Long COVID – an update

A young woman sitting by a window, looking sad and tired.

We last talked about Long COVID or PACS in August 2021. Today, we know about 10 – 15% of people infected with COVID-19 develop lasting post-infection systems. In some places, these rates can be as high as 20 – 30% of those infected. Even those who had an asymptomatic COVID infection (without symptoms) can later develop long Covid.

In December 2021, almost 20,000 patients in Malaysia who had recovered from COVID-19 were still dealing with long COVID. These symptoms usually last for 4 – 12 weeks, but can last for longer periods as well.

With the Delta, Omicron and other variants in Malaysia, it’s important to stay informed about the risks of long COVID, the symptoms, and how it can be treated, eased and prevented. Scientific research is still in progress, but we now know a little more that can help.

Risk factors for long COVID

You might be at greater risk for long COVID if you:

  • are a woman
  • are an older adult
  • were admitted to the ICU or needed ventilator support for COVID-19
  • have chronic conditions such as
    • lung disease
    • heart disease
    • high blood pressure
    • diabetes
    • kidney disease
    • liver disease
    • brain/nervous system disorders
  • are obese
  • are an organ transplant recipient
  • are currently or were recently pregnant
  • are poor and unable to receive proper treatment

Further studies have shown that patients are at higher risk for long COVID when they

  • have a high viral load during the initial infection, or a high amount of viruses in the body
  • have dormant Epstein-Barr virus (EBV) reactivated by the COVID infection. EBV is what causes mononucleosis or kissing disease, and is also associated with chronic fatigue syndrome.

While many studies have focused on adults, it’s important to remember that children are also at risk of long COVID. During a study on COVID-19 patients aged 12 or younger, 32% reported that they were still experiencing fatigue. 22% reported problems with thinking and remembering.

Signs and symptoms of long COVID

If you have long COVID, you may experience any of the following:

  • Allergies or intolerances to food and medicatio
  • Anemia
  • Anxiety
  • Blood clots in the lungs and other parts of the body
  • Brain fog or difficulty concentrating
  • Brain tissue damage and loss of grey matter
  • Coughing
  • Dementia
  • Depression
  • Diabetes
  • Diarrhoea
  • Dizziness or lightheadedness, especially when standing
  • Dry skin
  • Dysautonomia (inability to regulate blood pressure, breathing rate and body temperature)
  • Erectile dysfunction
  • Fatigue, even from daily activities
  • Fever
  • Gastrointestinal problems or bleeding
  • Hair loss
  • Headache
  • Heart problems, palpitations or heart failure
  • higher risk of heart attack and stroke
  • Hormone imbalance
  • Hypercoagulability (prone to blood clots)
  • Infertility or sterility
  • Insomnia or trouble sleeping
  • Kidney dysfunction
  • Loss of appetite
  • Loss of balance
  • Loss of smell or taste
  • Lung fibrosis or scarring
  • Memory problems
  • Menstrual cycle (period) changes
  • Mood swings
  • Nausea/vomiting
  • Pain in the muscles, joints, chest or stomach
  • Pins and needles sensation
  • Pneumonia
  • Sensitivity to light or sound
  • Shortness of breath
  • Skin rashes
  • Swelling in the leg
  • Vision problems
  • Voice damage

Rarely, long COVID has also been known to cause

  • encephalitis (inflammation of the brain)
  • cranial nerve palsies
  • peripheral nerve problems
  • movement disorders

Treating long COVID

There is no one way to treat long COVID. Your doctor may prescribe steroids, or bronchodilators if you have a post-viral cough.

SSRIs (selective serotonin reuptake inhibitors) can help when prescribed. It is still not clear how these antidepressants are effective for long COVID. However, some think that they can reverse or ease the problems that a COVID-19 infection may have caused in the central nervous system.

Pulmonary or cardiac rehabilitation can also help patients who do not have exercise-induced fatigue. If you feel ready to exercise, it may help you recover.

Complementary treatments such as acupuncture, meditation and changes in diet can also make it easier to recover from long COVID.

There is some anecdotal evidence that antihistamines can help with long COVID symptoms. However, no formal scientific studies have been published on this topic yet. Discuss any antihistamine use with your doctor or medical professionals before you start.

In Malaysia, the Ministry of Health is following the World Health Organisation’s recommendations to address long COVID, across 3 parts:

Recognition: recognising long COVID as a disorder that needs special care. National guidelines and protocols have been established since June 2021 for specialised medical services including

  • general care
  • primary care
  • respiratory care
  • organising pneumonia
  • immunocompromised care
  • nephrology
  • obstetrics
  • paediatrics
  • rehabilitation
  • psychiatry

Rehabilitation: addressing the medium and long-term effects of long COVID with rehabilitation and therapy. If you are suffering from long COVID symptoms, seek treatment immediately. You may be prescribed general or specialised rehabilitation to help you recover.

Research: A cohesive research agenda to prevent research waste and improve results for patients. Various local and international clinical studies are being conducted to understand more details about symptoms, risk factors, and the impact of Long COVID.

It is important to treat COVID-19 and long COVID as quickly and efficiently as possible to avoid the deaths and disability caused by both. It is equally important to prevent the spread of COVID-19 to vulnerable and immunocompromised Malaysians. Everyone should continue to take precautions by

  • getting vaccinated or boosted against COVID-19. Studies have shown that while the vaccination will not give you 100% immunity against COVID-19, it can make the infection less severe and reduce the effects of long COVID.
  • masking up around other people with a mask that fits well and filters out droplets.
  • maintaining social distancing, avoiding crowds, and staying at least 1m away from other people in public spaces.

Where to go in Malaysia

Below is a list of Malaysian hospitals that provide specialised long COVID rehabilitation:

Selangor/Kuala Lumpur/Putrajaya

Pahang

Kelantan

  • Hospital Raja Perempuan Zainab II

Penang

  • Hospital Pulau Pinang

Kedah

Melaka

Negeri Sembilan

Perak

Sabah

Sarawak

Terengganu

Johor

References

Dubby H. (2010) Covid 19 Omicron outbreak: Cardiologist warns of tidal wave of heart disease linked to long Covid [Accessed: 1 Mar 2022] Available at: https://www.nzherald.co.nz/nz/covid-19-omicron-outbreak-cardiologist-warns-of-tidal-wave-of-heart-disease-linked-to-long-covid/ZYMK3ZEV2J62UAI2VQ4DTHYIOY/

Ken D. Jr. (2022) Third of adults aged 65 years or older at risk for one or more long COVID symptoms [Accessed: 28 Feb 2022] Available at: https://www.healio.com/news/infectious-disease/20220225/third-of-adults-aged-65-years-or-older-at-risk-for-one-or-more-long-covid-symptoms

Korin M. (2022) Should You Take Antihistamines for Long COVID Symptoms? [Accessed: 28 Feb 2022] Available at: https://www.prevention.com/health/a39122406/anthihistamines-long-covid-symptoms/

Nature (2022) Long COVID and kids: more research is urgently needed [Accessed: 28 Feb 2022] Available at: https://www.nature.com/articles/d41586-022-00334-w

Nicola D., PhD (2022) Long-Haul COVID and Neurologic Symptoms: What Neurologists Know So Far [Accessed: 28 Feb 2022] Available at: https://www.neurologyadvisor.com/topics/general-neurology/long-haul-covid-neurologic-symptoms-what-neurologists-know-so-far/

Sayako A. (2022) FEATURE: Reduced brain function, immune disorder a possibility of “long COVID” [Accessed: 28 Feb 2022] Available at: https://english.kyodonews.net/news/2022/02/263518f1cd8b-feature-reduced-brain-function-immune-disorder-a-possibility-of-long-covid.html

Shi En K. (2022) Long COVID can manifest in dozens of ways. Here’s what we know so far. [Accessed: 28 Feb 2022] Available at: https://www.popsci.com/health/long-covid-symptoms-treatment/

Tharanya A. (2022) Khairy: Long Covid affects 10-15 pc of people [Accessed: 28 Feb 2022] Available at:  https://www.nst.com.my/news/nation/2022/02/774666/khairy-long-covid-affects-10-15-pc-people

Tharanya A., Dhesegaan B.K. (2021) Khairy highlights consequences of failing to treat ‘Long Covid’ [Accessed: 28 Feb 2022] Available at: https://www.nst.com.my/news/nation/2021/09/730473/khairy-highlights-consequences-failing-treat-long-covid

The Lancet (2021) Understanding long COVID: a modern medical challenge [Accessed: 28 Feb 2022] Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01900-0/fulltext

Timna J. (2022) Inside a long COVID clinic, a chronic condition is revealed [Accessed: 28 Feb 2022] Available at: https://www.smh.com.au/national/inside-a-long-covid-clinic-a-chronic-condition-is-revealed-20220223-p59yub.html

UC Davis Health (2022) 11 things doctors have learned about long COVID [Accessed: 28 Feb 2022] Available at: https://health.ucdavis.edu/news/headlines/11-things-doctors-have-learned-about-long-haul-covid/2022/02

Categories

Archives