Long Covid: Recovery and support

AS more new Covid-19 cases are reported every day, Malaysia will have to prepare for the inevitable increase of those suffering from long Covid and provide the necessary support. This is particularly vital as we move into the endemic phase of Covid-19.

In order to craft a comprehensive response, further information is needed on the conditions of long Covid in a local context, which can help the government introduce policies that can adequately address the situation.

Post-Covid syndrome, also known as long Covid, refers to the persistent state of ill health experienced by Covid-19 survivors, who although no longer infectious to others, experience a range of symptoms that continue for weeks or months beyond the initial illness. It can happen to any Covid-19 patient, including those who were not hospitalised.

Some patients develop medical complications that may have lasting health effects. A Chinese study published last month in The Lancet showed that in some cases, long Covid can last for more than a year.

The United States’ Centers for Disease Control (CDC) defines post-Covid syndrome as “a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes Covid-19.”

Meanwhile, the United Kingdom’s National Institute for Health and Care Excellence defines Acute Covid-19 as signs and symptoms of Covid-19 that remain for up to 4 weeks, Ongoing Symptomatic Covid-19 as signs and symptoms that persist from 4 weeks up to 12 weeks, and post-Covid syndrome as symptoms that continue for more than 12 weeks.

A clinical study, published in June, conducted by the Health Ministry on 1,004 category 4 and 5 Covid-19 patients, found that 66% had long Covid, where patients continue to show symptoms for 12 weeks or more.

Long Covid in Malaysia

To gather more information on the state of long Covid in Malaysia, Prof Dr Moy Foong Ming of Universiti Malaya’s Faculty of Medicine and her colleagues Prof Dr Awang Bulgiba Awang Mahmud and Prof Dr Noran Naqiah Hairi are also conducting an ongoing study looking into post-Covid 19 conditions among Covid-19 survivors in Malaysia.

Dr Moy explains that although the percentage of those suffering from long Covid is only about 20%, with 1.5 million former Covid-19 patients recovered and returning to the community, the number is quite substantial. These individuals may face a variety of challenges once they return to their daily lives.

Initial findings show that the most commonly reported symptoms for long Covid were tiredness (11.5%), feeling anxious (9.4%) and depressed (8.1%), brain fog (9.8%) and insomnia (8.3%).

“From our preliminary findings on long Covid among 525 respondents from the community setting, 46.7% and 20.6% of them experience post-Covid symptoms up to 12 weeks and more than three months, respectively,” says Prof Moy, whose research defines long Covid as symptoms which persist more than three months post recovery.

The study also found that there is no difference in the proportions of long Covid among the different age groups.

According to Dr Moy, long Covid is significantly associated with the severity of the infection.

“There are higher proportions of respondents suffering long Covid for those in the severe category (require oxygen) which is 31.3%, followed by moderate (28.8%), mild (17.2%) and no symptoms (7.8%),” she says.

One effect of long Covid is reduced work productivity, as more than one third of respondents reported that their work is affected and had to take leave or reduce work hours due to prolonged symptoms. Post-Covid patients who suffer brain fog may have their jobs affected, said Prof Moy.

What compounds the difficulty they face is that employers, family members and peers may not be understanding and have little empathy for the situation faced by individuals suffering from long Covid. Their mental well-being may also be affected with symptoms of anxiety and depression.

While stage 4 and 5 Covid-19 survivors have follow-up sessions by clinics or hospitals, survivors in categories 1,2, and 3 are not, and will need to seek help from either private or public primary care clinics.

“These individuals need to be educated and informed on when and where to seek treatment. Support for mental well-being should also be provided,” says Dr Moy, who suggests that NGOs establish support groups with the guidance from healthcare professionals.

Any Covid-19 survivor (regardless whether or not they experience long Covid) who would like to participate in the Universiti Malaya study can find the survey at this link: https://redcap.link/o13kt7tr

Rehabilitation facilities

According to Health director-general Tan Sri Dr Noor Hisham Abdullah, treatment for long Covid patients is based on the symptoms exhibited by the patient (symptomatic relief) and the body functions involved.

In the UK, the National Health Service (NHS) has set up Post-Covid Care Centres offering specialist help at clinics across the country. In Malaysia, some public hospitals such as University Malaya Medical Centre and Sungai Buloh Hospital provide dedicated Long Covid clinics. Private hospitals and medical centres are also setting up post-Covid health checks, rehabilitation, and recovery programmes.

Some of the major challenges faced by Malaysians who are suffering from long Covid is the lack of empathy or understanding by others, says Dr Helmy Haja Mydin, a respiratory physician at a Kuala Lumpur hospital.

“As some aspects of long Covid are not easily demonstrable or physically/objectively measurable, it is easy to dismiss the manner in which it can impact patients. This has an impact on social interaction, work placement and expectations,” Dr Helmy says.

For the long term, there are a number of policies that can be introduced here in Malaysia to assist those struggling with long Covid.

“There is a lot of discussion regarding the need for acute hospital beds, ICUs, and so on but not enough regarding the need to prepare short-term and medium-term rehabilitation facilities that will allow patients to recover faster,” says Dr Helmy, who explains that this will have subsequent impact on social and economic activities.

He explains that rehabilitation facilities can range from the provision of oxygen use to physiotherapy, and it should also include increased provision for mental health support on top of physical recovery.

“There should also be a mechanism in place that recognises the potential need for prolonged medical leave following Covid-19. This will allow employees to get the necessary rest and recovery period prior to returning into a more productive position.”