‘Long COVID’ - A Psychosomatic Aftermath of the Virus
By Dilanthi Jayamanne
It has been approximately one year and two months since the island nation started experiencing the pangs of being infected by the SARS CoV-2 virus causing COVID-19. But unlike in China which allegedly gave birth to the virus, Italy, the United States of America and the United Kingdom which suffered dearly at its hands during wave one and two Sri Lanka did not reach such massive heights in the number of cases that were diagnosed and ever-increasing death toll of large numbers dying or dropping dead on a daily basis. In both waves it must be said the virus was comparatively generous towards the Lankans.
With majority cases being detected from the Western Province during the first wave the numbers stood at 2,815 cases and the death toll at 11 by 1st August 2020.
By 1 April 2021 the main cluster detected at an apparel factory in Minuwangoda and its sub-clusters detected at the Peliyagoda fish market and the Prison had reached the colossal 87,910 with a death toll that numbered 568. The total number of cases in the country by then stood at 92,706. Having escaped thus far with a few grazes in the second wave the country has not been so lucky this time. Call it the third wave or an extension of the second wave which there is serious doubt as to whether it really ended is currently reaching gigantic figures in this small island. With daily PCR positive cases topping the three thousand mark and the number of deaths each day being in the 20s 30s and 40s as the COVID-19 numbers detected in the post New Year COVID-19 cluster had reached 71,879 while the death toll a total 1,269 by 26 May 2021.
A midst the plus points of reinvigorating Sri Lanka’s tired nature and environment, COVID-19 would leave behind, that is if even this small isle situated in the Indian ocean is to see the last of it, a legacy of issues in the spheres of society, psychology and health. Children being forced to remain at home and kept out of their school environment, large numbers losing their jobs when earlier such instances only came up due to political reasons, fear, a drastic increase in anti- social behaviour in children and adults, crime, and possibly long term and short-term health issues stemming from the SARS CoV-2 virus. The country’s burden would be the heavier to carry.
According to Professor and Consultant in Clinical Immunology and Allergy, Institute of Immunity and Transplantation, Royal Free Hospital and University College, UK, Suranjith Seneviratne, many countries with big outbreaks such as the one that is currently being experienced in Sri Lanka were being affected by what is termed as ‘Long COVID’, which needs to engage the attention of medical practitioners in several disciplines to help manage the cases. It may require the efforts of the psychologist, the physiotherapist, the occupational therapist and perhaps even the clinician who initially attended to him or her while being in hospital with the viral infection. A General Practitioner alone would be unable to handle the list of health issues related to a ‘Long covid’.
Such ‘Long COVID’ symptoms could and would make one believe that they were imagining themselves to have these symptoms. But it is not a psychological issue but were several issues which need to be addressed even by the occupational therapists to ensure that these persons were able to go back to their lives.
There was wide scale research going into Long COVID which has also become a public health crisis in several countries. ‘Long COVID’, describes varied symptoms that persist even after four weeks from the onset of a diagnosed COVID-19 infection. Prof. Seneviratne said that the most common symptoms include fatigue, breathlessness, and cough while there were also those who have palpitations, chest pain gastrointestinal dysfunction, and even neural and cognitive discrepancies such as forgetfulness. The situation is such that there are those who are unable to revert to their day-to-day activities or perhaps engage in their professions as they formally did.
Some of those who seek medical attention say that they are unable to walk the same distances that they used to when they were in good health.
Professor and Consultant in Clinical Immunology and Allergy, in addition to boosting the immune system during post viral syndrome or post viral fatigue people also need adequate sleep, a balanced a proper meal, exercise and maintain their Vitamin D level in the mid-range. A person daily requires about 1,000 international units of the vitamin D. Although people in Asian countries like Sri Lanka are able to obtain this from the sun, they too are not able to be exposed themselves for long periods. There aren’t many food items that have vitmin D either. Therefore, the low vitamin D level is best to supplemented for a minimum period of four months. At the same time being a non-expensive, easy to do intervention not too much of the vitamin should be taken.
Sri Lanka entertained the herbal concoctions and syrups during the second wave towards the latter part of last year in a bid to boost immunity. That was one reason why the herbal syrups was in such demand for a certain period last year also during the second wave of COVID-19.
However, with the extended families in Sri Lanka there is a large amount of social support to encourage any person who is perhaps going through these symptoms which has nothing to do with any psychological disorder in them, to overcome he observed.
The local experience
Consultant Physician, Dr. Eranga Narangoda who is currently at Base Hospital Homagama said that while patients who recover from COVID-19 could have non- specific issue lasting for several months there were also those who lung issues as a result of COVID pneumonia. They could have developed issues in their lung tissue due to the complication. This could be more serious case which requires close medical attention. The hospital hosts a clinic in which fully recovered discharged patients were asked to attend after a lapse of two weeks of being cured of COVID-19. Patients who have significant symptoms of lung complications were asked to undergo a chest X-Ray and a CT scan. Only five% of COVID-19 patients developed lung issues owing to COVID pneumonia however, he said.
Such lung issues could be permanent and would result in these persons having to remain under medication for long periods which could even be for the rest of their life. They may even have to use an inhaler like patients with asthma. He warned that smokers were most vulnerable amongst those who suffered such long COVID effects and were at times forced to lifetime medication even after recovering from the virus.
Dr. Narangoda observed that there were also those who attended the clinic with non-specific symptoms such as fatigue etc which were part of post viral syndrome. However even these symptoms could affect their jobs and their lives and therefore need attention.
Both these categories should seek medical attention- especially those who have a persistent cough and breathing difficulties.
- Findings on Long COVID
According to reports and studies post-COVID conditions were a wide range of new, returning, or ongoing health problems people experienced for over four weeks after first being infected with the virus that causes COVID-19. Even people who have no symptoms when they were infected could have post-COVID conditions.
The Centres for Disease Control and Prevention (CDC) of the United States notes that experts around the world were working to learn more about short- and long-term health effects associated with COVID-19.
- The post COVID Conditions or Long COVID symptoms identified by it were:
Tiredness or fatigue
Difficulty thinking or concentrating (sometimes referred to as ‘brain fog’)
Loss of smell or taste
Dizziness on standing
Fast-beating or pounding heart (also known as heart palpitations)
Difficulty breathing or shortness of breath
Joint or muscle pain
Depression or anxiety
Need to remember
- Also, the more serious issues are when the lung tissues are affected.
- May lead to life time medication
- A complete recovery may take five to six months when affected with non-specific symptoms. But there are a large number of studies across the world to gather more information on Long COVID to arrive at a definite time period of recovery.
In the years to come if the country does get over this pandemic crisis, the State health service may be called upon to cater to more and more of Long COVID clinics as the entire country is affected by the coronavirus.