Effect of neuromuscular electrical stimulation on the recovery of people with COVID-19 admitted to the intensive care unit: A narrative review.

The rehabilitation of patients with COVID-19 after prolonged treatment in the intensive care unit is often complex and challenging. Patients may develop a myriad of long-term multiorgan impairments, affecting the respiratory, cardiac, neurological, digestive and musculoskeletal systems. Skeletal muscle dysfunction of respiratory and limb muscles, commonly referred to as intensive care unit acquired weakness, occurs in approximately 40% of all patients admitted to intensive care. The impact on mobility and return to activities of daily living is severe. Furthermore, many patients experience ongoing symptoms of fatigue, weakness and shortness of breath, in what is being described as "long COVID". Neuromuscular electrical stimulation is a technique in which small electrical impulses are applied to skeletal muscle to cause contractions when voluntary muscle contraction is difficult or impossible. Neuromuscular electrical stimulation can prevent muscle atrophy, improve muscle strength and function, maintain blood flow and reduce oedema. This review examines the evidence, current guidelines, and proposed benefits of using neuromuscular electrical stimulation with patients admitted to the intensive care unit. Practical recommendations for using electrical muscle stimulation in patients with COVID-19 are provided, and suggestions for further research are proposed. Evidence suggests NMES may play a role in the weaning of patients from ventilators and can be continued in the post-acute and longer-term phases of recovery. As such, NMES may be a suitable treatment modality to implement within rehabilitation pathways for COVID-19, with consideration of the practical and safety issues highlighted within this review.

Why the mask? The effectiveness of face masks in preventing the spread of respiratory infections such as COVID-19 - a home testing protocol.

Since the start of the COVID-19 pandemic there has been much debate in the media on whether masks should be worn to stop the spread of the virus. There are two ways in which they could work. Firstly, to protect the person wearing the mask, and secondly, to reduce the likelihood of the person wearing the mask passing the disease on to anyone else. This is not an easy issue to address and many factors come into play such as droplet size, aerosol transmission and the viral load, as well as the specific properties of any given mask. The method used in this study was to measure the change in relative humidity when wearing a mask, compared to no mask, in various scenarios, based on the assumption that as the virus is air-borne the smaller the increase in humidity the less the spread of the virus. The results above show that the use of a mask, excluding some simple home-made ones, significantly reduces the spread of humidity. However, their effectiveness is device specific and needs to be considered in greater detail for each type of mask, especially the direction of escaping air when forward flow is blocked.