data-anchor="?v=CGJYKzd7fUI">short video</a>,&nbsp;the&nbsp;physiotherapy team at the Solothurn Citizens Hospital&nbsp;<a class="Hyperlink SCXW174738013 BCX0" href="https://www.solothurnerspitaeler.ch/uebungen-physiotherapie/" target="_blank" rel="noopener">shows and explains the various exercises</a>&nbsp;to make breathing easier&nbsp;(page in German, videos in various languages).&nbsp;

Body positions to ease breathing

Shortness of breath, inner restlessness, stress
Targeted breathing exercises can help with&nbsp;inner restlessness&nbsp;or in&nbsp;stressful situations. They ensure better ventilation of the lungs and give you inner peace and well-being.
For breathing training, choose a&nbsp;well-ventilated room&nbsp;or, even better, go&nbsp;outside. Whenever possible, inhale slowly <a href="/en/vademecum/breathing/#exercise-to-unclog-the-nose" target="_self" data-anchor="#exercise-to-unclog-the-nose">through your nose</a> and let the breath flow out through your nose in a relaxed and automatic manner (or via <a href="/en/vademecum/breathing/#pursed-lip-breathing" target="_self">pursed lip breathing)</a>.
Please&nbsp;do not practice on a full stomach.
Initially, perform the exercises at rest&nbsp;for two weeks at least once a day. After this first training phase, you can integrate the breathing exercises into everyday life and use them at any time in stressful situations.
The 3 breathing exercises at a glance:
<ul>
<li>The&nbsp;three-stage breathing&nbsp;- creates a reservoir of fresh life energy in the body.</li>
<li>Opening the chest&nbsp;- gives you rest and relaxation.</li>
<li>The&nbsp;change of breath&nbsp;- is good for the lungs and circulation, and is also suitable for inflammation of the airways, coughing, accumulation of mucus and oppression in the chest area.</li>
</ul>
Here you can find a PDF with <a title="Altea VM Breathing Breatingexercise V2.0" href="https://adm.altea-network.com/assets/8fd834e5-df77-4124-b454-2c1761d874e8?download" target="_blank" rel="noopener">instructions and illustrations for the breathing training</a>.

Breathing training

Shortness of breath, air hunger, fast breathing
Pursed lip breathing helps when it is&nbsp;difficult to&nbsp;breathe&nbsp;in&nbsp;deeply, as well as in case of&nbsp;shortness of breath, air hunger,&nbsp;or when&nbsp;breathing is faster than usual.
Pursed lip breathing brings relief in many ways: it calms the breathing and keeps the bronchi open longer, which improves exhalation.&nbsp;Breathing becomes slower, calm, and relaxed&nbsp;and deeply breathing in becomes easier. Air hunger is satisfied, and anxiety can be brought under control.
Performed regularly, the pursed&nbsp;lip breathing&nbsp;technique can have a preventive effect and reduce shortness of breath episodes.
&nbsp;
This is how it works:
<ul>
<li>Breathe in calmly, if possible, through your&nbsp;nose.</li>
<li>Pucker up your lips as if you were carefully blowing out a candle.</li>
<li>Let the air flow out evenly through the small gap between the loosely stacked lips. Make sure you&nbsp;breathe out at least two times longer than you breathe in.</li>
<li>Do not force&nbsp;your lungs to empty completely.</li>
<li>Repeat the technique as often as it feels good for you.</li>
</ul>
<span data-ccp-charstyle="jlqj4b" data-ccp-charstyle-defn="{&quot;ObjectId&quot;:&quot;bb3bba04-9fce-4676-b159-12b532d20b15|168&quot;,&quot;ClassId&quot;:1073872969,&quot;Properties&quot;:[134233614,&quot;true&quot;,201340122,&quot;1&quot;,469775450,&quot;jlqj4b&quot;,469778129,&quot;jlqj4b&quot;,469778324,&quot;Default Paragraph Font&quot;]}">Here you will find a <a title="Altea VM Breathing Pursed lip breathing v2.1" href="https://adm.altea-network.com/assets/de6bd75a-b483-480a-9fc7-3d61a3ad2696?download" target="_blank" rel="noopener">PDF on pursed lip breathing</a> with instructions and illustrations.&nbsp;
Here are some videos about pursed lip breathing :&nbsp;&nbsp;
<ul>
<li><a href="https://www.youtube.com/watch?v=CGJYKzd7fUI" target="_blank" rel="noopener" data-anchor="?v=CGJYKzd7fUI">SoH - Positions to Ease Breathing and the Pursed Lip Technique</a></li>
<li><a href="https://www.youtube.com/watch?v=A_54zno2fMU&amp;list=PLPbj_BS6skC9SmmtD_YRCDz4uo204-bDT&amp;index=6">Ligue Pulmonaire Suisse : Souffler avec les l&egrave;vres, &ccedil;a soulage. Sais-tu comment faire?</a>&nbsp;(in French)</li>
</ul>

Pursed Lip Breathing

Restlessness, palpitations, anxiety, panic, fast breathing
In case of&nbsp;restlessness, palpitations, anxiety or panic, slow diaphragmatic breathing calms the nervous system by activating the parasympathetic nervous system. This nerve of the autonomic nervous system is responsible for calmness and serenity.
In addition,&nbsp;diaphragmatic breathing supports the heart&nbsp;in its activity and relieves it by slowing down the pulse.
In a&nbsp;state of excitement and&nbsp;stress, we usually breath too much. Doing so, we lose too much of the important gas carbon dioxide. All the muscles tense up and we get stressed and breathless. If we practice moving the diaphragm slowly and evenly, we get an optimal oxygen supply.
Please read the PDF with <a title="Altea VM Breathing Diaphragmatic Breathing V2" href="https://adm.altea-network.com/assets/3b454a3c-ad24-43ce-8c27-d7fdd762e364?download" target="_blank" rel="noopener">detailed information and</a><a title="Altea VM Breathing Diaphragmatic breathing V2" href="https://www.altea-network.com/media/zf3bdjyo/altea_vm_breathing_diaphragmatic-breathing_v2.pdf" target="_blank" rel="noopener">&nbsp;excercices for the diaphragmatic breathing</a><a title="Altea VM Breathing Diaphragmatic breathing V2" href="https://www.altea-network.com/en/long-covid/vademecum/breathing/">.</a><a title="Altea VM Breathing Diaphragmatic breathing V2" href="https://www.altea-network.com/en/long-covid/vademecum/breathing/">&nbsp;</a>

Slow diaphragmatic breathing

Shortness of breath, mouth breathing
Do not&nbsp;do&nbsp;the exercise&nbsp;if you&nbsp;have an infectious disease&nbsp;(e.g., flu, fever, cold)! Please consult your doctor if there are any other side effects.
Nasal breathing is the only correct way of breathing according to&nbsp;<a href="https://buteykoclinic.com/" target="_blank" rel="noopener">Dr. Buteyko's theory</a>. By breathing through the nose, the air is humidified and warmed. This decongests and protects the lung tissue. The nose cleans and disinfects the air, and the airflow reaches more parts of the lungs.

To breathe through your nose, the nose should be free - that's why this exercise is helpful.
Always&nbsp;breathe&nbsp;through your nose&nbsp;during this exercise! Repeat each step&nbsp;six times.&nbsp;
<ol>
<li>Slowly move your head backward and forward.</li>
<li>Inhale while moving backward, exhale while moving forward.&nbsp;</li>
<li>After a normal breath: pinch your nose, swing your head back and forward 3 times. Then breathe in and out slowly through your nose.</li>
<li>After a normal breath: pinch your nose and blow gently into it, but do not let the air escape. Then breathe in and out slowly through your nose.</li>
</ol>
Please read the detailed information and exercise instructions. (To come shortly)
Here you can find two videos explaining the Buteyko Breathing Method:&nbsp;<a href="https://www.youtube.com/watch?v=tgmKIwUqhkg" target="_blank" rel="noopener" data-anchor="?v=tgmKIwUqhkg">video 1 (by Buteyko Clinic International)</a>&nbsp;&nbsp;and&nbsp;<a href="https://www.youtube.com/watch?v=gY9JhCjvAeI" target="_blank" rel="noopener" data-anchor="?v=gY9JhCjvAeI">video 2 (by Dr. Mandell)</a>. &nbsp;

Exercise to unclog the nose

<div class="text">
The Wim Hof breathing training helps with lack of energy and shortness of breath. It strengthens the immune system and helps to deal more efficiently with the inhaled oxygen.
In addition, the alternation between activation and relaxation stimulates the entire nervous system - especially and sustainably the parasympathetic nervous system, that part of the vegetative nervous system that is responsible for rest and digestion. This in turn has a positive impact on our emotional state while supporting our immune system in maintaining or regaining a healthy balance.
As the name suggests, breathing training according to Wim Hof is training and therefore only shows an effect if it is used regularly.
</div>

<div class="col-12 col-md-4 offset-md-1">
<div class="text">
Please read Wim Hof's detailed exercise instructions and tips on breathing training in our <a href="https://adm.altea-network.com/assets/3b01e454-fe97-48f5-aa88-1479789ffee7?download" target="_blank" rel="noopener">Guidebook</a>.
Youtube breathing sessions led by Wim Hof:
<ul>
<li>In English for beginners: <a href="https://youtu.be/0BNejY1e9ik" target="_blank" rel="noopener">https://youtu.be/0BNejY1e9ik</a></li>
<li>In German for beginners:&nbsp;<a href="https://youtu.be/BckqffhrF1M" target="_blank" rel="noopener">https://youtu.be/BckqffhrF1M</a></li>
<li>Also popular: <a href="https://youtu.be/0q8SU_QyoIM" target="_blank" rel="noopener">https://youtu.be/0q8SU_QyoIM</a></li>
</ul>
</div>
</div>

Breath training according to Wim Hof

Since COVID-19 attacks the airways, shortness of breath and dyspnoea can occur during the acute infection, but also afterwards. Fear and feelings of suffocation or the limitation of physical performance can seriously affect everyday life.

Breathing

These exercices can help in case of Shortness of breath

Attention disorder, concentration difficulties, word-finding impairment and memory loss issues / &ldquo;Brain Fog&rdquo;
Many people report decreased concentration, impaired memory, or word-finding problems after COVID-19 infection. In that case, these complaints are part of Long COVID.
In Long COVID, it is common that the above difficulties occur at the same time as <a title="Fatigue" href="https://altea-network.com/en/vademecum/fatigue/" target="_self">Fatigue</a>, a common phenomenon of Long COVID. In detail, this means that cognitive complaints are particularly severe during periods of pronounced fatigue. Patients often describe Fatigue as a &ldquo;Brain Fog&rdquo; - a rapid and premature mental exhaustion.

<div class="col-12 col-md-6">
<div class="text">
The good news is that in most cases the symptoms improve significantly or even disappear completely over time.
What helps against disorders of thinking and perception?
<ul>
<li>Energy management</li>
<li>Neuropsychological/ergotherapeutic brain power training</li>
<li>Regular sleep and healthy daily structure</li>
<li>Mental health</li>
</ul>
Here you will find a PDF with <a title="Altea VM Thinking and perception- Energy management v2.0" href="https://adm.altea-network.com/assets/8ae5ae05-1650-4bd7-b19d-b4d2a7b133b1?download" target="_blank" rel="noopener">detailed information about the energy management / brain power training</a>.
</div>
</div>

Energy management, brain performance training

Difficulty concentrating and being unusually forgetful are possible cognitive symptoms of Long COVID. This also includes slowness in thinking or difficulty in expressing yourself. Impairment of the eyes has also been described.

Thinking and perception

Thinking and perception | Altea Network

Thinking and perceptions disorders are also part of Long COVID

<div class="text">
Fatigue&nbsp;
&ldquo;Fatigue&rdquo; is a form of pathological exhaustion that is physical, mental, or psychological in nature. Fatigue is one of the most common of the many symptoms of Long COVID.
Pacing means doing less than your strength currently allows. Pacing is a gentle way of using your resources.
Pacing helps when it has become difficult to calculate your day-to-day energy levels and when you are exhausted and feel completely worn out or very tired. Pacing can also reduce setbacks in your healing process.&nbsp;
The art of pacing involves finding your own optimal balance between conserving energy and practicing any activity, as well as continually increasing your activity. The goal: to get out of the ups and downs between good and bad days and returning to a stable energy level and everyday routine.
&nbsp;
More information and application tips on Pacing:
<ul>
<li>Detailed information and application tips in our Vademecum <a title="Altea VM Fatigue - Pacing part 1 v2.0" href="https://adm.altea-network.com/assets/f102b619-198e-444a-93ec-9de7fb0f83cd?download" target="_blank" rel="noopener">Pacing part 1: recognizing the limits</a> and <a title="Altea VM Fatigue - Pacing part 2 v2.0" href="https://adm.altea-network.com/assets/d0d94f3e-5fb2-4fcb-801b-d2eafa3df600?download" target="_blank" rel="noopener">Pacing part 2: The 4P&rsquo;s rule</a>.</li>
<li>Long Covid Physio. <a href="https://youtu.be/KS-FiXWLs9U">Navigating Pacing. (Podcast)</a></li>
<li>#MEAction. <a href="http://www.meaction.net/stoprestpace/"> Rest. Pace. (Video)</a></li>
</ul>
</div>

<div class="col-12 col-md-6">
<div class="text">
Procedure:&nbsp;
<ol>
<li>Identify your current limits in the four activity areas: physical, mental/cognitive, social, and emotional.</li>
<li>Identify your individual warning sign in each of the four activity areas.</li>
<li>Accept your current limits.</li>
<li>Communicate your current limits and get help.</li>
</ol>
Adjust your daily activities and tasks using the 4P's rule:&nbsp;
<ol>
<li>Prioritize</li>
<li>Plan</li>
<li>Pause regularly</li>
<li>Stay positive</li>
</ol>
&nbsp;
&nbsp;
&nbsp;
&nbsp;
<ul>
<li>Medinger, Gez. <a href="https://youtu.be/gUPvNwvkOlA">The Why, When and How of Pacing | Long Covid&rsquo;s Most Important Lesson. (Video discussion with experts)</a></li>
<li>Royal College of Occupational Therapists. <a href="http://www.rcot.co.uk/conserving-energy">How to conserve your energy.</a></li>
</ul>
Note: for more videos and links see the same page in other languages.
</div>
</div>

Pacing

<div class="text">
Heart rate monitoring is suitable for people with Fatigue to avoid <a href="https://altea-network.com/en/vademecum/fatigue/#pem-post-exertional-malaise" target="_blank" rel="noopener">crashes/PEM</a>. It refers to the constant measurement of the heart rate with a heart rate monitor and is used for <a href="https://altea-network.com/en/vademecum/fatigue/" target="_blank" rel="noopener">Pacing</a>. 
It is often difficult to develop a feeling for the limit of resilience and not end up in a crash/PEM. For many people, subjective perception is not tangible enough. With a defined upper limit (maximum heart rate), pacing becomes tangible and easier to implement. 
Crashes/PEM are often triggered by an activity for which the body has to provide the energy mainly without oxygen. The threshold from aerobic (with oxygen) to anaerobic (without oxygen) energy supply is called the anaerobic threshold. Heart rate is an adequate parameter to monitor anaerobic threshold. 
<ul>
<li>The threshold is very individual and depends on many factors. It can be determined relatively accurately with a cardio-pulmonary stress test. </li>
<li>It is also possible to calculate a guide value. You can find two ways to do this in our &ldquo;Heart Rate Monitoring&rdquo; guide. </li>
</ul>
Please read the detailed information on heart rate monitoring in our Vademecum.
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Heart rate monitoring 

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Post-Exertion Malaise (PEM) refers to the worsening of symptoms after physical, mental or emotional exertion, it is also referred to as "crash". PEM is a different symptom than a healthy person's "normal" fatigue after activity, excitement, or exertion. For many clinics, researchers, and affected people, PEM is considered the primary symptom of chronic fatigue syndrome (ME/CFS). Many people affected by Long COVID report similar "crashes" even after the smallest physical, cognitive, or emotional exertion.
Early detection of PEM is important and can reduce "crashes" and provide more safety during efforts in everyday life. Early detection also improves physical and mental well-being.
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How to recognize and reduce PEM:
<ul>
<li>Recognize PEM as a consequence or side effect of overexertion.</li>
<li>Keep diary to identify patterns of overexertion.</li>
<li>Search discussion with a doctor or an expert.</li>
<li>The following methods may help: Pacing / Return to sport / Specific rehabilitation</li>
</ul>
Here you will find a <a title="Altea Ratgeber Pem Pdf V1" href="https://adm.altea-network.com/assets/bf205e20-0d63-4d2b-9576-4b2dd74f5057?download" target="_blank" rel="noopener">PDF with detailed information about PEM</a>. Here you will find two short <a href="https://www.dialogues-mecfs.co.uk/films/post-exertional-malaise/" target="_blank" rel="noopener">videos about PEM</a>. Here you will find a <a href="https://www.youtube.com/watch?v=TGIo1v7KVJQ" target="_blank" rel="noopener" data-anchor="?v=TGIo1v7KVJQ">short introduction to PEM</a>.
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Post Excertional Malaise (PEM), recognize and prevent "crashes"

"Fatigue" describes a great amount of exhaustion that does not go away even with a lot of sleep. Such an all-encompassing fatigue is also known from other viral diseases. It is important to avoid, if possible, that the exhaustion becomes chronic.

Fatigue

Pacing Against Exhaustion and Chronic Fatigue Syndrome in Long COVID

Fatigue and exhaustion: these tips are important

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Taste and Smell Loss
COVID-19 can cause a loss of taste and smell. Approximately 80% of patients are affected. It has been shown that the SARS-CoV-2 virus enters the central nervous system through the mucous membranes of the olfactory and gustatory systems and can damage or destroy sensory cells.
Due to the damage or destruction of these cells, only an incomplete olfactory impression reaches the brain. This can lead to olfactory or gustatory confusion, so that affected persons can no longer recognize the smell or taste of coffee, for example. This can also impact appetite.
Fortunately, the sensory cells can renew themselves, and the course of olfactory and taste disorders with COVID-19 is generally considered favorable by experts.
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A simple smell training can significantly improve olfactory perception.
<ul>
<li>Step 1: smell regularly, for example in the morning and in the evening, for 10 to 15 seconds, each time four intensive scents.</li>
<li>Step 2: consciously perceive the smell and visualize it at the same time.</li>
</ul>
Advice:
<ul>
<li>The best fragrances to start with are clove, rose, lemon and eucalyptus.</li>
<li>Change the 4 training scents after 12 weeks.</li>
<li>Familiar scents, such as your favourite perfume or the smell of coffee, are also useful for training.</li>
</ul>
Please read further information and instructions in the <a title="Altea VM taste and smell - smell training v2.0" href="https://adm.altea-network.com/assets/ae229b5f-2ca6-426e-ab23-e605a81d5065?download" target="_blank" rel="noopener">Vademecum about smell training</a>.&nbsp;
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Smell training

COVID-19 can cause a change or loss of taste and/or smell. For example, foods may appear tasteless or have a different taste or smell. This disorder can resolve itself or persist over time.

Taste and Smell

Taste and Smell | Altea Network

Loss of the sense of taste and smell: these tips are important

Tinnitus (ringing in the ears)
Hearing loss has been observed in the context of SARS-CoV-2 virus infection, which can lead to tinnitus. Possible ways in which the virus could damage the inner ear or auditory nerve are also described in literature, as are isolated cases of tinnitus that have occurred in a possible association with the Covid vaccination.
This hearing disorder results in signals from a certain sound spectrum that are no longer transmitted to the auditory cortex of the brain for processing. Tinnitus develops due to central sensory compensation, which begins as overactivity of the auditory cortex. If there is a subsequent interconnection between the auditory cortex and other areas of the brain responsible for stress, emotion, attention, consciousness, memory, or sleep, this intrinsic activity in the auditory cortex may be perceived as &ldquo;ringing in the ears&rdquo;.
The good news: In most cases, even in the context of a COVID-19 infection, the tinnitus improves over time or even disappears completely.
In the <a title="Altea VM ENT Tinnitus V1" href="https://adm.altea-network.com/assets/2d313908-f7cc-4a40-8da2-abc2b7592941?download" target="_blank" rel="noopener">Vademecum Tinnitus after COVID-19</a> you will find further information, therapy options and links.&nbsp;

 Treatment options for tinnitus 

This group includes cold symptoms such as a sore throat, cough, earache, headache or fever. Tinnitus has also been reported. The dry cough that is characteristic of COVID-19 can in some cases become permanent.

Throat, nose, ears

Tipps against fever and other cold symptoms