OPINION
When does long Covid end? As the Covid-19 Pandemic progresses, some patients are experiencing prolonged multi-organ symptoms and complications beyond the initial period of acute infection and illness.
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HE LIST OF new and persisting symptoms reported by patients is extensive and includes: Chronic cough, shortness of breath, chest tightness, cognitive dysfunction, and extreme fatigue. This has been termed ‘Long Covid’ or ‘Post Covid-19 Syndrome’. The Syndrome is defined as a collection of symptoms lasting more than 28 days. The implications and consequences of such ongoing clinical manifestations are growing and is a health concern. Work is being done to try and understand why following Covid-19 infection, the impact varies from full recovery to severe persistent debilitating symptoms affecting multiple organs and mental health. Research suggests that one in five people who test positive for Covid-19 have symptoms for five weeks or longer. In the UK this equates to 186 000 individuals with symptoms persisting for five to 12 weeks. Med RX IV preprint survey done on 3 700 self-described Covid-19 ‘Long Haulers’ in 56 countries showed that nearly 50% could not return to full-time work six months after unexpectedly developing prolonged symptoms of Covid-19. The second study emphasised the course and severity of more than 200 symptoms over time, including those
34 April 2021 | MEDICAL CHRONICLE
affecting the heart, lungs, gastro-intestinal system, muscles and joints. There was also an in-depth look at neurological and neuropsychiatric symptoms. In a survey of 3 762 individuals in USA - More than 50% never sought hospital care - 8% were admitted to hospital for Covid-19 - 2 464 reported Covid-19 symptoms lasting six months. Among the most common symptoms were fatigue, worsening of symptoms after physical or mental activity, shortness of breath, trouble sleeping and difficulty thinking clearly. The majority, (80%) said that they coped with some form of cognitive dysfunction or memory loss that to varying degrees affected their everyday lives. This includes the ability to make decisions, have conversations, follow instructions and drive. Those who had Covid-19 symptoms for more than six months reported contending with 14 symptoms on average. Many reported relapses of symptoms seemingly triggered by exercise, mental activity or just everyday stress. More than 50% of respondents said that they had to reduce their hours at work due to the severity of the symptoms. Another 22% were not working at all due to their Long Covid. Studies show that even
those who were not hospitalised for severe Covid-19, the prolonged symptoms are having a major impact on lives and livelihoods. Six months after onset of illness, more than 75% of people hospitalised with Covid-19 in Wuhan between January and May 2020 continued to report at least one symptom: fatigue, muscle weakness, sleep difficulties, anxiety and depression. More than 50% had significant persistent abnormalities, which were more common in those who had been more severely ill. A Study done at Kings College in the UK, found that one in every 20 people experienced long term symptoms. Work done in the NHS in Wales reported one in 10 have symptoms after three weeks and some may suffer for months. Journal of American Medical Association – Team of Researchers from Italy reported nearly nine out of 10 patients (87%) discharged from hospital in Rome were still experiencing at least one symptom, 60 days after onset. Why do people suffer longer? There are a number of theories. Some theories from Kings College in the UK: - Severity of the initial illness - Prolonged and inappropriate immune
Prof Morgan Chetty, visiting Prof: Health Sciences, DUT chairman, IPAF, CEO: KZNDHC
response after the infection has been cleared -P atients being biologically predisposed to such a response. Other theories proposed why some people’s recovery is prolonged: - Relapse or re-infection - Inflammatory or other immune reactions - Deconditioning -M ental disorders like Post Traumatic Stress (PTS). SOME EXPLANATIONS Interferon alpha, when given to people as a treatment for Hepatitis C, generated a ‘flulike illness’ in many patients and post viral fatigue in a few. Researchers have studied this artificial infection response as a model of chronic fatigue. They found the baseline levels of two molecules in the body that promote inflammation: Interleuken 6 and Interleuken 10, predicts people’s subsequent development of chronic fatigue. The theory of ‘Super Antigen’ in the spike of the coronavirus, which causes multiple inflammatory syndrome in children is being proposed to cause multiple inflammatory syndrome in adults that may results in the presentation of Long Covid.
