Psychological scars from long Covid

Anyone who develops post Covid-19 symptoms should seek help at the rehabilitation centres run by the Health Ministry. — Filepic

For some of us who have recovered from Covid-19 and are still experiencing some symptoms, we could have what is known as post-Covid or long Covid.

According to Dr Janet Diaz, the World Health Organization’s Head of Clinical Management, this emerging illness occurs in individuals who have had confirmed or probable new coronavirus infections, “usually three months on from the onset of the Covid-19, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis.”

She explained that some of the most common symptoms of long Covid, include shortness of breath, cognitive dysfunction, which people call brain fog, as well as fatigue.

These are the three most common symptoms.

However, there have been more than 200 symptoms that have been reported in patients.

Besides brain fog, which is characterised by concentration and memory problems, other symptoms in the mental health arena would include anxiety, depression and sleep disturbances.

We do not yet know what causes these distressing symptoms, but there are several possibilities for why they may occur:

They could be the result of the specific effects of Covid-19 on the brain, the immune system, or other organ systems.

They could also be the result of traumatic aspects of the experience of having Covid-19.

No explanation

It is well known that long-term hospitalisation, particularly in intensive care units, can lead to what is called post-intensive care syndrome, which often includes severe weakness, cognitive problems like poor concentration and even post-traumatic stress disorder.

This theory, however, does not explain why severe mental health symptoms occur in people who were not seriously ill at the time of their initial infection.

Another possibility to be considered is that ongoing psychological symptoms could be due to despair patients experience from long-term breathing problems or persistent fatigue.

Our understanding of how long this condition lasts is still not completely clear.

It has been described that long Covid can last three months; some have described it as six months and potentially up to nine months; or even one year according to other emerging findings.

Locally, statistics have shown that 60% to 70% of long Covid patients recover after six months from infection, said Health Minister Khairy Jamaluddin.

The minister must be congratulated on his far sightedness in directing the establishment of long Covid rehabilitation centres throughout the country.

He said the comprehensive rehabilitation programme involves interdisciplinary specialists, including rehabilitation specialists, medical officers and physiotherapists, adding that other specialists can be provided based on the specific needs of the patient.

Presumably mental health services would also play a crucial role in this rehabilitation programme.

Undoubtedly, some people may feel their symptoms are dismissed or taken lightly by their families, or their workplace, leaving them feeling alone and frustrated.

In some reported cases, even their doctor did not believe their symptoms; complex medical concerns were attributed only to anxiety.

Part of the reason for this apathy is because we do not yet understand why long Covid develops.

We still need to learn of the mechanisms of the disease developing, only then can we narrow down on a specific treatment.

Some Covid-19 survivors feel their symptoms are not taken seriously by their families and employers, leaving them feeling alone. — dpaSome Covid-19 survivors feel their symptoms are not taken seriously by their families and employers, leaving them feeling alone. — dpa

A significant study to validate the reality of long Covid was one conducted by Tan Jin-In hospital in Wuhan, China, which was published in the August 2021 issue of The Lancet.

The authors reported that they compared adult patients who had been hospitalised with Covid-19 to a group of age-matched adults living in the same community who had not been infected with Covid-19.

After one year, half of the infected patients had fully recovered, but the other half reported at least one continuing symptom. Covid-19 survivors had more mobility problems and mental health symptoms like pain, anxiety and depression, than control participants.

We do not know if long Covid represents a distinct syndrome, or if it is like other post-viral syndromes.

We must also be careful to not dismiss new symptoms as reflective of a post-Covid condition because this could lead new illnesses or conditions to be missed.

Last month, Dr Patrick Soon-Shiong, an American transplant surgeon and billionaire bio-scientist quoted on CNN: “For months and months this virus will continue to reside in the body, in fact in every vital organ in the body, with no known long-term consequences. The virus may even go deep into the bone marrow and this is of concern because some viruses are known to cause cancer.”

Therefore, while we continue to comprehend the true nature of long Covid, it is very clear that preventing the Covid-19 infection is the best way to prevent the development of long Covid.

We know for sure that vaccination reduces hospitalisation, and mortality.

Public health measures such as mask wearing in the appropriate places, physical distancing and handwashing are proven measures to prevent Covid-19.

We should also heed Khairy's advise that any person who develops post Covid-19 symptoms should go and seek care in rehabilitation centres operated by his Ministry.

In many countries we now see support groups being formed to provide people struggling with long Covid the opportunity to connect with each other.

These groups serve to ensure people that they are not alone in their suffering and connect them to available resources and information.

This is crucial because many patients have experienced frustration, as doctors often do not have solutions to address their symptoms and cannot tell them what to expect or when and if they will return to normal.

Those in need to discuss their mental health challenges related to long Covid may contact Malaysian Mental Health Association for advice on appropriate mental health support.

Datuk Dr Andrew Mohanraj is a consultant psychiatrist, Green Ribbon Group policy advisor and Malaysian Mental Health Association president. For more information, email The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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