Experts explain why COVID-19 survivors report other complications

•LUTH sets up post COVID long-haul clinic to address situation
•Medical experts say COVID-19 is not a one-off illness, still leaves some damages behind
•New study shows how having had COVID-19 may negatively impact performance at work
•COVID-19 infections can trigger lingering, severe symptoms of long COVID even in vaccinated people
•New study paves way to better understand, treat those suffering from long COVID

Medical experts have alerted to deadly complications in ‘long COVID’ survivors. They said the situation is dire because over 80 per cent of patients are not aware because they never knew they had COVID-19, they were not tested. The experts said the patients could be at risk of sudden death due to collapse of vital organs such as the lungs, heart, kidney, lever, brain and nervous system.

While COVID-19 can cause a period of acute illness, some people continue to experience symptoms, such as breathlessness, muscle aches and fatigue, for months or even years – a condition that has been labelled long COVID.

Studies have suggested COVID may have a lingering impact, including through damage to organs such as the heart and lungs, while research has suggested less than a third of patients who have ongoing COVID symptoms after being hospitalised with the disease feel fully recovered a year later.

Head of Infectious Disease Unit and COVID 19 response team at the Lagos University Teaching Hospital (LUTH), Dr. Iorhen Akase, and a consultant neurologist, member of the LUTH COVID response team and consultant in the post COVID long-haul clinic at LUTH, Dr. Agabi Osigwe, told The Guardian that any organ system can be affected and the commonest symptoms they see is when people are still feeling tired, having headaches and difficulty in thinking clearly.

Akase and Osigwe said LUTH has created special clinic for long COVID due to the overwhelming influx of patients. On prospective look at the COVID pandemic, how it occurred and the impact on Nigerians, Akase said: “COVID- 19 was first reported in December 2019 and January 2020, and we had our first case in February 28, 2020. Over the course of two years, we have had a total of over 260,000 confirm cases and over 3,000 deaths so far. 

“We do know that this is an underestimation of what the true picture is because many people who were ill did not come to the hospital and of course the impact of COVID has been huge because death of 3,000 people at a time is quite significant even against the total population of 200 million.

“Additionally, the effect of COVID on education, economy, travel, tourism and many areas of life was significant. If you look at it from all these aspect, it was quite a significant event for all of us as a whole country.” 

On whether COVID-19 is a one-off illness, Akase said: “There are two ways to look at this, the first way is that people that have COVID-19 can have it over and over again. People can have COVID-19 infection once and they can get infected again, twice or a number of times.

“The second aspect of this is that we have seen that COVID has acute that is the immediate aspect of it where people are ill with fever, cough and all what we know as COVID-19 symptoms and can recover. But now what we are saying is, that might not be the end of COVID illness itself. We are saying that after that immediate period of some people being ill, in fact, some had COVID but they did not experience any symptoms until maybe when they want to travel and are asked to go for testing then discover they are positive but they had no idea about it. Whether people were ill or they had mild illness or they had the severe one known as acute COVID, we are saying that after that period, which is called acute COVID travails, they eventually still have issues with that initial COVID that they had. Clearly, we now know that COVID-19 is not a one-off illness, it can happen again and again. Also, we now know that even when it happens once after that initial illness, other issues can come up later, which is as a result of that first infection that they had. 

“In other words, if somebody has COVID-19 now, the COVID can potentially affect some of his organ system and some tissues in his body: it can affect the lungs that aids breathing, it can affect the heart that pumps blood to the body, it might affect the muscles thereby causing weakness. So, on a long term though the person has become apparently well, he or she is not back to his functioning capacity as at that time. 

“We get to hear of patients that had COVID and before they could run maybe like five kilometres, but these days they can only run maybe like one kilometre and they get tired; all of these is coming on the grounds of the COVID-19 they have had before.
 
“We are saying that COVID is not a one-off illness though the acute and serious phase may have gone, it still leaves some damages behind.” 

On the meaning and implications of COVID long-haul, Akase said: “Firstly, we have seen that COVID-19 is not a one-off illness; secondly, COVID-19 affects more than just the lungs. I know cough is the commonest symptoms of COVID-19 but it is not just the lungs that COVID affects, it affects the brain, liver, kidney, and almost any tissue in the body. 

“We have said that the initial COVID-19 infection is called acute because it doesn’t last long, we do not expect it to last for more than four weeks. Most people recover within four weeks of getting COVID, that is the acute COVID that they have, but we are now saying that after that four weeks, some people’s COVID extends, they have symptoms and complications beyond this four weeks. 

“Sometimes it is the breathing problems, sometimes when the breathing problems stops, other problems will come in but this is traceable to that COVID-19 that they had and it keeps going on and on.

“Some of the symptoms can be traceable to any organ system in the body, it can occur from the head. If we are talking about the head then we are talking about the brain. For example, they keep having headaches, they find it difficult to think clearly, they cannot make decisions, they are easily tired and some times they have problem sleeping, it is either they sleep too much or they sleep too little. Some have problems remembering things; some have pains, inability to move; weaknesses in other parts of the body. Some people can have problems in the heart, which makes their heart beat too fast or they are easily panicked when something happens. For some people, it is in the kidneys.

“What I am trying to say is that any organ system can be affected, the commonest symptoms we can see is when people are still feeling tired, headaches, having difficulty in thinking clearly.

“This is what long COVID is and we can say this happens when these symptoms go on for more than four weeks. Some people can have these symptoms for up to a year. We have colleagues who are working on something similar elsewhere, this is not just reported in Nigeria alone, it has been reported in United States and other countries and we are going to hear more about this consequently.”

On who can have long COVID, Osigwe said: “Anybody who has had COVID-19 before whether they were physically ill or not, whether they had just simple illness like malaria, can have long-haul COVID. You know some people had COVID and they thought they had malaria because that is how it came (fever, joint pains and all of that). They would think they had just malaria but they didn’t know that what they had at that time was COVID.

“The long and short of this is that anybody who has had COVID before, whether they had severe symptoms or mild symptoms, any of these people can have long-haul COVID.”

On whether the symptoms that a person with acute COVID has is the same as the one he/she would have during the long haul or are there new symptoms, Osigwe said: “A few people who had difficulties with breathing may still find out that the difficulty in breathing is still going on longer than that time, this is still part of long COVID but we have seen that the larger majority of people who has long COVID had new symptoms that were not part of what they had in the beginning. 
For example, if they had difficulty in breathing and fever had come, after the acute COVID this would have cleared but they see that after this one has cleared they see new symptoms coming up. For example, they are now feeling very tired, the headache has increased, the inability to think clearly has also now come; these are things that were not there before but has now come on board after they have recovered from the COVID. But to all that extent you would see that there is a link, all of them would tell you that ‘it is after I recovered from that COVID that all these things have started.’

“From the history we have heard, they would tell you, ‘the first COVID I had, after that one finished it seemed as if I got better but my body has not come back fully.’ That is why it is called long COVID because COVID is supposed to be short, it is supposed to finish after four weeks but you know when it does not finish before that four weeks, it keeps going on and on, that is when it is called long COVID.” 

On how the patient will know that he/she has long haul symptoms, Osigwe said: “ First and foremost, if they were ill at the time of COVID-19 and they were tested positive, if afterwards they are now having symptoms that started after that diagnosis, they should begin to suspect that what they are experiencing now is long-haul COVID.

“There is another group of people who were ill, who perhaps thought what they had was malaria and refused to go to the hospital to get tested for COVID. But COVID was circulating all over the place, some other persons felt changes in their body but did not go to the hospital to get tested but after they claimed to have recovered from that illness, their bodies have not returned to normal; they are always tired, feeling depressed, feeling sad and all of that had happened after the illness that they had around the time of COVID. These set of people should begin to suspect that maybe it is long-haul COVID that they are having.”

On the impacts of long-haul COVID, Osigwe said: “Having understood what long-haul COVID is, the impact is quite significant. As we all know before COVID, some people had a particular pattern of living but now after recovery, they find it had to go back to how they use to live. They find it hard to move on and this is of great concern for a lot of people. Imagine a medical doctor, who we all know in his field of work, uses his brain to make decisions all the time such as recommending a particular test or prescribing a drug for a patient. And now after recovery from COVID, starts experiencing brain-fog and cannot make appropriate decisions concerning the health of his patients; this is obviously a big problem and the same goes for others in different fields. Then for extreme cases, we have those who get depressed, breathing difficulty and other physical challenges; picture a traffic-warder who can’t direct traffic because of his physical disability. Therefore the implication for such patients is that it affects their livelihood, productivity, ability to properly function and also their health in general.”

On whether they still have patients going through these symptoms, Osigwe said: “Yes, I’ve repeatedly seen patients with long-haul COVID. Here at LUTH, we treated over 4,000 patients with COVID. Some of those patients who got treated and discharged over some period kept calling to complain about different challenges. One in particular had to start using wheelchair to move around, another couldn’t smell or taste food for months. The long-haul COVID can affect any organ in the body irrespective of age, religion and social status.”

On what has LUTH done to help these patients, Akase said: “Knowing the burden that comes with long-COVID, the hospital has created a new unit called ‘Post-COVID Clinic’ where these patients can easily access health care. This clinic involves different specialists due to the fact that the symptoms are amorphous. We examine the patients thoroughly at this clinic including free tests and from the results; we direct them to the appropriate specialist for further treatments. The hospital has also started a research in collaboration with North-Western University in America to provide the best care where its needed, as well as get answers to what is really happening to these patients. We have made additional resources available for all willing patients at the clinic to document their problems for further research on the issue.”

On whether remedies like ginger, bitter kola, vitamin C and so on help patients with long-haul COVID, Akase said: “Trial and error sometimes worsen situations. We have seen these clearly from some of the vitamins we take. For example, taking 1000mg of vitamin-C in a day is a lot and could eventually affect the kidneys in the long run. Secondly, I have patients who have taken these remedies and it has clearly not worked for them. Long-haul COVID is an entity but the treatment is not single. The treatment is individualised for patients based on presentation and peculiarity.”

On how people with long-haul COVID can access the clinic, Akase said: “We have a dedicated staff that has been employed to man this Post COVID Clinic. There is also a helpline, which is always available to listen to complains and render help. The number is 09023309196. The clinic day at LUTH is every Wednesdays by 12 noon but we are always available to attend to patients even outside the clinic days.”

ELSEWHWERE, two million people in the United Kingdom (U.K.) are thought to be living with long COVID, data has revealed, the highest figure since official surveys began.

Figures from the British Office for National Statistics (ONS) reveal that as of May 1 this year, two million people living in private households in the UK – or 3.1 per cent of the population – reported they were still experiencing COVID symptoms more than four weeks after their first suspected coronavirus infection.

About two in five of those with long COVID, or 826,000 people, noted that infection was at least a year ago, while one in five, or 376,000 people, said it was at least two years ago. In addition, 71 per cent of those with long COVID said their symptoms had a negative impact on their day-to-day activities, with 20 per cent saying their ability to undertake such activities had been “limited a lot”.

The latest figure is a 10 per cent rise on the number of people with long COVID-19 reported last month, and is almost twice as high as the figure reported as of May 2 last year, when just over one million people self-reported having long COVID.

“As a proportion of the UK population, the prevalence of self-reported long COVID was greatest in people aged 35 to 69 years, females, people living in more deprived areas, those working in social care, teaching and education or health care, and those with another activity-limiting health condition or disability,” the ONS added.

Meanwhile, individuals who contract COVID-19 often experience memory, attention and concentration problems, even after recovering from the initial illness. A new study from the University of Waterloo shows individuals who had contracted COVID-19 reported significantly more cognitive failures at work.

“COVID-19 is going to be an ongoing part of life, at least for the foreseeable future,” said James Beck, an associate professor in Waterloo’s Psychology department. “It is now common for people to catch COVID-19, recover, and then return to work. Yet, in our study, people who had contracted COVID-19 reported more difficulties at work, relative to people who had never caught COVID.”

Beck and his graduate student, Arden Flow, collected data from a sample of 94 full-time working adults who either had or had not contracted COVID-19 at least one month prior to the study. Both groups were matched on key demographic characteristics.

“Relative to the group who had never had COVID-19, the group who had contracted COVID-19 reported more cognitive failures at work, which are defined as problems with memory, attention, and action,” Beck said.

A second finding of the work is that cognitive failures were associated with decreased self-ratings of job performance, as well as increased intentions to voluntarily leave one’s current job.

“These results may have important implications for managers and organisations more broadly,” Beck said. “Individuals returning to work after contracting COVID-19 may experience difficulties returning to their pre-COVID-19 level of performance and accommodations may be necessary. These accommodations might include reducing workloads, extending deadlines, or providing flexible work arrangements.”

The study titled “The effects of contracting Covid-19 on cognitive failures at work: implications for task performance and turnover intentions” was published in the journal Scientific Reports.

Also, a new study has found COVID-19 vaccines can lower the risk of death by 34 per cent and long COVID by 15 per cent compared to the unvaccinated with Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) infections.

The researchers also observed that vaccines have been remarkably effective in fending off some of the worst long COVID symptoms, including lung and blood-clotting disorders.

However, the researchers also found that mild breakthrough COVID-19 infections can trigger lingering, severe symptoms of long COVID even in vaccinated people.

Experts say these findings highlight the need for new vaccines and ongoing safety protocols beyond immunisations to help prevent long COVID.

A study at the Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System suggests that vaccination alone may not be enough to stop breakthrough COVID-19 infections and prevent long COVID.

The findings were published in Nature Medicine.

Meanwhile, a new study published in current issue of PLoS Pathogens is the first to link SARS-CoV-2 specific T cells to lung function and those who suffer from long-term COVID symptoms (PASC). The study found that patients suffering from long COVID had virus-specific T cell levels more than 100 times higher than those who recovered from the disease.

“The persistence of high numbers of virus-specific T cells in individuals with long COVID suggests that there may be hidden viral reservoirs that are maintaining and leading to long-term symptoms. Current treatments for long COVID, out of necessity, are focused on addressing specific symptoms and not the root cause of the illness. This evidence points toward the reservoirs as a significant factor causing long COVID, which can guide future treatments,” said the paper’s senior author Brent Palmer, PhD, associate professor of allergy and clinical immunology at the University of Colorado School of Medicine on the University of Colorado Anschutz Medical Campus.

The findings could shift treatment recommendations to focus on vaccines and antiviral medications that could reduce long COVID symptoms and help clear the virus from people’s system.

The study addressed the cause of long COVID by better understanding the adaptive immune response to the SARS-CoV-2. The research team’s findings linked systemic inflammation, persistent pulmonary symptoms and reduced lung function to the presence of high numbers of SARS-CoV-2 specific T cells. During the primary infection, these virus-specific T cells are important for controlling infection but in the context of long COVID, they are associated with ongoing symptoms, shortness of breath and lung damage.