The COVID-19 pandemic has had a significant impact worldwide. Not only has COVID-19 caused huge mortality, it has also disrupted our day-to-day lives, general well-being and taken a toll on overall health.
With new variants of COVID-19, more transmissibility and more people experiencing ‘mild’ COVID-19 infection, some of us may experience ‘long COVID’.
What is ‘long COVID’?
The definition of ‘long COVID’, i.e., post-covid-19 syndrome, is evolving. Post-covid-19 syndrome is experiencing symptoms that develop during or after acute COVID-19 infection.
This can be further divided into three categories:
i) acute COVID-19 with symptoms of COVID-19 infection for up to 4 weeks;
ii) ongoing symptomatic COVID-19 where symptoms may last between 4 weeks – 12 weeks from onset; and,
iii) chronic or post-COVID-19 with symptoms last for more than 12 weeks. There can be varied symptoms, affecting multiple different organs, which tend to fluctuate in intensity and nature over time.
A diagnosis of post-COVID-19 syndrome does not necessarily need a positive test for COVID-19 infection. Usually, it is diagnosed by your doctor assessing your symptoms. This is because many individuals experiencing post-COVID-19 syndrome often have had a relatively mild acute illness or may have been asymptomatic, and hence, undiagnosed with COVID-19 infection.
What are the symptoms?
The commonest symptoms in the for those with acute COVID-19 syndrome tend to be fatigue and sleep disturbance, whereas, for those experiencing chronic post-COVID often notice anxiety and breathlessness.
However, there are a wide range of symptoms that can often be debilitating. These include:
• Fatigue, fever, body aches and pains.
• Breathlessness, cough
• Chest pain, chest tightness, palpitations (the feeling of your heart racing)
• ‘Brain fog’, with loss of concentration or memory issues
• Headache, changes in your sleeping pattern, dizziness
• Changes in your vision
• Numbness or tingling of hands and/or feet
• Abdominal pain, nausea and vomiting, diarrhoea
• Weight loss or reduced appetite
• Muscle or joint pains
• Mood changes – low mood and anxiety
• Skin rashes, hair loss
• Tinnitus (a ringing sound in ears), ear aches, sore throat, loss of taste and/or smell, nasal congestion.
Who tends to get it?
At the moment, we do not know why some people develop post-COVID-19 syndrome and other do not.
Early worldwide research has highlighted some risk factors:
• Prolonged low oxygen levels and/or admission to intensive care unit (ICU), requirement for ventilatory support during acute COVID-19 infection has been associated with persistent breathlessness, fatigue and muscle weakness.
• History of pre-existing lung-related disease
• Higher body mass index (BMI)
• Older age adults
• Female sex
• White ethnicity
Other factors which may contribute towards a prolonged recovery from COVID-19 are a weak or deficient antibody response following infection, a relapse or reinfection, inflammation within organs and blood vessels and mental factors, such as post-traumatic stress.
A special note for children
Most children affected by COVID-19 infection tend to be asymptomatic or have less severe disease than adults. Naturally, the concern that many parents have is therefore focused more on the possible long-term effects of COVID-19 for their children’s overall health.
Currently, many studies are underway to understand these long-term effects of COVID-19 on children.
We know from the latest findings that children may experience respiratory-related concerns and general conditions, such as headaches, as possible long-term related effects of COVID-19 infection. However, these conditions usually do not require Specialist intervention and tend to be managed well for children.
The pandemic has lent to nearly a third of all children and adolescents reporting anxiety and/or sadness, regardless of their COVID-19 infection status. This is important to be highlighted for all parents, caregivers and healthcare teams to ensure all children and young people are being holistically cared for.
What do I do if I’m experiencing symptoms?
As we are seeing higher numbers of COVID-19 infections in Singapore and worldwide, post-COVID-19 syndrome is likely going to be more frequently seen.
If you are experiencing any of the above symptoms, please come and speak to us. Based on your assessment you may require further investigations to ensure no other underlying illness is causing your symptoms. This may include some blood and urine tests, ECG (electrocardiogram) and/or x-rays.
In some instances, you may need to see a Hospital Specialist and we will discuss this with you in depth.
In addition to assessing and reviewing symptoms of post-COVID-19 syndrome, we can also help in managing your other chronic illnesses which will require a thorough review following COVID-19 infection, such as high blood pressure, diabetes, kidney disease to name a few.
At present times, we do not have all the answers and optimal treatment methods for post-COVID-19 syndrome. We understand the anxiety this uncertainty brings and the ways it can severely impact your personal and professional life.
At Osler Health International, our patients are our priority and we ensure to guide you through this uncertain period and transition with the support of compassionate healthcare and allied health professionals.
Dr Trisha is a British trained family doctor who is based at Osler Health Star Vista clinic.
For appointments call: T: 63392727
Resources:
1. National Institute for Health and Care Excellence (NICE) guidelines. COVID-19 rapid guideline: managing the long-term effects of COVID-19. Published 2/1/2022.
2. Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care BMJ 2020; 370 :m3026 doi:10.1136/bmj.m3026
3. Ontario College of Family Physicians: Answers to questions about Long COVID, April 2021. + check more https://www.ontariofamilyphysicians.ca/tools-resources/covid-19-resources/long-covid
4. Dani M, Dirksen A, Taraborrelli P, Torocastro M, Panagopoulos D, Sutton R, Phang BL. Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clinical Medicine Jan 2021, 21 (1) e63-e67; DOI: 10.7861/clinmed.2020-0896
5. Nalbandian, A., Sehgal, K., Gupta, A. et al. Post-acute COVID-19 syndrome. Nat Med 27, 601–615 (2021). https://doi.org/10.1038/s41591-021-01283-z
6. Van de Vyver J, Leite A C, Alwan N A. Navigating the social identity of long covid BMJ 2021; 375 :n2933 doi:10.1136/bmj.n2933
7. Nasserie T, Hittle M, Goodman SN. Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19: A Systematic Review. JAMA Netw Open. 2021;4(5):e2111417. doi:10.1001/jamanetworkopen.2021.11417
8. David A S. Long covid: research must guide future management BMJ 2021; 375 :n3109 doi: 10.1136/bmj.n3109
9. Zimmermann P, Pittet L F, Curtis N. Long covid in children and adolescents. BMJ 2022; 376:o143 doi:10.1136/bmj.o143
10. Magnusson K, Skyrud K D, Suren P, Greve-Isdahl M, Størdal K, Kristoffersen D T et al. Healthcare use in 700 000 children and adolescents for six months after covid-19: before and after register based cohort study BMJ 2022; 376 :e066809 doi:10.1136/bmj-2021-066809
11. Matta J, Wiernik E, Robineau O, et al. Association of Self-reported COVID-19 Infection and SARS-CoV-2 Serology Test Results With Persistent Physical Symptoms Among French Adults During the COVID-19 Pandemic. JAMA Intern Med. 2022;182(1):19–25. doi:10.1001/jamainternmed.2021.6454
12. Iqbal FM, Lam K, Sounderajah V, Clarke JM, Ashrafian H, Darzi A. Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and meta-analysis. EClinicalMedicine2021;36:100899. doi:10.1016/j.eclinm.2021.100899 pmid:34036253
13. Munblit D, Bobkova P, Spiridonova E, et al., Sechenov StopCOVID Research Team Incidence and risk factors for persistent symptoms in adults previously hospitalized for COVID-19. Clin
