'Long Covid' causing distress among survivors in recovery

Larina Manilall uses plastic crockery and utensils for her safety, battles to communicate with her husband and child, is unable to work and can’t watch TV or type a text.

Doctors initially believed she was seeking attention or exaggerating her condition. But they soon realised the 41-year-old Durban woman is suffering from “long Covid” after contracting the virus in December — and her life has been turned upside down.

Most people with Covid recover in two to three weeks. But some can experience symptoms for months. There is no data on the prevalence of long Covid in SA, but medical experts understand from both local and global experience that about 30% of Covid patients will experience persistent symptoms beyond three months of the initial illness. 

Specialist physician and pulmonologist Dr Rubeshan Perumal, who treats patients at Groote Schuur Hospital Post-Covid-19 Lung Disease Clinic, said that based on the about 1.8-million confirmed Covid cases in SA, doctors estimate that more than half a million people have suffered long Covid over the past year — and many have probably still not completely recovered. 

Manilall is on a leave of absence from her job as a pharmacy manager at the Inanda Clinic, north of Durban, and when she is not being subjected to various medical tests, she is at home, barely making it out of bed on some days. 

“I went back to work in March and even my colleagues were surprised at my speech,” she said. “In my head I believed I was speaking properly, but that was not the case. I had problems with word placement and delayed speech. Since December I have fallen twice due to nasty dizzy spells. I was relieved to get the MRI results even though they showed 25 lesions on my brain and inflammation. It means I now have a diagnosis.” 

Manilall said she has to use plastic crockery because she often drops things. 

Natalie Bothma from Fish Hoek in Cape Town told the Sunday Times that her body is still covered in a rash she developed shortly after contracting Covid in January. “It’s like I have chicken pox … I went to my GP, who then referred me to a dermatologist,” she said. “They say it’s inflammation. I am very self-conscious about it.”

Another Covid survivor, Jerome Snyman from eMalahleni in Mpumalanga, said he had to give up driving as his hands often “just go numb”, while a burning sensation has persisted in his feet since November. 

“I am grateful to have survived Covid, but how much longer am I going to suffer?”

Perumal, who is a member of the World Health Organisation working group on care models for long Covid, said it is almost impossible to attribute a patient’s experience of their symptoms to any one organ system. 

“Breathlessness, fatigue and effort limitation are often multifactorial and may take their origin in the brain, heart, lungs, muscles — and often with a complex interaction between these systems. There are also tremendous effects of Covid on a person’s social, economic, emotional, and psychological wellbeing,” Perumal said.

“The severity of symptoms varies from mild chest discomfort to incapacitating breathlessness. Some patients report tiredness while others experience a severe form of fatigue that can best be described as a lead blanket, sinking these patients into a deep state of listlessness. Other common sequelae such as hair loss and skin rashes may not be serious from a medical perspective but can be extremely distressing to patients.” 

At the Groote Schuur clinic, doctors have seen patients across the full spectrum of characteristics, “young and old, previously fit and those with multiple co-morbidities, all races and from all walks of life”, he said.

HIV/TB specialist physician and head of the University of KwaZulu-Natal’s internal medicine department, professor Nombulelo Magula, said the laboratory diagnosis of long Covid without timeous clinical evaluation was a setback. 

“Clinical investigations are under way to determine the extent of the burden of long Covid in SA,” Magula said. “The challenge we face is that the laboratory data published on a daily basis is for public health surveillance and response purposes. The majority of the individuals tested are not assessed clinically for disease severity at the time of the laboratory diagnosis. Disease severity is a major risk factor for long Covid. 

“It is crucial that patients are assessed thoroughly, taking a comprehensive history and conducting a detailed clinical examination, followed by appropriate laboratory and radiological investigations, to determine the underlying cause of the presenting symptoms to ensure other diagnosis are not missed.”