Last week, the government acknowledged that an increasing number of people are being afflicted with post-Covid syndrome or long Covid.
It takes roughly two weeks to recover from mild or moderate Covid-19, but some people experience lingering health problems after recovering from the acute phase of the illness.
Such patients, including those who originally had no symptoms, might indeed be severely debilitated, and medical science has yet to find a clear reason as to why this happens.
People living with long Covid – or “long haulers” as they are called – suffer from a broad spectrum of symptoms, such as fatigue (the most common symptom), breathlessness, chest pain or tightness, brain fog, insomnia, tachycardia (a fast heartbeat) upon movement, palpitations, dizziness, pins and needles, joint pain, depression and anxiety, tinnitus, ear aches, feeling sick, diarrhoea, stomach aches, loss of appetite, intermittent fever, headaches, sore throat, changes to sense of smell or taste, and so on.
Our statistics show that 62.4% of Covid-19 category 4 and 5 patients continue to have symptoms even after more than three months.
Long haulers live with profound uncertainty as symptoms recede and return, sometimes inexplicably.
Apparent recoveries can be followed months later by heart-breaking relapses.
The Health Ministry has put in place measures to support long Covid sufferers. There are around 30 public hospitals nationwide offering rehabilitation services. However, the queue and wait time to get an appointment is long.
And more importantly, most of the public do not know such programmes exist.
Some private hospitals also offer such rehabilitation programmes, but the price may be steep and most insurance companies do not cover these inpatient and outpatient services.
While the authorities are working with different groups to provide better care for those with long Covid symptoms, more needs to be done.
Says consultant rehabilitation physician Dr Nor Azira Ismail: “I hear a lot of people complaining about having post-Covid-19 symptoms, but I wonder where they go and what they do?
“Not many people are coming in voluntarily for long Covid consultations unless they are referred by a respiratory physician.
“So far, I’ve only had one patient who came to improve her cardiac endurance (by herself) as she had cardiomyopathy.
“People don’t seem to look at function and quality of life; when they recover from Covid-19, they are relieved, so whatever function they have left, they just manage and cope.”
Around 60% of long Covid patients belong in the working age group and rehabilitation is important so that they can go back to their pre-illness state and be independent again.
She says: “The virus causes your body systems to go haywire and there are problems from head to toe – they have multisystem issues;
“Some can cope with normal activities, but when they start working, they notice they lose concentration after an hour, so we have to address each person individually.
“We don’t want to miss anything that is disturbing their life.”
Working together
When a patient comes in for consultation, the rehabilitation physician will assess his problems and work on goals.
Those with severe symptoms need to be admitted for two to four weeks, or more, if required.
Usually, those in the working age group want to get back to work as soon as possible, but there are some who still need oxygen supplementation as their lungs are not working optimally.
“They may be afraid or anxious of getting off the oxygen, and we need to rebuild their confidence, so we assist them in terms of breathing.
“Other patients appear healthy, but when they sit up in bed, their oxygen levels drop to 60% and they get very scared,” shares Dr Nor Azira.
She explains: “We look at a few parameters, including the heart rate and blood pressure.
“These two go together: when you lack oxygen, your heart rate goes up, and that means your heart is compensating by pumping harder.
“When you have anxiety, your heart also pumps harder and these things contribute to breathing issues.”
The post-Covid rehab programme may consist of doing 30 minutes of intense physiotherapy, followed by a five-minute rest, then 30 minutes of occupational therapy, five minutes rest, and so on.
Muscle-strengthening activities do not need equipment, especially for patients who are very weak.
She says: “If you ask them to push your hand, which is giving resistance, it’s also a way of strengthening.
“Imagine having to do that for 30 minutes – it can be very tiring.
“If they cannot sustain it, then we reduce the time.
“Patients go through at least five or six sessions daily, depending on their capability – it’s tough love!”
Any rehabilitation requires a bit of pushing for the patient to improve.
Dr Nor Azira points out: “It’s not torture! We are doing things together and the patient’s input is important, so they must tell us if they are tired or if they cannot take the intensity of activity.
“If we push too hard, it might cause the heart rate to soar further and this can induce arrhythmia. We don’t want patients to have a heart attack when they exercise!”
Once the patients’ goals are met and they can confidently and safely do the activity, they can be discharged.
However, she admits that with long Covid, patients seldom return to pre-fitness levels.
“They either have lingering fatigue issues or get palpitations easily, which could be psychological as well.
“We do counsel them; however, since there is a stigma with mental health, some of them don’t want to be implicated with having a psychiatric condition as it can impact work, promotion, etc.
“It’s something of a worry, especially in the private sector,” she says.
Still, Dr Nor Azira wishes more people are aware that rehabilitation help is available for long Covid and patients don’t have to suffer in silence.
“If long Covid is affecting your quality of life, consult a rehab physician to see if something can be done.
“We can sit down and talk – rehab is not only physical and medical as we see the patient as a whole.
“Many simple things can help, even going to the spa!” she says.
Already a subscriber? Log in
Get 20% OFF The Star Digital Access
Cancel anytime. Ad-free. Unlimited access with perks.
