What are clinical trials and what should I know about them?

Clinical trials are an important part of medical research. They are carried out to test whether new treatments are effective, safe, well tolerated and potentially better than the current standard treatment. Clinical trials are subject to special monitoring by national and regional authorities and others.

By taking part in clinical trials, patients can gain access to the newest medications and therapeutic approaches. In many cases, though, taking part in a clinical trial also means that not much is known about the treatment you are receiving. Most trials are therefore carried out by doctors known as investigators at specialized medical centers.

Before you take part in a clinical trial you should find out all about it and carefully weigh up the advantages and disadvantages.

Further information about clinical trials is available from vfa (Germany’s association of research-based pharmaceutical companies).

Which simple procedures can help in COVID-19? What can I do besides taking medications?

As well as taking medication, there are plenty of other ways to help yourself and aid your recovery.

Make sure you get enough sleep and drink plenty of herbal tea or water.

Inhaling hot steam can be helpful to relieve symptoms such as a cough and blocked nose. Just add a spoonful of table salt to a bowl of hot water and inhale the steam it produces or use an inhalation device.

Depending on the course taken by the illness and the individual symptoms in your case, it can be helpful to investigate the rehabilitation options. After severe illness, rehabilitation can help you to overcome the physical and mental problems that may occur as a result of COVID-19.

As an alternative, you can consider trying respiratory physiotherapy or targeted stamina training to improve your lung function and fitness.

Ask your doctor about these and other ways to support your treatment. He/she can advise you and help you to consider which procedures could be helpful.

What treatment is available for long COVID?

The treatment of long COVID depends on the symptoms that are present.

The goal of treatment is to improve the state of health and to prevent the existing symptoms from becoming chronic. If fatigue symptoms (tiredness, exhaustion, lack of resilience) last for several months, they can develop into chronic fatigue syndrome.

Different treatment options are available depending on the individual situation:

  • pain therapy
  • supporting psychotherapy, instruction on relaxation
  • movement therapy, physio-training, fitness training
  • special therapy programs combining neuropsychological training and relaxation exercises.

Specialist treatment may also be necessary if the function of particular organs and/or organ systems is damaged. Psychotherapeutic support is often necessary as well because long COVID causes depression and anxiety about the future in many cases.

Ambulatory or residential rehabilitation can also help to improve the overall state of health.

Further information about long COVID and post COVID syndrome is available in a patient guide produced by AWMF (Association of the Scientific Medical Societies) at an info portal from BZgA (longcovid-info.de) and at the Federal Health Ministry’s website gesund.bund.de.

Which relaxation techniques can help me to overcome the effects of the illness?

Many people use relaxation techniques to resolve the internal restlessness and tension that can often occur in the context of illness. There are many different options, such as yoga, progressive muscle relaxation, autogenic training and breathing or mindfulness exercises.

As an introduction to relaxation techniques you can watch online video tutorials. Try out different methods. See what you like best and what does you good. Sports clubs and adult education classes (Volkshochschule) offer suitable courses.

Ask your doctor about these and other ways to support your treatment. Ask his or her advice and find out which procedures you could use.

You may want to talk to other people who have been similarly affected. COVID-19 self-help groups have been established in many towns during the pandemic. They offer an opportunity for people to connect and share their experiences.

Where can people find help if they develop anxiety or depression because of the pandemic?

This pandemic is an enormous psychological burden for many people. Some are ill for a long time and have difficulty returning to everyday life; others experience great anxiety that the illness could strike them or their family. Many people have also come to feel increasingly lonely because the limitations placed on social contact have disrupted their daily routines and prevented them from meeting up with others.

Young people and those with existing psychological problems are particularly strongly affected.

For some people, the psychological burden takes the form of diffuse anxious thoughts; others react with physical symptoms such as respiratory distress and racing heartbeat or sleep problems. However, certain strategies can be used to ensure that anxiety and negative mood don’t become constant companions.

An important initial step is to accept and express the negative feelings. Don’t suppress them. Regular exercise and relaxation techniques can also help you to overcome negative feelings. Find out which strategy is the right one for you. That way, you can learn to deal with your negative emotions and regain your quality of life.

To combat social isolation, it is helpful to intensify your contact with other people. You can also use all the many telephony and video-telephony options to do this. Get back in touch with old friends as well. Get in touch with people you haven’t heard from in a long time. Social connectedness helps everyone.

If you have the feeling that you cannot get your worries and cares under control, there are many people you can turn to for help. Go to the Support section for an overview of relevant links. Many advice centers offer the option of phone consultations. You can use telemedicine services and get advice in videoconferences or chats. And you can also contact your health fund and ask about the therapy options. Smartphone mental health apps can be helpful as well.

Perhaps you should consider consulting a doctor. Anxiety about the future and depression are often a feature of long COVID and may require psychotherapy. Your doctor can help you to consider whether psychotherapy could be helpful and can discuss the next steps with you.

If you cannot get an appointment with a psychotherapist in the near future, you can approach outpatient psychiatric clinics at hospitals. As a stop-gap until a therapy appointment becomes available, you can also make use of e-mental health programs such as apps giving psychotherapeutic support by smartphone. Many health funds offer programs that their clients can use free of charge.

The Institute for Psychology at Greifswald University provides videos and other help for dealing with mood swings, anxiety, depression and loneliness for adults, young people and children.

At the Max Planck Institute for Psychiatry website you can download a guide offering more tips and exercises to improve mental health in the pandemic.

After treatment in hospital, what happens next?

It is generally the case that the more severe the illness and the longer the hospital stay and the period in intensive care, the longer the patient takes to recover from COVID-19.

After their time in hospital, patients who have been seriously ill are not always able to cope with everyday life on their own. Many of them need help and support; some have long COVID.

After in-patient treatment in hospital, a period of rehabilitation can follow on to stabilize the patient’s health. The doctor responsible for the patient in hospital and the hospital’s social service (Sozialdienst) can give advice about the options and apply for a period of rehabilitation.

When a patient is not transferred directly to a rehabilitation clinic, the family doctor takes over their care. The hospital providing the patient's acute treatment sends a letter to the family doctor giving comprehensive information about the illness and the examinations and treatments that were carried out in the hospital.

After a stay in hospital, patients are entitled to further treatment and assistive devices depending on their personal needs. The family doctor can coordinate and apply for these.

The World Health Organization (WHO) has published a leaflet for patients called “Support for Rehabilitation Self-Management after COVID-19-related Illness” which you can download free of charge here. It gives a lot of helpful information for your recovery, such as breathing exercises, brain training, tips on coping with anxiety and mood swings and instructions for physical exercise after leaving hospital.

How are COVID-19 patients ventilated?

Respiratory distress is a particularly common symptom in hospitalized patients with COVID-19. Many are given oxygen to support their breathing for this reason. A distinction is made between invasive and non-invasive methods of ventilation.

The non-invasive methods include the use of a face mask and the delivery of high dose oxygen via the nose (known as High Flow Nasal Oxygen Therapy). In these methods, oxygen is supplied at slightly increased pressure so that it is pushed into the upper airways.

With invasive ventilation, the patients are usually unconscious. In a procedure known as intubation, a pipe is inserted into the trachea (windpipe) through the mouth or a tracheostomy (incision in the trachea) so that the air from the ventilator is delivered directly into the lungs. Before intubation, the patient is put into an induced coma and he/she then remains unconscious throughout the ventilation period. Patients are often positioned lying face down during ventilation to improve the supply of oxygen to the rear areas of the lungs.

ECMO (extra-corporeal membrane oxygenation) devices are also known as artificial lungs because they allow oxygen uptake to happen outside the body. These devices may also be used in the invasive ventilation of COVID-19 patients if their lung tissue is no longer able to take up oxygen. In ECMO, the patient’s blood is pumped through the device so that carbon dioxide can be removed and oxygen added. The treated blood is then put back into the patient’s blood vessels.

According to the Robert Koch Institute (RKI) more than one in every two COVID-19 patients in ICUs (56%) needs invasive ventilation.

In which cases is it necessary to have in-patient treatment in a hospital?

When patients become seriously ill, their state worsens about 7-10 days after symptoms begin; the worsening is often noticeable in the form of increasing respiratory distress.

For this reason it is important that a doctor checks how the illness is progressing right from the start, especially in patients with risk factors for severe illness.

If, after 7 to 10 days, the symptoms have not improved or have become worse (especially fever and respiratory distress), it is often advisable for further examinations and treatment to be carried out in hospital.

Further information about the course and treatment of the illness is available from the Robert Koch Institute.

A short film by APS, the patient safety alliance, shows how you can prepare for a stay in hospital.

Can my family doctor treat the illness or do I have to go to a specialist?

If you have health problems, he first person to consult is usually your family doctor and this is the case with COVID-19 as well. After a positive test for COVID-19, you should contact your doctor quickly and discuss what you need to do.

The type of treatment depends on how the illness progresses in each individual case. If the symptoms are mild, it is not usually necessary to consult a specialist. In such cases, it is usually sufficient to rest and treat the individual symptoms, such as cough and fever, as necessary.

For patients who are at increased risk of becoming severely ill, antiviral treatment early on in the illness can also be helpful to prevent it from worsening.

In severe cases, patients typically experience a worsening, including increasing respiratory distress and/or hypoxemia (lack of oxygen in the arterial blood), about 7 to 10 days after the symptoms start.

If you find that your COVID-19 is getting worse, it’s important to call a doctor or the medical standby service quickly so that they can find out whether you need examination and treatment from a specialist or admission to hospital.

Further information about treatment is available at the Federal Health Ministry’s website gesund.bund.de.