Understanding long COVID and why it matters
Key points:
- As the number of people infected with COVID-19 increases, concerns of those suffering from long COVID symptoms are rising too.
- Children are at risk of developing long COVID due to rising Omicron infections among them.
- Vaccines are still recommended as the best way to combat COVID-19 and to deter long COVID symptoms.
FULL REPORT
“You know once you’re negative, you feel like the virus is no longer in your body, but you feel the after effects of what it’s done to your body,” Professor Dr Yang Farina Abdul Aziz, a long COVID sufferer shared in an interview with Faqcheck Lab.
A chemistry professor at Universiti Kebangsaan Malaysia (UKM), Professor Yang Farina is one of an increasing number of long COVID sufferers coming forward with their experiences. Their symptoms include crippling lethargy, joint pains and problems with memory and concentration, also known as “brain fog”.
Professor Yang Farina’s long road to recovery has severely affected her life.
“I found it very difficult to lecture,” she said. “I had problems saying words, remembering terms, and delivering my lectures… I could only do it for 10 minutes and had to tell them (students) I needed a rest.”
She saw herself decline physically. A naturally active person who enjoys the outdoors, she found going on her usual hike laborious, causing her lethargy and shortness of breath.
Long COVID is becoming a growing concern as the number of COVID-19 infections in Malaysia have risen dramatically. The Omicron wave has seen an exponential rise in daily cases, pushing the total number of infections in the country to more than four million.
With the number of infected people increasing, concerns of those suffering from post-COVID symptoms are rising too.
According to the Malaysian Health Ministry, there are over 25,000 patients in Malaysia who are receiving treatment for long COVID with follow up appointments at public and private healthcare facilities.
To get a clearer picture of the facts, Faqcheck Lab spoke to molecular virologist Dr Vinod Balasubramaniam, who is also co-lead of Infection and Immunity Research Strength, a group that specialises in understanding viruses and their impact on human immunity.
He warned that the number of long COVID patients could be exponentially higher than what is reported, due to the public not fully understanding long COVID and its symptoms.
"You might be having long COVID that you don't know of. You have this lingering cough and you're thinking, ‘You know what? I just recovered from COVID six months ago and I'm still coughing.’
“I am looking at between 30% to 40% more people (of the total infected), who have not self-reported, to be long COVID patients,” said Dr Vinod.
Globally, at least half a billion people have been infected with one of the many variants of COVID-19. And according to the World Health Organisation, it is not going to end anytime soon, with worries of new variants still lingering.
More worrying is the fact that the new variant has put those vulnerable at greater risk due to its high infectivity rate. This includes children, with experts reporting a sharp increase in COVID-19 cases among the young.
Living with long covid
Part of the problem with long COVID is how little it is understood. Despite ongoing research on symptoms and treatments, those who remain unwell want more to be done - and fast.
Having recovered from her COVID-19 diagnosis in early 2021, Professor Yang Farina found herself simply not feeling better. If anything, new ailments started appearing.
She said the symptoms began appearing a few months after her COVID-19 infection.
“I had this cough for about four months. It’s not like I have it every time. But when I start talking, I feel a shortness of breath and I’ll start coughing. It gets worse at night as well.”
In a World Health Organisation (WHO) advisory that explains how to diagnose long COVID, head of clinical care Dr Janet Diaz, said the current definition of long COVID is those having symptoms “at least two months” after a COVID-19 infection. This varies from patient to patient.
From their observations as well, those suffering from long COVID can also experience symptoms for far longer, ranging from six months to well over a year.
And the problems don’t end there with well over 200 different types of symptoms having been attributed to long COVID.
Among them, researchers have identified nine clinical features that constitute long COVID:
- Chest/throat pain
- Abnormal breathing
- Abdominal symptoms
- Fatigue/malaise
- Anxiety/depression
- General pain
- Headaches
- Cognitive dysfunction
- Muscle pain
“This virus is sneaky,” Professor Yang Farina quipped. “Because it causes changes in human physiology.”
But it was no laughing matter when new health issues started cropping up.
A visit to an ear, nose and throat (ENT) specialist saw her diagnosed with rhinitis, a reaction that causes nasal congestion, runny nose, sneezing and itching. She was put on steroids to alleviate the symptoms. She also began having gut related issues.
Professor Yang Farina admitted that the changes brought about by long COVID caused her to feel defeated and depressed because there was nothing she could do about it at the time.
“I had to give it time to fully recover… my fitness is slowly getting back to where it was and I’m slowly coming back to be the person I was before COVID.”
The children of long covid
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If there was one silver lining in the early days of the pandemic, it was that children were able to combat COVID-19 infection more effectively than adults and were at lower risk of side effects.
But new mutations have complicated matters, especially with children. The highly infectious Omicron variant is pushing daily cases and hospitalisations to an all-time high.
Dr Vinod cautioned that the Omicron variant - and its new BA.2 subvariant - pose a greater threat to children compared to past variants.
Adding to that, as infections rise so do the risks of children developing long COVID symptoms.
Worryingly, research seems to point to no significant differences in symptoms of long COVID between adults and children, highlighting that it may be as disabling for children as it is for adults. [Sweden, Italy, Netherlands]
In rare cases, it has been observed that children have sustained organ damage from the infection, such as heart inflammation or inflammation of the pancreas, which can lead to long-term complications.
But it has also been observed that a majority of children recover from long COVID symptoms after three months.
Dr Vinod’s primary concern is the long term impact on children, especially those who get re-infected.
“We don’t know what happens to children repeatedly infected by COVID… I am worried about that.”
Mitigating and learning
“Vaccination reduces long COVID’s incidence by preventing people from getting infected in the first place. In theory, the shots could also protect against the condition by minimising the length of time the virus has free rein in the body during breakthrough infections” - Freda Keier, Nature, 25 Jan 2022
Recalling her experience with COVID-19, Professor Yang Farina is a firm believer in vaccines. She compared her encounter with long COVID and that of her fully vaccinated son who was recently infected.
“My son had COVID about three weeks ago and it resolved itself very, very quickly. Very quickly,” she emphasised, adding that he had no symptoms of long COVID.
“So different from what the mother had, because I got COVID before the vaccines!”
That said, Professor Yang Farina was frustrated with the medical community in Malaysia for sidelining long COVID sufferers.
She criticised the lack of empathy shown to COVID-19 survivors, and called on the health industry in general to listen more to those suffering from long COVID.
“I would like the Ministry of Health to actually pay more attention to those suffering from long COVID because it’s real,” she said, pointing out that the affliction can affect a person’s ability to function normally.
“Can you imagine now there are more than three million people in Malaysia with COVID. I would like to see more emphasis on long COVID instead of just COVID.”
As part of her efforts to help the medical community better understand long COVID and its symptoms, Professor Yang Farina has joined her university’s research into long COVID as a subject.
For now, there is no comprehensive treatment for long COVID. In Malaysia, treatment for long COVID sufferers is designed specifically to cater to the patient’s needs by the hospitals.
For those suffering from post-COVID symptoms, below is a list of hospitals that provide treatment opportunities to long COVID sufferers:
- University of Malaya Medical Centre
- Sunway Medical Centre
- Sungai Buloh Hospital
- Ara Damansara Medical Centre
- ReGen Rehab Hospital
- Subang Jaya Medical Centre
- Daehan Rehabilitation Hospital Putrajaya
- Prince Court Medical Centre
FAQCHECK TEAMS:
Xiamen University Malaysia: Siew Tong En, Sean Elijah Tan, Liu Zihan
Universiti Kebangsaan Malaysia: Ong Wei Chin, Seri Haidah Jaapar, Nurul Hidayah, David Win & Kuroshini
University of Nottingham Malaysia: Nathaniel Chan Jia Yoong, Nursarah Mohammad Firdaus Aloysius, Dayana Salim, Farah Aina Azaharuddin, Soh Annjo & Nur Ain Nabila
SPECIAL THANKS:
Profesor Dr Yang Farina Abdul Aziz & Dr Vinod Balasubramaniam (Monash)
