October, 13, 2021
With the rapid advancement of the COVID-19' virus across Sri Lanka, a large number of both adults and children are currently in recovery. While most recover completely from the disease within just a few weeks, a significant portion of infected patients continues to experience symptoms long after their initial recovery period. Older patients and those with many serious medical conditions are most likely to experience lingering COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for more than four weeks to months after initial infection. This condition is termed 'Long-COVID' or 'Post-COVID syndrome', and is an emerging clinical entity of the current COVID -19 pandemic.
Prof. Shaluka Jayamanne, Consultant Physician, explains, "When a patient is infected with COVID, about 80% of the people will have no symptoms or mild symptoms. The virus enters through the nose, into the upper respiratory tract and reaches the lungs where the alveolar cells are present, where the major effect takes place. In a majority of people, the body reacts to the virus and stops it from reaching the alveoli, so the virus is cleared early and is avoided from reaching a severe condition named a Cytokine storm, which causes severe pneumonia. Therefore, a majority of those affected by COVID-19' can recover through home-based care, but they should be closely monitored for symptoms of pneumonia.
"However, 20% of those affected by COVID-19' go on to experience symptoms due to high-risk factors brought about by a weakened immune system. These patients who do not sometimes have good home support require hospitalization at COVID wards or intermediate care centres with High Dependency Unit facilities to accelerate their healing process under close monitoring. Those who are pregnant are also encouraged to seek out hospital care to avoid complications and have quick access to treatment should their condition take a turn for the worse. Further, 5% of those symptomatic patients, go on to develop severe symptoms of the disease after six days and require ventilator support and intensive care to recover."
Even after 14 days, some patients continue to experience symptoms of pneumonia. Patients are unable to go about their normal daily tasks because they are unable to breath as well as before or faint during activity due to hypoxia (low blood oxygen levels). These patients are highly encouraged to seek out care from a hospital for further monitoring to see if their lungs are damaged or if they are going through a phase of chronic pneumonia.
Symptoms of long COVID-19 can last weeks to months or even longer. This may include patients having difficulty in breathing, sweating excessively, experiencing excessive weight loss, struggling with a persisting cough long after testing negative for the virus. Further, patients also may experience brain fog, fatigue, persistent loss of smell or taste, hair loss, cough, joint and chest pain, memory and sleep problems, depression and anxiety, fever, dizziness when standing, worsened symptoms after physical or mental activities and numbness.
Prof. Jayamanne explains that these risk factors are heightened when patients do not treat themselves for their pre-existing conditions such as hypertension, diabetes, or ischemic heart disease. "If patients have poor control over their pre-existing illnesses, there is a massive risk of them succumbing to symptoms of these illnesses during a bout of COVID-19'. So it is vital for them to continue their medication for these conditions and go for regular health checks to a medical centre after their home-based care."
Although COVID-19 is seen as a disease that primarily affects the lungs, it can damage many other organs, including the heart, kidneys, liver and brain. This organ damage may increase the risk of long-term health problems. Some adults and children often go on to experience multisystem inflammatory syndrome after they have had COVID-19. For at-risk patients, this Post-COVID period following their discharge from a hospital needs supervised care and should be handled with a persistent cautious attitude.
Advising those who are eager to go back to the full scope of their activities too soon after infection, Prof Jayamanne comments. "At the end of the day, COVID-19 is a form of pneumonia, which affects the lungs. Although a symptomatic patient is discharged from the hospital due to a stabilization of their oxygen levels, it does not mean that their lungs are at full capacity. Even with a poor lung capacity of 50%, a patient can maintain their oxygen levels without requiring ventilator support because lungs have a good reserve. Therefore, when a patient such as this with poor lung capacity, go back to activities such as exercise too fast too soon, which require the full capacity to function, they often become hypoxic in a critical manner. Further, some patients may even go on to develop other respiratory tract infections that further affect their Oxygen saturation levels if proper caution is not taken. All patients and their care takers should be fully briefed about these possible aftereffects before being discharged to avoid critical implications in the days that follow."
While it is true that most people who are infected will not get very sick, it's currently impossible to know who will recover quickly and who will have persistent symptoms. The best way to prevent severe COVID-19 is to get vaccinated, manage symptoms properly and slowly, and follow a nutrient-rich diet that fortifies the immune system.
To better support Sri Lankans on their journey of healing from the COVID-19 virus, Hemas Hospitals has now set up Post-COVID Clinics at both their hospitals in Wattala and Thalawathugoda. The post-COVID clinics enable patients who have recovered from COVID-19' or suspect that they must have had COVID-19 at some point, to screen and investigate how well they have recovered from the infection, the extent of harm that has been done to their bodies, the current condition of their immune systems, and their status of general health. Appointments at these Post-COVID Clinics can be obtained by calling 0772862456 (Wattala) or 0779405838 (Thalawathugoda). As the first hospital in Sri Lanka to be awarded the COVID-19' Safety Certification by the SLSI Hemas Hospitals adheres strictly to the Ministry of Health directives and guidelines, and have implemented a stringent COVID -19 safety protocol at all of its treatment points.