September 1, 2020

South Africa: The Long-Term Effects of Covid-19

While the majority of those who test positive for the virus recover fully, there are a growing number of people who can’t seem to shake unusual symptoms that linger months later.

On the morning of 21 July 2020, Vusi Sidindi felt like he was coming down with the flu. He immediately got tested for Covid-19. Later that day, his condition worsened. Struggling to breathe, he rushed himself to Life Kingsbury Hospital in Cape Town, where he was told the following day that he tested positive for Covid-19. This was the beginning of a lengthy battle to regain his health.

After being discharged, Sidindi started experiencing unusual complications beyond the common Covid-19 symptoms of fever, a dry cough and tiredness, among other things. “The first thing I noticed was upper back pain. I still have [it] till this day,” he says.

Sidindi noticed that he would experience sharp pain whenever he sat or lay down for longer than 30 minutes, forcing him to keep moving onto his sides or his stomach when he tried to sleep.

Eventually, he went to a physiotherapist. The massage along with some medication helped him manage the pain. “The pain is there, but it is bearable … I could see it subsiding.”

A month later, Sidindi tested negative for Covid-19. But he still experiences tightness in his chest, making it impossible for him to exercise. “I haven’t been able to jog as I used to in the morning, because I need to catch my breath.” His doctor recommended he take walks while he recovers, which, he was told, could take six to eight months.

Respiratory and heart issues

General medical practitioner Tracey Moumi says health professionals have seen a rise in Covid-19-related respiratory issues. The most affected patients are the elderly and those with comorbidities such as heart conditions or diabetes. People with underlying chronic illnesses are also battling to manage their conditions after contracting the coronavirus.

For example, if they have to take … medication for their respiratory system, it clashes with other medication [they are taking at the same time]. That gives us the challenge of controlling the systems properly,” she says.

Shakira Choonara, an African Union Youth Advisory Council member, has also noticed that a small proportion of Covid-19 patients experience long-term health effects. “Most of the long-term health effects are experienced by those who are hospitalised, and [especially those who end up] in the intensive care unit (ICU).”

She says some of these patients develop what medical health professionals call post-Covid-19 lung disease, which is permanent damage to the lungs.

In a report that looks at how Covid-19 continues to affect survivors, pulmonologists Ganesh Raghu and Kevin Wilson say some survivors may experience respiratory problems for months – or even longer.

“Fibrotic abnormalities of the lung have been detected as early as three weeks after the onset of symptoms regardless of whether the acute illness was mild, moderate or severe. Abnormal lung function such as restrictive abnormalities, reduced diffusion capacity and small airways obstruction has also been identified at the time of discharge from hospital and two weeks after discharge,” says Raghu and Wilson.

The pulmonologists say it is still too early to work out which Covid-19 patients are at a higher risk of developing long-term pulmonary abnormalities, though one’s medical history does play a part. They are also not certain whether these abnormalities will become permanent or will improve on the current medication used to treat Covid-19.

“We hypothesise that most Covid-19 survivors will manifest early pulmonary abnormalities, which could range from being asymptomatic, to mild to severe and debilitating.”

A Harvard Health article published by the Harvard Medical School explains that the fever a patient experiences when they have Covid-19 puts stress on the heart. Difficulty breathing also limits the heart’s oxygen supply. “All infections ramp up your body’s immune response, and the resulting flood of inflammatory molecules may injure the cells lining blood vessels and make blood more likely to form clots. Both factors boost the risk of a heart attack,” the article says.

When one organ in the human body is affected – for instance, the lungs – the rest of the organs are also put under pressure, Choonara explains.

Mental health effects

Sidindi has also been experiencing terrible anxiety, which has affected his sleep. “You stay awake longer, because you are afraid to sleep. You don’t know how you are going to breathe,” he tells New Frame. His doctor prescribed sleeping pills, which he took for two weeks after he was discharged from the hospital.

Chooonara says mental health issues form part of the long-term effects of Covid-19 – and this affects everyone, not only those who have tested positive. People feel anxious when a family member contracts the virus, or because they have lost a job or can’t socially engage, Choonara explains.

Some of those who have tested positive for Covid-19 – especially those who become debilitated because of the disease – end up suffering the effects of post-traumatic stress disorder or post-intensive care syndrome. “When you are in … settings [such as in a general hospital ward or in the ICU], you either witness how people are dying or you are gaining anxiety,” she says.

Clinical psychologist Erica Munnik says the pandemic has brought about a spike in feelings of uncertainty, worry and anxiety. While some people feel isolated and out of touch with loved ones, others are engulfed by fear when they find out they have tested positive.

“If one gets the news that they are Covid-19 positive, there is going to be the feeling of stress or worry – or panic attack, which causes difficulty breathing. Panic attacks mimic the symptoms of Covid-19,” she explains.

In May, Cassey Chambers, operations director at the South African Depression and Anxiety Group (SADAG) said that before the national lockdown, they received an average of 600 calls a day from people across the country. “During the lockdown we have seen a huge increase. Our calls have doubled. We are now getting over 1 200 or 1 400 calls a day from people who are feeling really anxious, overwhelmed and worried about the future,” Chambers says.

It will take some time for people to feel “normal” again, Munnik says, but she also notes that people find ways to cope, adjust and become more resilient. “Coping is not always positive [though],” she warns. “There are things like … alcohol and substance abuse, which we know are prevalent in South Africa.”

Unlike other countries with sufficient resources, South Africa can only focus on an immediate response to Covid-19. But the growing number of people experiencing long-term ill effects needs to be considered, Choonara says.

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