Understanding Long Covid

Being diagnosed with Covid-19 is traumatic enough but imagine being discharged after going through the difficult process of recovery, only to find that the effects of the disease still linger.

It can be overwhelming. Around the world, cases of long Covid are now being documented as some patients continue to report symptoms related to the disease for weeks or even months, after leaving the hospital and being told that they have recovered.

In Malaysia, according to a clinical study conducted by the Health Ministry on 1,004 Covid-19 patients from categories 4 and 5, who received follow-up treatment, 66 per cent were found to suffer from long Covid.

Gleneagles Hospital Kuala Lumpur (GKL) endocrinology, internal medicine, and bariatric surgery specialist Dr Saiful B. Kassim says fatigue is one of the common symptoms of long Covid.

Prolonged fatigue is similar to chronic fatigue syndrome (CFS) described after other infections, such as SARS, MERS and community-acquired pneumonia (CAP), he explains.

An analysis of 1,077 patients in a Covid-19 post-hospitalisation study in the United Kingdom (UK) also found that a quarter of participants had significant symptoms of anxiety and depression.

In Wuhan, China, a study this year found that more than three-quarters of Covid-19 patients still had at least one symptom six months after being discharged from the hospital.

This is consistent with a study last year in Italy, which showed 87.4 per cent of Covid-19 patients experienced at least one symptom two months after discharge from hospital.

The Long Road

Dr Saiful says these symptoms may be severe. A lot of patients also report that they are unable to access health services and are struggling to have their cases taken seriously to get treatment. Their quality of life is certainly affected.

"Many patients are unable to return to work or resume a normal social life. Many have also described how it affects their mental health."

Dr Saiful says long Covid occurs in one in 10 patients. Data from the United Kingdom Office for National Statistics indicate that one in 10 patients have shown symptoms lasting 12 weeks or longer.

Many patients experience symptoms for 60 to 90 days after initial infection. In some people, it may be longer.

"Having more than five symptoms in the first week is one the key risk factors for long Covid. The risk also rises with age, particularly over 50 years as well as being female," says Dr Saiful.

Body mass index is also a risk factor, but no prior past medical history has been linked to long Covid except for asthma and lung diseases, such as chronic obstructive pulmonary disease, tuberculosis, and pulmonary fibrosis.

Data from King's College Hospital in the UK showed that one in seven long Covid patients have been ill for at least four weeks, one in 20 for at least eight weeks, and one in 45 for at least 12 weeks.

Dr Saiful says after excluding serious complications or co-morbidities, and until the results of long-term follow-up studies are available, long Covid patients should be managed pragmatically and symptomatically with emphasis on holistic support while avoiding over-investigation.

The Future

Patients can recover but not fully, he explains, especially if they suffered multiple organ failures during infection.

Experts also believe it may take months for a Covid-19 patient's lungs to recover. And if the infection has damaged the kidneys, it may raise the risk of long-term kidney disease and the need for dialysis.

For a quarter of patients who suffer either a loss of smell or taste distortion, the problem will resolve in a couple of weeks. However, for most, the symptoms will persist and lead to a lack of appetite, anxiety, and depression.

One study shows that 60 per cent of people who recover from Covid-19 have signs of heart inflammation. This occurs even in patients with no prior history of cardiac problems.

Those with long Covid are also susceptible to brain fog, fatigue, headache, and dizziness. However, the cause and duration of these symptoms are unclear and still under investigation.

Patients who are hospitalised and treated in the intensive care unit (ICU) also seem to have a higher risk of post-traumatic stress disorder.

"The majority of people who have had this disease are only one year or less into their recovery. It will take longer to know and understand what is next for patients who suffer from long Covid," says Dr Saiful.

About Long Covid

• Long Covid or Post-Covid-19 Syndrome affects one in 10 patients.

Risk Factors

• Female
• Aged above 50
• Experienced more than five symptoms in the first week of infection

Symptoms

• Fatigue and shortness of breath
• Cough
• Joint pain
• Chest pain
• Memory, concentration, or sleep problems
• Muscle pain, headaches
• Irregular heartbeat (palpitations)
• Loss of sense of smell and taste
• Depression, anxiety
• Fever
• Dizziness when standing and worsening symptoms after physical activity

Doctor featured

Dr Saiful B Kassim
Consultant Endocrinologist
Gleneagles Hospital Kuala Lumpur

This article was written by Meera Murugesan on August 31, 2021, based on information available at the time. The original article can be found on the New Straits Times*