Long-Covid: it’s a reality for many

COVID-19 infections continue to rise with some survivors complaining about its after-effects.

Weeks after recovering from the virus, some people have complained of symptoms including headaches, fatigue, body pain, shortness of breath, hair loss, memory loss, anxiety, depression, chest pain, nausea, vomiting, insomnia and skin rashes.

Termed Long-Covid or Post-Covid-19 Syndrome, the symptoms vary from one survivor to the next.

A recent report by the Ministerial Advisory Committee on Covid-19 to Zweli Mkhize, the Minister of Health, found that patients who normally suffered from symptoms for more than 28 days, or after 28 days of infection, could be characterised as having Long-Covid. It said the incidence of Long-Covid was higher in women than in men.

The report found that despite symptoms, patients with Long-Covid do not need isolation, as they were not infectious.

“It is found that two-thirds of patients with mild or moderate Covid-19 were still symptomatic, with previously hospitalised patients being particularly affected,” said the report.

In a webinar hosted by the UKZN last Thursday, Professor Kennedy Nyamande, the head of the pulmonology and critical care department at the university, said scientists had a lot to learn about Long-Covid. He said from the research available anyone who had the virus was susceptible to Long-Covid.

Nyamande said it was not only hospitalised patients who suffered from Long-Covid. “Anyone can get LongCovid. People could have suffered from mild symptoms and still get it but those who presented with more severe symptoms were more likely to suffer from it.”

He said pre-existing conditions also played a factor in Long-Covid.

Nyamande listed the possible causes: Persistent viraemia (where the virus enters the bloodstream); weak/absent antibody response; relapse; reinfection; and post-traumatic stress.

He said it was important that the patient’s mental health was assessed as many suffered from social isolation, loneliness, anxiety, stress and depression. Nyamande said should the symptoms persist, patients should seek medical help – first from a GP; then from a specialist should the GP think it necessary.

Nyamande spoke of four cases he dealt with where patients suffered from Long-Covid.

The first case was of a 53-year-old male, who approached them in March this year, five months after the initial Covid-19 infection. The man, he said, had a background of hypertension, dyslipidemia (abnormal level of cholesterol), coronary artery disease, and a coronary artery bypass graft surgery five years ago.

“He was diagnosed with Covid-19 in October 2020 and he was in ICU on high flow nasal oxygen, non-invasive ventilation plus steroids.”

Nyamande said the patient improved and was sent home by his doctor.

“A week later, he started feeling unwell and in March this year, after climbing a few flights of stairs, he suffered shortness of breath.”

He said when the man was sent to them, his oxygen levels were at 96% with room air. His vitals were normal so they requested a CT scan, which looked for blood clots in the lungs as well as parenchymal cuts. All the tests were clear.

He was, however, found to have active alveolitis (interstitial pneumonia) and the patient was diagnosed with Long-Covid. The man was given a high dose of prednisone and reviewed a month later. He was better and was weaned off the medication over the next four weeks.

Nyamande spoke of a second case, of a 58-year-old patient with hypertension and diabetes. He was admitted to a hospital a week after testing positive and discharged after two weeks of receiving medication and steroids. His cough and shortness of breath, however, continued and worsened in March when he did ordinary activities such as walking to the toilet.

Nyamande’s third case, of a 66-yearold female, was similar and she was diagnosed with Long-Covid. The fourth case was of a 44-year-old woman with no comorbidities. She suffered from shortness of breath seven months after the initial infection.

He said there were different avenues of help patients could seek. One avenue was self-management. This entailed eating healthily, getting enough sleep, quitting smoking, limiting alcohol consumption, getting plenty of rest and sleep, gradually increasing activity and monitoring blood oxygen levels.

Nyamande said if the symptoms continued, professional help was needed.

“You should see a doctor when there is unexplained chest pain, confusion, increased shortness of breath, focal weakness, and your oxygen levels lower than 96%.”

Murray Hewlett, chief executive of Affinity Health, also spoke about LongCovid.

Hewlett said there was no definitive way to predict how long it would take for a person to fully recover from LongCovid. He listed extreme and unwavering fatigue as one of the most common complaints.

“Chronic fatigue syndrome is a complicated and challenging condition that can interfere with one’s ability to engage in normal activities, including going back to work. There is no cure for chronic fatigue syndrome with treatment focused on symptom relief.

“It’s important to be patient and kind to yourself during your recovery. Be prepared that some days will be worse than others.“