Survived Covid-19? This is why you are not off the hook for illness and death

If you're among the 1.5 million South Africans who have recovered from Covid-19 but remain unwell, you are far from alone.

In what is believed to be the largest study yet of “long Covid”, US researchers have catalogued numerous diseases and discovered that survivors — even those who were not hospitalised — have an increased risk of death in the six months after diagnosis.

The findings echo a report last December to health minister Zweli Mkhize from the ministerial advisory committee on Covid-19.

It recommended respiratory, cardiac and musculoskeletal rehabilitation in dedicated outpatient clinics, and said data on long Covid patients should be formally collected “given the considerable socioeconomic impact this condition may have”.

Researchers at Washington University School of Medicine in St Louis, who looked at more than 87,000 Covid-19 survivors, said long Covid was likely to place a “massive burden” on the world's population in coming years. 

“It is not an exaggeration to say that long Covid-19 — the long-term health consequences of Covid-19 — is America's next big health crisis,” said Ziyad Al-Aly, senior author of a paper about the team's findings published on Thursday in Nature.

“Given that the burden of long Covid-19 is substantial, the lingering effects of this disease will reverberate for many years and even decades. Physicians must be vigilant in evaluating people who have had Covid-19. These patients will need integrated, multidisciplinary care.”

Investigators found that after surviving the initial infection, Covid-19 patients had an almost 60% increased risk of death over the following six months compared with the general population.

“These later deaths due to long-term complications of the infection are not necessarily recorded as deaths due to Covid-19,” said Al-Aly.

“As far as total pandemic death toll, these numbers suggest that the deaths we're counting due to the immediate viral infection are only the tip of the iceberg.”

SA has recorded just over 54,000 deaths attributed to Covid-19, but the latest Medical Research Council estimate of “excess deaths” — those in excess of predicted numbers based on historical statistics — are almost three times higher.

The US researchers said they had confirmed that even though Covid-19 is initially a respiratory virus, over six months it can affect nearly every organ and regulatory system in the body, including:

• Respiratory system: persistent cough, shortness of breath and low oxygen levels in the blood;
• Nervous system: stroke, headaches, memory problems and problems with senses of taste and smell;
• Mental health: anxiety, depression, sleep problems and substance abuse;
• Metabolism: new onset of diabetes, obesity and high cholesterol;
• Cardiovascular system: acute coronary disease, heart failure, heart palpitations and irregular heart rhythms;
• Gastrointestinal system: constipation, diarrhoea and acid reflux;
• Kidney: acute kidney injury and chronic kidney disease that can, in severe cases, require dialysis;
• Coagulation regulation: blood clots in the legs and lungs;
• Skin: rash and hair loss;
• Musculoskeletal system: joint pain and muscle weakness; and
• General health: malaise, fatigue and anaemia.

While no survivor had all of these problems, many developed a cluster of issues that have a significant impact on health and quality of life.

Among hospitalised patients, those who had Covid-19 fared considerably worse than those who had flu, according to the analysis.

“Compared with flu, Covid-19 showed remarkably higher burden of disease, both in the magnitude of risk and the breadth of organ system involvement,” Al-Aly said.

“Long Covid-19 is more than a typical postviral syndrome. The size of the risk of disease and death and the extent of organ system involvement is far higher than what we see with other respiratory viruses.”

Al-Aly and his colleagues will continue to monitor the patients they studied and also plan to look at whether they fare differently based on age, race and gender.

In its report to Mkhize, the ministerial advisory committee said incidence of long Covid is higher in women than in men, and reported symptoms include fatigue (98%), headaches (91%), loss of smell (76%), shortness of breath (71%), persistent cough (69%), sore throat (67%), muscular pain (64%) and fever (63%).

Patients also reported depression, anxiety and post-traumatic stress disorder, it said, adding that stress-reduction techniques, peer support and referral to a psychologist or psychiatrist may be required

“Fatigue and low energy levels may be helped by graded exercise programmes, tailored towards the individual,” the MAC said.

“Key features are careful pacing, prioritisation and modest goal-setting. Patients should engage in low intensity exercise initially, increasing gradually only if tolerated.

“Where available, respiratory or cardiac rehabilitation programmes may be useful, particularly for those patients who had severe Covid-19, and/or who had significant underlying cardiopulmonary comorbidities.

“A six-week respiratory rehabilitation programme significantly improves respiratory function, quality of life and anxiety in older patients with Covid-19. Breathlessness and cough may respond to breathing control exercises.”

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