Recovered patients might not regain their previous health, nor fully recuperate from the Covid-19 disease, medical research reveals
LSurvivors might have overcome the death-dealing covid-19 disease and reduced the number of active cases in the country, but is recovery the ultimate silver lining? Medical research reveals that while others may have sadly succumbed to the virus, recovered patients must still deal with the consequences of the disease, post-recovery.
This is the reality for 27-year–old Zikhona Debe, a covid-19 survivor from a small town called Vlakfontein, south of Johannesburg in Gauteng. Debe, who is a food service supervisor at South Rand Hospital, says it was a month after recovery that she realised the headache she was experiencing was far from ‘normal’.
She says that although she does not know when exactly she might have been exposed, it was in July that she was declared positive.
Persisting symptoms for the long-hauler
Debe explains that she contracted the virus at her former place of work, Charlotte Maxeke Academic Hospital, where coming into contact with patients was inevitable. Her job, where she worked under food aid, entailed delivering food to patients in the wards.
She mentions, however, that she was prompted to go for testing only after one of her colleagues was reported to be positive. Moreover, it was the hospital’s requirement that all employees go for testing.
Centers for Disease Control and Prevention (CDC), a national public health institute in the United States, reports that symptoms may appear within two to 14 days after exposure. Debe claims, though, that she started experiencing symptoms only after her positive test result.
She told Wits Vuvuzela that prior to the knowledge of her status, she never suspected that she might have also been infected, as she never experienced any signs of infection. “I experienced symptoms [only] after testing positive. I must say that this disease is a mind disease (exists only in the mind), because once you know that you are positive, that is when you start feeling sick.” She says her symptoms, which were mild and persisted for just three days, included the loss of sense of taste and smell, headache and tiredness.
During her time of infection, a government quarantine centre in Tembisa called School of Rail, in Esselen Park Campus, became Debe’s home for 14 days. This was the average recommended quarantine period at the time. A media statement released on 17 July by Health Minister Zweli Mkhize announced that the isolation period has now been reduced to 10.
Although patients typically recover after two to six weeks, the disease can sometimes result in a prolonged illness in both young and old, irrespective of whether a patient experienced a mild disease, was asymptotic or had underlying chronic conditions. This is according to the World Health Organisation (WHO).
Debe could have celebrated on realising she had not been added to fatality statistics, but her negative covid-19 test did not mean recovery. The headache lingered for quite a while, making her a covid-19 long-hauler. A Mayo Clinic article describes this term as patients who encounter ongoing symptoms and further develop long-term health complications.
“I started getting the severe headache during quarantine (in addition to the other symptoms) and it lasted for about a month after I was discharged from the self-isolation centre,” Debe says. “I would get the headache almost every single day [within the same month]. It would just come and go.”
A patient’s recovery period depends on the severity of the disease, but the general consensus in medical research is that symptoms are likely to subside and settle within two weeks. This often holds true for symptomatic individuals with a mild case, as maintained by WHO and Patient.info, an online medical platform aimed at supplying evidence-based information to patients and medical professionals.
According to the CDC, however, patients might experience recurring symptoms that can persist for a long time, extending beyond the initial phase of recovery. These symptoms include shortness of breath and muscle or joint pain.
In addition, data released by WHO through its epidemic information networks indicates that a patient is in the initial phase of recovery at least two weeks after exposure or infection. Although symptoms may linger during this time, the initial phase is when a patient is not infectious or contagious to others.
Professor Francois Venter of the Wits Reproductive Health and HIV Institute (WRHI) says, “The immune system is [triggered] in all sorts of ways we do not fully understand, but there seem to be individuals who experience more severe immune responses and longer symptoms as a result.” He adds that in terms of susceptibility, “Obesity seems to be a risk factor for long-term [impact of] covid-19. However, we (medical researchers) are not sure why.”
WHO indicates that, based on 56 000 confirmed cases showing the most common acute symptoms, 38% of the cases reported tiredness and 14% reported headache. Tiredness ranks third highest after fever (88%) and dry cough (68%). So while people with covid-19 most typically experience fever and dry cough, fewer than one in five report headaches.
Debe says the headache was a distraction and compromised her concentration at work, but for fear of being regarded as incompetent at her new job, she still insisted on working her full shift. “I never worked shorter hours or took a day off, because I also didn’t want to stay at home and do nothing,” she says. “Sometimes my supervisor would send me home, but I stayed until I felt better.”
She told Wits Vuvuzela, “I was worried about the [recurring] severe headache, but when I found out I was not the only one experiencing it, I was a bit relieved.”
Professor Elizabeth Mayne at the Department Of Molecular Medicine and Haematology, Wits University, described what could possibly trigger recurring covid-19 symptoms in recovered patients.
“A significant number of complications from covid-19 appear to be related more to an overactive immune response than to damage done by the infection itself,” she told Wits Vuvuzela. She says this kind of infection complication has been seen in other viral infections, where the reaction caused by the disease has long-term sequelae (a condition resulting from a previous disease or injury) for the individual’s health.
Vaccination and treatment
In South Africa, a drug called dexamethasone is the current treatment for covid-19 patients. With Aspen Pharmacare being one of the local producers of the drug, the substance comes in injectable and tablet form. In South African hospitals, however, it is administered as an injectable.
As far as treatment is concerned, Debe says she never took any form of medication, nor consulted a doctor to report the lingering symptom. “I just drank lots of water, that’s all,” she says. “I naturally don’t like tablets [because] I struggle to swallow them. Sometimes I end up vomiting [if tablets are taken forcefully].”
Mayne says the use of dexamethasone is a key intervention to mitigate the adverse health effect on people who recover from the disease. One of its uses is to inhibit inflammation, a medical word defined as a reaction that can cause pain (among other things) as a result of infection.
“This is an immunosuppressant agent (medication meant to prevent the immune response of an individual) called a corticosteroid (an anti-inflammatory drug). This hopes to dampen down an inappropriate inflammatory immune response.”
Debe says while she treated the headache mostly at home, she consulted the doctor only after being discharged from the quarantine centre and has not had a follow–up since then.
Doctor Masono Nchabeleng, a 13-year general practitioner at Netcare Park Lane Hospital in Parktown, Johannesburg, says, however, that a close eye is kept on patients after they are discharged, to check if symptoms are lingering. “We tell them in the wards to come back if anything happens.”
He told Wits Vuvuzela, “Most people, believe me, have done very well (recovered quickly). I don’t even have to meet them (for check-ups). After they are told they are positive, we give them symptomatic treatment (medication) just to make sure we control [the symptoms] and prevent any further problems.” He says patients are advised to consult and do a follow-up should any complications arise.
Venter, however, mentions that “there are no protocols for following up”, but if a problem appears then investigations may be done on the [affected] organ. “For people without symptoms, we don’t generally pursue this, though,” he says.
Given potential health complications that may arise in post-recovery, Venter told Wits Vuvuzela, “We do the usual stuff for looking at organs. If we see they are affected, for example if the patient is confused, we may need to check the brain. If we hear things in the lungs, we get an x–ray.”
Had Debe reported the lingering headache to a doctor, perhaps her fate could have potentially been changed. Nonetheless, maybe covid-19 survivors will not have to endure the after–effects in the long run.
Ongoing vaccine trials in the country, led by Wits University under the South African Medical Research Council (SAMRC) and Vaccines and Infectious Diseases Analytics Research Unit (VIDA), could serve as a door of hope and promise long-term recovery for covid-19 patients. Vaccines are typically delivered to stimulate resistance to an infectious disease in a person’s body.
Mayne, however, says the vaccine will serve as a measure to prevent the infection. “The vaccine is prophylactic, not therapeutic. What that means, in summary, is that it prevents you from getting the infection rather than treating complications you already have.” Does this mean those with complications will have to live with deteriorating health until they succumb? Ongoing studies on the long-term effects of covid-19 may come up with answers.
Limited body of knowledge on long-term covid-19
Professor Lucille Blumberg, deputy director of epidemiology and the founding head of the division of public health surveillance and response at the National Institute for Communicable Diseases (NICD), says, “The vaccine is designed to prevent or reduce the chances of infection, or at least reduce the risks of severe illness. We have no idea yet if this will be so. Phase three studies [are] in progress for some vaccines.”
Blumberg acknowledges that, given the novelty of the pandemic, the body of knowledge around covid-19 is yet to grow. “We are all still learning – this is a new pathogen (any micro–organism that can cause a disease). Experience only began early this year and the pandemic and the cases are ongoing,” she says. “So it is still early days for knowledge of long covid-19 and post-infectious problems.”
Covid-19 is primarily understood as a disease that affects the lungs, but what is starting to emerge is that not only the respiratory system is under attack. An article on ‘coronavirus long-term effects’ published by Mayo Clinic indicates that multiple organs, including the brain and heart, can also be affected. Therefore, as a result of organ damage, the risk of survivors suffering from longer-term health problems is increased.
Nchabeleng corroborates that the virus affects multiple organs, labelling it as a ‘multi-organ disease’. “It affects all the organs. It affects the liver, the kidneys, the brain and also the lungs. We think that all the organs can be affected, such that people can also suffer from psychological problems.” He says, however, that unlike our European and Western counterparts, Africa has not seen much evidence of these effects.
Venter reiterates that there is an absence of local studies on long-term covid-19 health effects. “It has been such chaos and we have been pushed to focus on the severely ill. This, sadly, has not been on the priority list.”
Mayne says a study by the National Health Laboratory Service, in collaboration with the SAMRC, is one of the locally planned efforts to track after-effects in 8 000 patients across the nation.
The coronavirus has patently shaken the world. The lives of millions of people across the globe have been upended. Nevertheless, those who remain to live and witness a pandemic-stricken world are urged to comply with what Nchabeleng labels the ‘SSM’: “sanitise, social distancing and mask-wearing”. [su_audio url=”
FEATURED IMAGE: The harsh reality for survivors is, the battle against the disease does not end when one is declared ‘negative’ and survival does not equate to recovery. Research informs that once you are infected, your health will never be the same again. Photo: Palesa Mofokeng.