Full health continues to elude millions who have recovered from Covid-19
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Johannesburg - Millions of people around the world who have recovered from Covid-19 are finding that full health still eludes them. Weeks, or even months after seemingly recovering from even a mild case, many patients still confront a wide range of health problems.
As researchers try to measure the duration and depth of what's being called "Long Covid”, the scale of the pandemic and drain on health resources could continue well after the contagion ends.
An article published in the Wits Journal of Clinical Medicine, (Post-Acute Covid-19 Sequelae PACS – ‘Covid Long Hauler 2021– professors Guy A. Richards, Richard van Zyl Smit, Dr Adrian Wentzel and Robert Miller) said prolonged symptoms were less common but still affected a considerable number of patients.
The study recorded self-reported symptoms on a cell phone app for 4,182 COVID cases. Of these, 558 (13.3%) had symptoms for around 28 days, 189 (4.5%) for around eight weeks and 95 (2.3%) for around 2 weeks.
The major symptoms were the same as for other studies: fatigue, headache, dyspnoea and anosmia with predisposing factors being age, BMI and gender. Richards said clear clinical syndromes may be recognisable but they may also overlap.
“PACS is real, but not always easy to define. It may affect multiple organ systems. More detailed studies are needed so that effective, evidence-based therapies are found. Where specific organ dysfunction occurs, preventative strategies should be developed and tested and response to these interventions documented,” he said.
Richards added that “Long Covid’ clinics are being established in resource-rich countries, but this may not always be possible in low or middle-income countries.
Director at the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ( ME/CFS) Foundation, Retha Viviers said it is important to note that the medical fraternity does not have all the answers yet and the prevalence is difficult to explain..
“At this stage it looks as if 10-15% of patients who had Covid seem to develop Long Covid permanently. It has been found that six months after acute infection, up to 50% of people are unwell. Going forward this percentage gets less as more and more people recover,” she said.
ME/CFS said in SA, 2.91 million people had Covid so far and it’s possible that as many as 291 000 will not recover and will have Long Covid.
“Children also get Long Covid. Hence Long Covid could have a massive impact on health systems and work absenteeism going forward,” Viviers said.
Dr Murray Dryden from the Division of Public Health Surveillance and Response at the National Institute for Communicable Diseases (NICD) agrees with Viviers and says the high burden of persistent symptoms is concerning for SA due to the potential for placing an additional burden on an already overwhelmed healthcare system, a decline in work productivity and the resultant decline in production, and an increased need for economic support among those affected.
Professor Jonny Peter, Head of the Division of Allergology and Clinical Immunology at the University of Cape Town and Groote Schuur Hospital, says that people who are admitted to hospital with severe Covid-19 usually have symptoms for at least four weeks.
“Covid-19 is a long infection for many people. If you look at people two months after hospitalisation, about 80% will have some kind of ongoing symptom such as fatigue and respiratory symptoms. This relates to the lung damage which occurs in people and will depend on how severe the illness was,” he said.
Along similar lines, a recent article in the New England Journal of Medicine refers to Long Covid as the next “health disaster”.
Peter says that the cost of Long Covid for the individual is huge – people seek medical care – this is costly and adds a burden on medical aids, those who have to go to the public health sector have to pay for taxis but their biggest cost is loss of income.
“Many people work on a no work no pay basis. People can be off work for months or even permanently resulting in increased poverty. There is no standard care for Long Covid (yet). Most healthcare practitioners are not aware of Long Covid and diagnosing can take long, resulting in more costs to the patient.
“Apart from the financial impact on people they suddenly have health issues which can lead to feelings of hopelessness and some do develop anxiety and/or depression. In America Long Covid has been declared as a disability,” he said.
The first Long Covid study done in SA found that 82% of patients still had persistent or new symptoms, a month after their discharge from hospital.
Dryden, who led the study, says irrespective of the disease severity, whether severe or asymptomatic, any patient who becomes infected with SARS-CoV-2 can develop Long Covid.
“Initial estimates suggested that 1 in 10 people who are infected with SARS-CoV-2 are at risk for developing long Covid, but these were only rough estimates. There isn’t a lot of data for asymptomatic or non-hospitalised patients with Long Covid internationally,” he said.
The latest statistics from Gauteng Health shows that 5 287 597 Covid-19 vaccinations have been administered in the province as of yesterday. The number of individuals vaccinated stands at 3 580 971 and individuals fully vaccinated sit at 2 574 447.