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As of the time of writing, there are approximately 27,000 active cases of Covid-19 cases in Malaysia. Besides the jaw-dropping number of cases reported in the urban areas everyday, Covid-19 outbreaks were also detected in the rural areas, where the lack of healthcare services is a huge concern. The Director General of Health Malaysia Datuk Dr Noor Hisham Abdullah pointed out that for the first nine months of year 2020 the total deaths associated with Covid-19 were less than 100; yet we achieved 71 death cases in just the first nine days into 2021.

While most people with Covid-19 recover and return to normal health, some Covid-19 survivors can have symptoms that can last for weeks or even months after recovery from it. This is to say that even after Covid-19 survivors were discharged from the hospitals and thought it’s all over–

Tens of thousands of people in the United States have such a lingering illness following Covid-19. In the US, they were called post-Covid “long haulers.” In the United Kingdom, they are said to be suffering from “long Covid.”

Indeed, published studies (1,2) indicate that 50% to 80% of patients continue to have bothersome symptoms three months after the onset of Covid-19— even after tests no longer detect virus in their body.

If you think that only individuals with severe Covid-19 suffer from long-term consequences, that’s not true – even people who are not hospitalized and who have mild illness can experience persistent or late symptoms.

“My fatigue was like nothing I've experienced before”

One of the most commonly reported sequelae of Covid-19 infection is persistent fatigue. A study conducted in Wuhan, China found that 63% of the Covid-19 patients they studied experienced fatigue within 6 months after being discharged from the hospitals. Jade, a Covid-19 survivor from the United Kingdom, quoted saying “My fatigue was like nothing I've experienced before”. For the record, she is only 32 years old, living a healthy lifestyle (she goes to the gym three times a week) and only had mild symptoms of Covid-19 infection. Study confirmed that persistent fatigue following Covid-19 infection is a common symptom, regardless of the severity of the disease.

Just imagine going from your young, energetic self to become someone who is always tired and feeling fatigue. And no, this persistent fatigue is not the same as the one you experienced after watching a whole night of K-drama and go to work the next morning. It can be a debilitating symptom that affects your work performance, personal safety and the ability to enjoy your life.

Permanent lung damage

Covid-19 infection is a viral infection that affects primarily (but not exclusively!) the airway and lung. It can cause things ranging from mild upper airway symptoms that are similar to flu, to progressive life-threatening pneumonia.

This image shows a CT scan from a man with Covid-19. Pneumonia caused by the new severe acute respiratory coronavirus 2 can show up as distinctive hazy patches on the outer edges of the lungs, indicated by arrows. Photograph: AP. Image courtesy of The Guardian at https://www.theguardian.com/world/2020/apr/15/what-happens-to-your-lungs-with-coronavirus-covid-19

How does Covid-19 damage the lung?

Your lungs contain millions of tiny air sacs called the alveoli – they are like balloons filled with air. You count on these alveoli to contain oxygen for you and pass the oxygen to the bloodstream to be used by your body. Covid-19 infection can cause these alveoli to deflate or collapse.

Some of these infections progress to acute respiratory distress syndrome (ARDS), in which those alveoli were filled with fluid. Once the alveoli deflate or fill with fluids, they can no longer fill with oxygen. Your blood is now low in oxygen and you are at risk of lung failure.

As a result, some Covid-19 survivors can also experience long-term breathing problems such as shortness of breath or breathlessness, as well as chest tightness and coughing. By examining the lungs of some Covid-19 survivors, scientists confirmed that some Covid-19 survivors indeed suffered from lung injury and deterioration in lung function.

Is Covid-19 lung damage reversible?

After a serious case of COVID-19, a patient’s lungs can recover, but not overnight. When there is an injury to the lungs, it will be followed by scarring. Over time, the lung tissue heals, but it can take three months to a year or more for a person’s lung function to return to pre-Covid-19 levels.

The damage is beyond lung

While it primarily affects the lungs, SARS-CoV-2, the virus that caused Covid-19, is not satisfied with just damaging one’s lungs. Some Covid-19 survivors experienced long-term consequences which are not lung-related, such as:

Multiple organ damage

A study on young (an average of 44 years old), low-risk population with Covid-19 infection, almost 70% of them have impairment in one or more organs four months after the first symptom appeared. The reported organ damage includes those at the heart, kidneys, liver, pancreas and spleens.

"Novel Coronavirus SARS-CoV-2" by NIAID is licensed under CC BY 2.0

Kidney is one of the main targets of Covid-19 unpleasant sequelae. Many of the severely ill Covid-19 patients died because of kidney failure. One of the reasons is the cells at kidneys contain the ‘entrance door’, i.e. ACE2, that helps SARS-CoV-2 to gain entry into our body system. Once SARS-CoV-2 enters into the kidney cells, they destroy them mercilessly and set off a chain of inflammatory events that further damage the kidney tissues.

Another important organ, the heart, is not spared from Covid-19 either. A growing number of studies suggest many Covid-19 survivors experience some type of heart damage, even if they didn't have underlying heart disease and only had mild Covid-19. A study that looked at the hearts of 100 Covid-19 survivors found that 78% of them have some abnormalities in their heart and 60% of them have heart inflammation. What that means of these people is that they may end up feeling fatigue and exhausted; also, they might not get up to the active level they were at before. Things could be even worse for those who had underlying heart disease.

It’s like dementia arrived earlier than it should

‘I feel like I have dementia’, said Ms. Mizelle, a 53-year-old Covid-19 survivor. A small group of Covid-19 survivors experienced what is known as the Covid-19 brain fog, which can include memory loss, confusion, difficulty focusing, dizziness and grasping for everyday words.

Increasingly, Covid-19 survivors say brain fog is impairing their ability to work and function normally. Experts say some of the symptoms they are experiencing are thought to be caused by postural orthostatic tachycardia syndrome (POTS), a blood circulation disorder. The inadequate control of blood flow in POTS may be what leads to brain fog, increased heart rate and severe long-term fatigue.

Brain damage and psychological problem

Not that we want to scare you deliberately, but it appears that Covid-19 can also cause neurological and psychological problems as consequences. One of the first spectroscopic imaging-based studies of neurological injury in Covid-19 patients found that the severity of neurological symptoms varies, ranging from one of the most well-known — a temporary loss of smell — to more severe symptoms such as dizziness, confusion, seizures, and stroke.

A study in the UK found that persistent fatigue, breathlessness and psychological distress were commonly reported at 7 weeks after Covid-19 survivors discharged from the hospital, with many of them experiencing a significant drop in their quality of life. Unfortunately, life after Covid-19 may not be rosy for some — a handful of them struggled with mental health disorders such as anxiety, depression, insomnia and post-traumatic stress disorder (PTSD). Covid-19 infection has caused tremendous sufferings, and we haven’t even talked about its effects on the frontliners, healthcare professionals and those who were impacted by the economic downfall.

Life after ventilators

Many of the symptoms we mentioned above can happen regardless of the severity of Covid-19. You can imagine just how bad things would be for those who suffered from severe Covid-19, especially those who required mechanical ventilation to breathe.

National Heart Lung and Blood Institute (NIH), Public domain, via Wikimedia Commons

Many Covid-19 patients on ventilators will not survive, and the survival rate is even slimmer for elderly patients who require mechanical ventilation. Besides the high death rate, there are also many health risks associated with being on a ventilator:

Infections
Lung collapse (called atelectasis)
Blood clots and skin breakdown,
Pulmonary edema (fluid buildup in the lung),
Muscle weakness,
Pneumothorax (air leaks out of your lungs and into the space between the lungs and the chest wall, which can lead to pain, shortness of breath or life-threatening pressure onto the heart) and
Vocal cord damage

More data is needed

There are so many uncertainties about lives after Covid-19. For example, we don’t know who will be more likely to develop long Covid. Research is underway to differentiate symptoms of a prolonged course of Covid-19 illness and how it is best to be managed by healthcare professionals.

Nevertheless, it is clear that regardless of your age, health status and the severity of Covid-19 infection, you can suffer from long-term health effects from the infection. We should be cautious of seeing Covid-19 as an acute, short-term infection; it is best to view it as a potential long-term illness for some people, and those people may be you or your loved ones.

More empathy, less stigma

Life after Covid-19 can be pretty tough for some individuals, hence we should never discriminate against Covid-19 survivors.

Remember: stigma hurts everyone by creating more fear or anger toward ordinary people instead of focusing on the disease that is causing the problem. Stigma can also make people more likely to hide symptoms or illness, keep them from seeking health care immediately, and prevent individuals from adopting healthy behaviors. The last thing we want when controlling a pandemic is to have social stigma get in the way of the effort. Let’s cultivate empathy and caring for Covid-19 survivors instead.

(Of course, no hugging during this period. But kindness can be propagated without close contact too!)

Most importantly, we should all play our part: wash hands, wear masks, following SOPs, social distancing, avoid crowded places and close contact, as well as get tested when indicated. Read more about Covid-19 SOPs on the Ministry of Health Malaysia website here.

If you have any enquiries related to Covid-19, you can consult our Covid-19 Task Force, which consists of professional doctors and healthcare professionals, for FREE! You can access to free Covid-19 virtual health advisory by downloading the Doc2Us® app on http://onelink.to/doc2us or use our web chat https://web.doc2us.com/

Stay safe, and let’s fight off the pandemic together!

Disclaimer: Covid-19 is a novel disease. The information and scientific evidence of its development and vaccines are changing as we speak. Some content of this article may be outdated in the future. We encourage you to always speak with a healthcare professional you trust for the latest updates on Covid-19 and its vaccines.

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“My fatigue was like nothing I've experienced before”