The signs and symptoms of post-Covid

  • A webinar by SLMA 

Covid-19, as we all know, is a very physically taxing disease. While ill, one faces many physical symptoms such as tiredness, shortage of breath, headaches, fever, and more. 

After the Covid-19 outbreak, an increasing number of patients worldwide who have survived Covid-19 continue to battle the symptoms of the illness, long after they have been clinically tested negative for the disease. Certainly it is not an easy disease to recover from, but once recovered, it is important to note that you are still not at 100% strength. As we battle through this pandemic, the challenging part is to manage Covid-19 sequelae which may vary from fatigue and body aches to major issues within your body.

The Sri Lanka Medical Association (SLMA) recently held a webinar detailing symptoms post-Covid-19, where doctors from various fields involving Covid symptoms shared their knowledge on how to handle post-Covid symptoms and what one should do. The webinar featured Consultant Chest Physician Dr. Amila Rathnapala, National Hospital Kandy Consultant Cardiologist Dr. Gotabhaya Ranasinghe, and Hambantota District General Hospital Consultant Neurologist Dr. Kishara Gunaratne.

Pulmonary complications

Dr. Rathnapala began the webinar by discussing the epidemiological model that has been put forward by experts, explaining that we are currently facing an acute pandemic of Covid pneumonia. “With time and the introduction of vaccines, the rates will eventually go down, but after which, we will face another pandemic of pulmonary fibrosis,” he informed. Pulmonary fibrosis is a serious, lifelong lung disease. It causes lung scarring (tissues scar and thicken over time), making it harder to breathe. Symptoms may come on quickly or take years to develop, and there is no cure in existence. He added that medications may slow down scarring and help preserve lung function, but this is a post-Covid symptom that recovered patients should be vary of. “95% of Covid-19 patients will have moderate to no symptoms, but 5% will show severe to critical symptoms. Among the 5%, we are aware that there is a 20% death date, about 30-50% will fully recover and the rest of the 30-50% will show symptoms of pulmonary fibrosis,” he stated.

One of the risk factors for the development of lung fibrosis in Covid-19 is advanced age and the second risk factor is increased disease severity which includes co-morbidities such as hypertension, diabetes, and coronary artery disease 12, and lab findings like lymphopenia, leukocytosis, and elevated lactate dehydrogenase. The third risk factor, he explained, is prolonged ICU stay and duration of mechanical ventilation. While disease severity is closely related to the length of ICU stay, mechanical ventilation poses an additional risk of ventilator-induced lung injury (VILI), abnormalities of pressure, or volume settings underlying this injury, leading to a release of proinflammatory modulators, worsening acute lung injury, and increased mortality, or pulmonary fibrosis in survivors.

He urged any recovered Covid-19 patients who are still experiencing lung discomfort to seek medical attention immediately, as rehabilitation in the acute stage and particularly in the recovery stage is beneficial.

Cardiac complications

Dr. Ranasinghe explained that while symptoms of acute Covid-19 last up to four weeks after the illness begins, ongoing symptomatic Covid-19 symptoms last from four to 12 weeks after the illness starts. After this, it becomes Long Covid syndrome, where symptoms develop during or after Covid-19 and continue beyond 12 weeks after illness starts. Explaining some of the signs and symptoms of Long Covid, he said: “Signs and symptoms that develop during or after an infection consistent with Covid-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis is Long Covid Syndrome. This is prevalent in 5-30% of Covid-19 patients, but the cause is unknown and there is an increased risk for patients with pre-existing cardiovascular disease/diabetes/obesity.” He observed that these high risk people have the worst outcome.

The cause for Long Covid is still unknown, but studies have hypothesised that one possibility is the infection makes some people’s immune systems go into overdrive, attacking not just the virus but their own tissues. That can happen in people who have very strong immune responses. The virus itself getting into and damaging our cells might explain some symptoms like brain fog and a loss of smell and taste, while damage to blood vessels in particular could lead to heart, lung, and brain problems.

He also informed that clinical studies have also reported an association between Covid-19 and cardiovascular disease. Pre-existing cardiovascular disease seems to be linked with worse outcomes and increased risk of death in patients with Covid-19, whereas Covid-19 itself can also induce myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism. It was observed that drugs used to reduce cardiovascular risk such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have numerous effects that might influence susceptibility to or the severity of Covid-19. He also highlighted that potential drug-disease interactions affecting patients with Covid-19 and comorbid cardiovascular diseases are also becoming a serious concern. 

Neurological complications

According to Dr. Gunaratne, post-Covid syndrome can be due to symptoms related to residual inflammation, organ damage, and impact on pre-existing health conditions and non-specific events due to hospitalisation or or prolonged ventilation. “The pandemic statistics highlight the need for careful and continuous follow up of all patients with Covid-19 with regular screening for probable long term persistent neurological sequelae,” he stated. 

Naming the 10 most frequent neurological symptoms and signs of Long Covid, he commented: “The primary neurologic symptoms reported includes; brain fog (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%) and myalgias (55%). Most patients (85%) also reported fatigue.” Many neurologic symptoms such as headaches and anosmia present during the acute infection and never go away. Other symptoms like “brain fog” tend to become more prevalent over time.

As the cause for Long Covid is still unknown, there is not much that can be done in terms of treatment, but more often than not, patients with these symptoms are treated according to whichever symptom they are showing. Although it is not a cure for the overall problem, treating the symptoms individually can greatly reduce a patient’s discomfort and unease, which is why all three doctors at the webinar emphasised the importance of seeking medical attention immediately if such a symptom arises.