When a person’s PCR (polymerase chain reaction) test comes back positive, it means they’ve been infected with a variant of the coronavirus, or Covid-19. The next step is treatment which will continue until the virus can no longer be detected. However, in some cases, even after the patient no longer has signs of the virus, they still suffer from symptoms that can prevent them from resuming their normal life. This condition is known as “Long COVID”. If we understand it, we can watch for abnormal symptoms and get treatment.
What are the symptoms of Long COVID?
Long COVID, or Post COVID sickness, refers to the condition of a patient's body 4-12 weeks after being infected with the coronavirus. Even though the patient no longer tests positive, they still feel symptoms, especially those whose original sickness was accompanied with severe symptoms and lung infection. When exposed to the virus, the body builds immunity through protein cells in internal organs such as the lungs, causing inflammation. Whereas the lungs used to be flexible, now they stiffen. Scarring or fibrosis may form. This causes the lungs to not work properly with symptoms such as being more tired than usual. Some symptoms may also be caused by side effects of medications or by being re-infected with the coronavirus but with a different variant.
How does COVID-19 infection affect the body?
COVID-19 has both short- and long-term symptoms. Those infected have different symptoms depending on health factors such as their immune level and congenital disease condition. There are three levels as follows:
• Green Patients – These patients don’t show any symptoms or only mild flu-like symptoms such as low-grade fever, cough, sore throat, runny nose, loss of smell, loss of taste, red eyes, rash, loose stool. Their breathing is normal and they show no signs of pneumonia.
• Yellow Patients – These patients have more severe symptoms. Onset of them includes shortness of breath, fatigue, chest tightness, respiratory problems, difficulty breathing, rapid breathing, coughing and tiredness, dizziness, vomiting, diarrhea three or more times a day, pneumonia, and complications from congenital diseases.
• Red Patients – This is the group with the most severe and dangerous symptoms. The patients have severe respiratory disorders, feel exhausted all the time, have difficulty speaking, chest pain, difficulty breathing, constant chest tightness, lethargy, slow reflexes, unconsciousness, pneumonia, decreased oxygen level and severe pneumonia.
As such, COVID-19 symptoms are clearly directly related to the respiratory system and lung performance. This is so even among those who don’t actually show symptoms. If the virus enters the lungs, the symptoms worsen quickly and complications arise easily. In most cases, after admission to hospital, the virus clears up within a few weeks of exposure. If symptoms continue for more than four weeks and a patient still feels that their body hasn’t returned to normal, it can be assumed that they are experiencing Long COVID.
What are the symptoms of Long COVID?
Long COVID symptoms vary from person to person. They can involve several bodily systems, including the respiratory system, nervous system and digestive system as well as the heart and blood vessels. Essentially, there are three types of Long COVID according to the nature of the symptoms, as follows:
- New or Ongoing Symptoms – This group of symptoms persist for several months after first exposure to the virus. It most commonly involves patients with severe symptoms which become more severe when engaging in strenuous activities. The symptoms include:
• Fever, headache, dizziness, fainting
• Shortness of breath
• Coughing
• Fatigue, easily tired
• Abdominal pain, diarrhea, eating less, loss of appetite
• Ear ache or ringing in the ears
• Feeling shaky, lacking concentration, feeling blurry
• Insomnia
• Mood swings
• Numbness, muscle and joint pains
• Loss of smell or taste
• Skin rash
• Irregular menstrual cycle - Multiorgan Effects – In this condition, several organs are severely affected by coronavirus infection. This causes a reaction known as a cytokine storm, a process where the body's immune cells produce more cytokines to fight the virus than needed. Consequently, instead of only fighting the virus, the cytokines invade healthy tissue cells in organs, causing them to fail. The condition is usually found in heart, lung, kidney, brain, and skin tissues. Patients at risk of Cytokine Storm are those with chronic medical conditions. This is why those with chronic comorbidities tend to have more severe symptoms than other groups of patients.
Multisystem Inflammatory Syndrome in Children Associated with COVID-19 (MIS-C) may develop among pediatric patients. In this case, Kawasaki Disease Syndrome causes multiple organs to become inflamed, high fever, rash, red eyes, and enlarged lymph nodes. Symptoms begin at the time of coronavirus infection or immediately after recovery and may have long-term effects on organs. - Long-term effects of hospitalization and from coronavirus infection – These patients have been severely affected by stress. It especially affects those admitted to ICU. Staying in hospital for a prolonged period weakens the body on top of the infection by the virus. Long-term hospitalization can affect your thoughts and speech. It leads to a kind of post-traumatic stress disorder (PTSD) which involves intubation and heart pumping. Stress from many factors causes the body to show abnormal symptoms even after the COVID-19 treatment is completed.
Long-term complications
• Myocarditis • Fatigue
• The perception of taste and smell is distorted
• Autonomic nervous system disorders
• Guillain-Barre Syndrome
• Fibromyalgia
• Fibrosis and pulmonary disorders
• Thrombosis
• Cardiovascular system disorders. In males, this may lead to erectile dysfunction as erection is caused by expansion of arteries in the penis.
• High blood pressure
• Complication of bacterial or fungal infection
• Inflammation of internal organs, including acute hepatitis, renal impairment, acute renal failure
• Insomnia
• Depression
• Those prescribed steroid drugs may experience stomach pain, acid reflux, unstable sugar levels and diabetes
Groups at risk of Long COVID
• Those infected with coronavirus and have severe inflammatory pain symptoms
• Those with congenital diseases such as asthma, diabetes, high blood pressure
• Those with obesity
• The elderly
• Those with low immune systems
How to take care of yourself after COVID infection and treatment
• Watch out for any abnormalities in your body such as fever, persistent cough, weakness, tiredness, or a feeling that your symptoms are getting worse. If you have any of these symptoms, you should see a doctor for diagnosis and treatment. If left untreated, it can lead to problems such as bacterial infection, blood clot in the lungs, coronary artery obstruction, and others.
• Avoid excessive activity such as strenuous exercise to give the lungs time to recover. Avoid working too hard. Start with light exercise such as walking to allow the body to adjust and heal itself without making the lungs work too much.
• Those whose treatment has included receiving oxygen or being on a ventilator should remain under constant medical supervision to restore full lung function.
• Those with a congenital disease or new congenital disease must receive ongoing treatment.
• Get vaccinated against COVID within 1-3 months of recovering from the virus.
• Be careful not to get re-infected with the coronavirus by masking, maintaining social distancing of 1.5 meters, avoiding crowded areas, and washing your hands frequently.
The exact cause of Long COVID remains unknown but data shows that up to 50% of patients are likely to experience it after being cured. The severity of symptoms varies according to individual factors and conditions. Consequently, observing your physical abnormalities and following strict instructions will help you return to a healthy and happy life. However, if the symptoms don’t subside or worsen, you should see a doctor for checking up and get advice on appropriate self-care.
For Krungthai-AXA Life Insurance customers, if you suspect that you have Long COVID, you can consult an online doctor with Krungthai-AXA Telehealth service. Just download Emma by AXA application, press “TeleHealth” and confirm your policy number the first time you use it. For more information, please visit https://www.krungthai-axa.co.th/th/telehealth.
References
• Corporate Communication, Faculty of Medicine, Ramathibodi Hospital https://bit.ly/3vPGahJ
• Bangkok Hospital
https://www.bangkokhospital.com/content/assessing-symptoms-of-covid-19
https://www.bangkokhospital.com/content/long-covid
• Ramkhamhaeng Hospital
https://www.ram-hosp.co.th/news_detail/1400
• Sikarin Hospital: Bangkok
https://www.sikarin.com/health/covid19/long-covid
• Thainakarin Hospital
https://thainakarin.co.th/cytokine-storm-tnh/
• Pobpad Hospital
https://www.pobpad.com/gbs
• Faculty of Medicine, Siriraj Hospital
https://www.si.mahidol.ac.th/sidoctor/e-pl/articledetail.asp?id=186