Death is not the only bad outcome for those who contract Covid-19.
Although there is a tendency to focus on the daily total number of new cases and the number of deaths, these figures do not paint the entire picture.
There are many other consequences of the pandemic that are not made readily apparent by the daily statistics.
One example is the impact of hospitals filled up with Covid-19 cases on the management and outcome of other diseases.
Each occupied bed displaces another case, just as each case reviewed by a doctor takes away time from another case.
This has implications on the manner and timing in which other conditions are diagnosed and treated.
Although the vast majority of patients infected with the SARS-CoV-2 virus remain thankfully asymptomatic (with no symptoms), those who do develop symptoms and survive do not always get away scot-free.
Multiple complications
The level of severity and risk of complications from Covid-19 are higher in the elderly and those with concurrent illnesses such as diabetes, kidney disease, heart failure, cancer and obesity.
Symptoms related to Covid-19 manifest in different ways, and how long they last differs between individuals.
These do not always correlate with the level of severity or presence of complications.
Prolonged symptoms that persist beyond 12 weeks from the start of the disease are part of the so-called long Covid syndrome, which is more common among those with complicated or severe illness.
They can be classified into a number of subgroups:
- Respiratory
- Symptoms include breathlessness, coughing and the need for supplemental oxygen.
- These symptoms and the impact on quality of life are higher in those who have significant damage to the lung tissue, especially scarring of the lungs (fibrosis), whether from Covid-19 or other lung diseases.
2. Mental health
- Symptoms include anxiety, depression, sleep disturbances, post-traumatic stress disorder, headaches, and a disturbance or slowing down cognitive function (also known as “brain fog”).
3. Cardiac
- Symptoms include palpitations and chest pain.
4. Blood clots
5. Miscellaneous
- This can include fatigue, muscle ache, generalised weakness, joint ache and/or hair loss.
Studies from China, the United States and Europe have shown that the most common symptoms are breathlessness, fatigue and anxiety/depression.
A study in Italy found that 87.4% of patients discharged from hospital who recovered from Covid-19 still had symptoms at day 60.
More than half complained of fatigue, approximately 40% had breathlessness, and 44.1% felt that they had a decline in their quality of life.
A study published in the latest edition of the journal The Lancet Psychiatry found that one in three Covid-19 survivors was diagnosed with a neurological or psychiatric ailment within six months of infection with the SARS-CoV-2 virus.
The study, which looked at 230,000 patient health records, identified the most common mental health conditions as anxiety disorders, mood disorders (such as depression), substance misuse disorders and insomnia.
The neurological conditions included diagnoses such as strokes and dementia.
Long-term care
As these long Covid symptoms present themselves in a variety of ways, it is only logical that long-term care is handled by a multidisciplinary team that not only assesses and manages the physical aspects of rehabilitation, but also the mental health aspects.
Besides doctors, there is a need to rope in psychiatrists, psychologists, physiotherapists and occupational therapists.
Nutritional and rehabilitation needs must also be taken into account and appropriate intervention introduced early.
All long-term Covid-19 follow-up studies have noted significant declines in quality of life and function.
Severe Covid-19 can cause muscle wasting and feeding difficulties, which, when combined with malnutrition, can worsen both physical and psychological outcomes.
Globally, there are increasing numbers of patient advocacy and support groups.
Many of these are on social media platforms such as Facebook.
They provide a space for patients to share their struggles, which may prove to be cathartic.
For some, it is an avenue to learn from the experiences of others and to be more aware of the stories behind the numbers.
Healthcare workers need to remind themselves that care does not conclude at discharge.
From a management perspective, we must proactively identify those at higher risk of long-term complications and screen for the conditions listed above, especially mental health.
These can be done in person or with increasingly available telemedicine tools.
Future needs
As we see the number of active cases go up, it is inevitable that we will have more patients with long Covid syndrome.
Policymakers will need to provide the necessary funding as services will need to be rejigged in anticipation of increasing needs.
The public has a more important role: we are at the front lines of this war and many of us need to be less nonchalant about the risk of getting infected with the SARS-CoV-2 virus.
The more cases there are, the more complications there will be.
It is imperative that we continue to adhere to the standard operating procedures in place, especially the use of face masks, physical distancing, and avoiding closed, crowded and poorly ventilated areas.
Last but not least, we must take advantage of the blessing that we have in the form of Covid-19 vaccines.
