Long Covid stalks patients Experts urge study into lingering effect

A month after a 73-year-old patient was discharged from the hospital where she was being treated for Covid-19, her daughter said she still suffers from shortness of breath. In fact, the daughter said, her mother has had to rely on a cane to walk around her home.

The patient is suffering from what is known as “long Covid” — where symptoms of Covid-19 persist for weeks after contracting the disease.

“It took a lot of energy and support from the family [to help her recover]. I don’t think she would have recovered this fast if I wasn’t a doctor,” said Narittaya Varothai, the patient’s daughter and chief of geriatric medicine at Phramongkutklao Hospital.

The World Health Organization has warned that Covid-19 could cause long-term health problems, which may persist beyond 12 weeks after recovery. In some cases, it said, the problems can be severe enough to interfere with daily activities.

To understand the condition officially known as PASC — post-acute sequelae of Sars-CoV-2 — better, the United States’ National Institutes of Health (NIH) launched a US$470 million (15.6 billion baht) study under the “Research Covid to Enhance Recovery”, or Recover, programme.

According to the deputy director of Ramathibodi Hospital, Chonnamet Techasaensiri, only a few studies have been held into long Covid in Thailand. He asked for cooperation from hospitals — in particular those with their own medical schools and research institutes — to collate their patient data to gain a deeper understanding into long Covid.

Similarly, Dujrath Somboonviboon, a pulmonologist and intensivist for Phramongkutklao Hospital who is unofficially in charge of the hospital’s post-Covid ward, said Thailand needs to start following up patients to gauge the condition’s prevalence.

“There are reports which suggest long Covid can strike regardless of how severe the patient’s symptoms were. It has been reported among asymptomatic cases too,” she said.

“Some people may wrongly believe that because they are healthy and strong, they will be able to recover from Covid-19 in a short time. In fact, they may have to live with symptoms such as fatigue and sleeping disturbances for a long time,” Dr Dujrath said.

She also said that as Covid-19 can damage multiple internal organs — including the heart, lungs, brain and nervous system — many patients have reported ailments they didn’t have before they were infected.

Earlier this month, Journal of the American Society of Nephrology published a study which found an increased risk of kidney problems in the post-acute phase of the disease. The medical journal The Lancet called long Covid “a modern medical challenge of the first order”.

Covid-19 can also cause long-term cognitive impairment, which British experts believe is brought on by the significant reduction in grey matter in certain parts of the brain after recovering from the disease.

Figures for infections, recovery and death have been reported, but the “recovery” figures tend to reflect the number of people discharged from hospital, not those who still suffer persistent symptoms, Dr Dujrath said.

“Now we have over one million people identified as ‘recovered’. If we use data in other countries, we might now have over 100,000 cases of long Covid but it’s not adequately addressed and there has been no clear protocol for treatment for this group of patients.”

Medical personnel need to be prepared to care for post-Covid patients. Another issue is that some patients may find post-Covid healthcare hard to afford.

At present, the government covers only the cost of Covid-19 treatment, but not yet the follow-up and treatment of long Covid after being discharged from hospital. “For many patients, just the cost of getting to the hospital are a big burden already,” she said.

Dr Chonnamet said patients should seek advice if they notice any lingering health problems after recovering.

Dr Dujrath agreed, saying patients do not need to feel afraid to seek out support, as the condition does exist and the symptoms can be managed.

However, she added, it is important the patients have the support they need from their friends and family.

“Chances are, the patients are already worried about their changing health condition. People around them need to be more aware of the patient’s new limits,” she said.

“A patient of mine who is a mechanic once told me he was worried about his job security, as he used to be far stronger before he caught Covid-19,” she said, noting that most recovered patients complain about persistent fatigue, mobility issues and anxiety.

Out of the over 1,000 Covid-19 patients who were cared for by Phramongkutklao Hospital’s Pulmonary and Critical Care Division since May, about 200 have come back for a follow-up. Over half the patients reported one or more symptoms of long Covid, Dr Dujrath said.

In the case of the 73-year-old patient, Dr Narittaya said her mother reported a “brain fog”, shortness of breath and muscle weakness.

As such, her treatments at home were adjusted to focus on breathing practice and cognitive training — including conversational skills, as well as time and spatial orientation exercises — supplemented with proper nutrition.

“When patients begin to recover from Covid, their sense of smell and taste aren’t 100% back. Often, they feel too tired to eat. However, without proper nutrition, their bodies won’t be able to recover — in such cases, meal replacement drinks should be provided,” Dr Narittaya said.

It took three weeks for her mother’s tastebuds to start registering flavours again, Dr Narittaya said, before underlining the importance of preventive action to stop future Covid-19 outbreaks.

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