Long COVID Syndrome Health experts make call to stay positive during road to recovery

 Health experts affirm that despite the challenges during the pandemic people shouldn’t be burdened with negative news

• Many had an impact on their cognitive abilities where their abilities to listen and understand were impaired
• Lesser deaths were reported in patients who had chronic lung diseases and asthma compared to patients with diabetes, obesity and kidney diseases
• The message given is that patients shouldn’t stop their asthma medication even if they test positive for COVID
• Ideally after two weeks a patient would return to normal, but in some cases it would take 6-8 weeks or even one year
• Certain groups of people- such as children- are sensitive to information and that they shouldn’t be burdened with negative news

The COVID-19 pandemic has taken a heavy toll on people’s day-to-day lives. Medical experts claim that living with uncertainty makes people anxious and this could lead to various health conditions. However, those who have tested positive for the virus may or may not experience prolonged symptoms which would last for a few weeks or longer. This condition is also known as ‘Long COVID Syndrome’ and has been identified in the Sri Lankan context as well. 

What is Long COVID?

The mental and physical demand makes them feel tired and they will complain of symptoms. On the other hand, males employed in 9-5 jobs have complained of symptoms. They would have been asymptomatic, but now they have developed symptoms. 
Dr. Neranjan Dissanayake

“Symptoms attributed to COVID would last for around four weeks, three months or even more,” said Dr. Neranjan Dissanayake, Consultant Respiratory Physician, Teaching Hospital and District Chest Clinic, Ratnapura. “These could either be sub-acute symptoms or symptoms of chronic Long COVID Syndrome. Even after acute symptoms are recovered you persist to have symptoms. People with mild symptoms usually recover within 14 days, but those with moderate symptoms would take between three to four weeks to feel better. These individuals go on having various symptoms.” said Dr. Dissanayake. 

Symptoms in the local context

“In the Sri Lankan context most people who visit our clinics had symptoms,” he continued. “Many complained of fatigue. Some were feeling breathless when they worked. Others said they felt a tightness in the anterior area of the chest. Another symptom was headache which wasn’t a normal headache, but more of a burning sensation. On the other hand many had an impact on their cognitive abilities where their abilities to listen and understand were impaired. Elderly people complained of loss of sleep. Some also experience gastroenterological issues and may have an abdominal influx. This would lead to loose stools, constipation and similar conditions. Some had feelings of nausea. There’s a prevalence of vomiting and nausea as well. Anecdotally people are very anxious. Some are on the edge and some are depressed and this could be attributed to long COVID,” the doctor explained. 
Dr. Dissanayake said that both males and females were affected by the virus. “A majority of females have complained of symptoms. This is because when they were in quarantine they were able to rest. But once they recovered and went home they were burdened with household chores; most of them have to work and play the role of mother. The mental and physical demand makes them feel tired and they will complain of symptoms. On the other hand, males employed in 9-5 jobs have complained of symptoms. They would have been asymptomatic, but now they have developed symptoms. If patients experience severe illness there will be damage to the heart, lungs and there would be blood clots in lungs as well.” he affirmed.  

High risk groups 

When inquired about risks to patients with chronic lung diseases and asthma Dr. Dissanayake said that lesser deaths were reported in patients who had chronic lung diseases and asthma compared to patients with diabetes, obesity and kidney diseases. “This could be because patients with respiratory illnesses are already taking precautions such as wearing masks, being secluded at home and so on. However this doesn’t mean that chronic lung disease is immune to COVID. These patients have a probability of dying if they contract severe COVID.
“We usually ask for the family history of patients who come with shortness of breath. Most of the time they complain of a running nose, wheezing attacks etc. Patients with a history of mild asthma should be aware of damage caused to the airways of the lungs. If inflamed the airways would be hyper responsive to external stimuli leading to constriction which will create a similar situation to asthma. Patients have complained of conditions such as rhinitis, 3-4 weeks after being discharged. Therefore the message given is that patients shouldn’t stop their asthma medication even if they test positive for COVID.”

Recovery depends 

Dr. Dissanayake reassured that even though it would be difficult to work like before it is part of the disease process and urged the public to not to exert. “Therefore, gradually incorporate yourself to this situation mentally and physically. Ideally after two weeks you would return to normal, but in some cases it would take 6-8 weeks or even one year. Recovery depends on the person. Underlying pathophysiology and support received from others play a role during recovery. On the other hand patients are dealing with much anxiety as they see a lot of people dying around them. I’m happy that we have been able to start post-COVID clinics with the guidance of Consultant pulmonologists which are dedicated to monitor the recovery of discharged patients. We intend to analyse their physical and psychological progress and develop them into rehabilitation clinics,” he said. 

A winning battle 

He also advised the public to get themselves vaccinated and not be misled by myths and what people say sans a scientific basis. “We now have vaccines with 60-70% effectiveness with possible side effects. Therefore the public should assist frontline healthcare workers at this moment. If you develop symptoms visit the hospital early, so that there won’t be a burden on resources. It is a long battle, but we can win this if we become more responsible.” he underscored. 

Complications for elderly persons

Elderly persons with chronic diseases or NCDs are in the high-risk group for getting complications of COVID. The most important precautions they can take is the vaccination and strictly adhering to health guidelines. 
Dr. Deepa Saranajeewa

Alarm bells have been rung regarding unvaccinated elderly persons who are succumbing to the virus as of late. “Although it is rare, there are a few patients who show certain post COVID conditions,” opined Health Ministry’s Directorate of Youth, Elderly and Disabled Persons Director Dr. Deepa Saranajeewa. “These post COVID conditions can be the continuation of respiratory ailments such as difficulty in breathing, change in taste and smell, general tiredness and body aches, diarrhea and sleep problems. Following severe illness and hospitalization the patients may also show severe weakness and exhaustion during the recovery period. Elderly persons with chronic diseases or NCDs are in the high-risk group for getting complications of COVID. The most important precautions they can take is the vaccination and strictly adhering to health guidelines. The protection of the vaccine is of utmost importance to anyone with comorbidities. In addition good compliance to the medical treatments of their comorbidities is extremely important now to ensure they are as healthy as they can be. All safety precautions should be strictly followed by the elderly who are with chronic diseases as well as those who care for them and live with them.” said Dr. Saranajeewa. 

Psychological impacts due to COVID 

There’s much anxiety because this sort of a situation hasn’t happened in recent times. People have fear of death and would react in a haphazard manner. They would be panic attacks or they would develop panic disorders and will lose the ability to think rationally”
- Dr. Jayamal De Silva

“Like during any other disaster this pandemic too has lasting psychological effects,” opined Consultant Psychiatrist at Colombo South Teaching Hospital Dr. Jayamal De Silva. “Some of the short-term impacts include the threat to us as well as our loved ones. There’s much anxiety because this sort of a situation hasn’t happened in recent times. People have fear of death and would react in a haphazard manner. They would be panic attacks or they would develop panic disorders and will lose the ability to think rationally. Realistically speaking people have the fear of losing employment. We have come across cases of atypical depression where people have complained that they feel a constriction in their throat and other unusual presentations, but nothing was found physically.
“Depression is understood by people who know it and general stress reactions could be witnessed,” Dr. De Silva added. “But there should be a certain degree of stress and anxiety or otherwise in order to keep oneself protected. If we are not anxious we would not adhere to safety guidelines. However such reactions could be overwhelming. People will experience acute stress reactions and they will be preoccupied with negative thinking if they come across people who exaggerate on negative news hence it’s best to stay away from them,” he added. He emphasised on the fact that certain groups of people- such as children- are sensitive to information and that they shouldn’t be burdened with negative news. 

Chronic conditions 

Speaking about long-term impacts he said that people have been under extreme stress for around one and a half years. “Chronic stress would lead to other conditions such as diabetes, gastritis, cholesterol, heart disease and other non-communicable diseases. When the brain receives a stress signal it stimulates the hypothalamus or the pituitary glands and release hormones. This results in a fight or flight reaction with increased blood pressure, increased metabolic rate and muscle activity. But if this happens every day there would be detrimental effects on our body. For example, muscles need energy and this comes in the form of glucose. But when these hormonal changes take place regularly they cause a surge in glucose supply to muscles which would eventually lead to diabetes,” he explained. 

Positive learnings 

“During the previous lockdown period we have observed a reduction in consumption of alcohol and tobacco,” he continued. “Due to the lockdown they had to stop it and many of them learned the health benefits of reducing alcohol and tobacco addiction and they are continuing with such practices. A substantial proportion of the people have given up on alcohol and tobacco smoking altogether.”

“From a social point of view events such as weddings were a burden on the less affluent people. In fact what is important is the union of two lovers. However the commercialisation of such events have resulted in unnecessary expenditure. With the pandemic, crowds have to be limited and people have realised that these kinds of socially manipulative events lead to unwanted expenses. This is another positive learning,” he added. 

Impact on psychologically challenged persons 

When asked how COVID impacts psychologically challenged person Dr. De Silva said that they would feel more burdened than others. “Since they are prevented from visiting clinics their medication will be stopped. As a result they may go into relapse. Therefore we are trying to post them their medication. Caretakers should keep in mind to give them their medications on time. If they haven’t received medication by post they could take records and visit a government hospital and any medical doctor will prescribe medicine. Or they could describe the situation to a general practitioner. On the other hand they could keep stock of medicine for two or three weeks,” he explained. 
He further said that changes in living situations may also have a negative impact. “Living in compact spaces will make them uncomfortable and they may get abusive. Hence caretakers should pay attention to early relapse signs. One way to control the situation is to temporarily increase the dose of medicine and avoid them facing stressful situations,” he added. 

Don’t worry too much! 

Dr. De Silva further said that while medical support is available in Sri Lanka people also need not worry too much about getting infected. “If we continue to worry too much it would lead to a reduction of our wellbeing. This in turn could weaken our immunity as well. One way out is to take yourself out of that situation. Another is to ask yourself why you’re worrying too much? We need to get along with our normal lives and for that we need to have a sound mind. Look at the pandemic as a temporary situation. If we can adapt ourselves to this situation then one fine day (hopefully sooner) we will be able to deal with the pandemic.” he underscored.