Unravelling Post-COVID Syndrome
By Dr. Riaz Mowjood
With the rapid spread of the COVID-19 virus across Sri Lanka over the past 1.5 years, a large number of people are currently recovering from this infection. While most recover completely from the disease within a few weeks, many others continue to experience symptoms long after their initial recovery.
Older patients and those with serious medical conditions are most likely to experience lingering COVID-19 symptoms; however, even young, otherwise healthy people can feel unwell for more than 12weeks to months after the initial infection. This condition is termed Long-COVID.
Although COVID-19 is seen as a disease that primarily affects the lungs, it can damage other organs such as the heart and brain. This organ damage may increase the risk of long-term health problems. Some adults and children often go on to experience multisystem inflammatory syndrome after they have had COVID-19.
Further, emerging evidence suggests some patients are also at risk for multiple systemic complications, including thromboembolic disease, systemic inflammatory response syndrome, cardiovascular complications, and hepatic and renal impairment. There is also an identified disparity in outcomes for different patient groups; older age, chronic illness, and obesity.
Identifying symptoms and signs
Symptoms of long-haul COVID-19 can last for weeks to months or even longer. This may include patients having difficulty in breathing, sweating excessively, experiencing excessive weight loss, struggling with a persistent cough long after testing negative for the virus. Further, patients also may experience brain fog, fatigue, persistent loss of smell or taste, hair loss, cough, joint and chest pain, memory and sleep problems, depression and anxiety, fever, dizziness when standing, worsened symptoms after physical or mental activities and numbness.
In critical cases, COVID-19 can make blood cells more likely to clump up and form clots, leading to heart attacks and strokes. Other parts of the body that can be impacted by these blood clots include the lungs, legs, liver, and kidneys. The virus can also weaken blood vessels and cause them to leak, contributing to potentially long-lasting problems with the liver and kidneys.
Patients with severe symptoms of COVID-19 often have to be treated in a hospital's intensive care unit, with mechanical assistance from ventilators to breathe. Simply surviving this experience can make a patient more likely to develop post-traumatic stress syndrome, depression, and anxiety.
Returning to peak health after COVID-19
The Post-COVID period needs supervised care and a persistent cautious attitude. In general, treatment for long-COVID involves addressing each symptom. Fatigue, which is a symptom most patients complain of, can be addressed by indulging in plenty of rest and pacing one’s daily tasks throughout the course of each day. Good sleep hygiene which involves going to bed and getting up at the same time each day, avoiding screens before bed, and avoiding caffeine and alcohol late in the day are also good habits to inculcate during this period.
Depending on each situation, patients might also require, medicine to relieve symptoms like cough or pain; cardiac rehabilitation to improve heart health through things like exercise, dietary changes, and quitting smoking; pulmonary rehabilitation such as breathing exercises to help strengthen the lungs; physical and occupational therapy which involves learning exercises, movements, and ways of doing everyday tasks; treatment for anxiety or depression; and exercises and strategies to help with memory and focus.
Further, patients should readdress their ongoing medications for other pre-existing ailments, ensure a nutritious diet and adequate hydration, be vigilant and vocal about their mental health and most importantly follow up with a physician periodically.
Reducing the risk of 'Long COVID'
While it is true that most people who are infected will not get very sick, it's currently impossible to know who will recover quickly and who will have persistent symptoms. The best way to prevent severe COVID-19 is to get vaccinated, managing symptoms properly and slowly as well as by following a nutrient-rich diet that helps fortify the immune system. Individuals can also lower their risk by social distancing, wearing face masks in public, and washing their hands as often as necessary.
Nawaloka Hospitals currently operates a post-COVID care centre geared to provide comprehensive multidisciplinary care and psychosocial resources for patients recovering from COVID-19. Introduced as a part of the hospital's chest and sleep unit, the centre ensures that at-risk COVID-19 patients are monitored, supported, and treated to avoid succumbing to critical post-recovery complications of the virus.
[The writer is Dr. Riaz Mowjood, Resident Consultant Respiratory and Chest specialist and Head of Nawaloka Hospitals' Chest and Sleep Centre]