Still So Much to Learn about Long Covid

By Regina Hoo

October 2021 FEATURE
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FOR IVY CHAN, January 2021 will forever be remembered as the time she had a close call with death. She had developed a fever just before Christmas, and afraid that it might be Covid, she went to the doctor for testing. The result came out negative, but her fever persisted.

A second trip to the doctor confirmed Ivy had Covid. She waited for two days to be contacted by the Health Ministry, but when the call never came, her husband drove her to the Sungai Buloh Hospital instead, on January 1. Her blood oxygen level had by then dipped to 86%. “I still felt fine but I was immediately put on a stretcher, wheeled into a room and straight onto a bed where they tried to get my blood oxygen level up again.”

It wasn’t working and Ivy had to be intubated. When she came to four days later, Ivy found herself in the Intensive Care Unit (ICU) with tubes extending from her limbs. “A nurse came to me with a flimsy straw-like tube, about 1ft,” Ivy recalls. “I didn’t know what she was going to do and because I was still groggy, I didn’t bother to ask.”

The tube was inserted in her mouth and down the throat, blocking out her air passage. When it was finally removed, Ivy remembers lurching upwards, at a 90° angle in bed before falling back down. Clinging to the tube was mucus from her lungs.

Ivy Chan during her hospitalisation at the Sungai Buloh Hospital. Pictured here, Ivy was still too weak to breathe on her own.

Ivy is 62 years old, and is on medication for diabetes and hypertension. “A group of doctors would come in daily to observe my condition and progress. It wasn’t just my lungs they were examining, which truth be told, were badly affected. My blood sugar level had also gone haywire, I had to be given insulin; but the other organs seemed fine,” explains Ivy, adding that blood would also be drawn at least five times throughout the day.

When Ivy was finally transferred from the ICU, her blood oxygen read 90-91%, an improvement but it still wasn’t safe for her to walk or breathe on her own. “I had to have on an oxygen mask.”

At her new ward, she met other Covid patients; it loaned the room an air of convivial solidarity. “Every morning after breakfast, the nurses would come in for the usual tests and readings, and we’d all compare our results, teasing each other about sneaking junk food into the ward if one of us showed a high blood sugar count; it was a good way to keep the spirits up and fighting.”

Ivy was discharged from Sungai Buloh Hospital on January 11; her blood oxygen had improved to 94-95%. “I could start breathing on my own again, and was prescribed the steroid medication Prednisolone. I started at 12 tablets for five days, with the amount to be reduced by one tablet every five days.”

The side effects were many, and ranged from mild to severe. Insomnia was a big problem: “I was only able to get about two to three hours each night.” Everything Ivy ate tasted bitter, her fingers shook when she handled the oximeter, and her hair dropped ... a lot.

When asked if these are Long Covid symptoms, infectious disease specialist Dr. Cheng Joo Thye explains that Covid, as a systemic disease, elicits multi-factorial responses. “There is still a lot that we don’t yet understand about Covid infections and why long-term symptoms are present, but what is known is these symptoms appear more common in recovered Covid patients of Categories 4 and 5.” Ivy was a Category 5 patient.

“Partly, these could be due to the virus or the body’s immune response to the pathogen. Or the duration of stay in the ICU, especially if the patient is on the ventilator, sedated and immobile. In time, muscle weakness and wasting will occur. The medications we give like steroids, also increase risks of infection.”

Two components are involved in looking at Covid infections, explains Cheng. “The first few days of infection when the amount of virus present in the body is at maximum is called the viremic phase. Symptoms are the usual suspects of cough, flu, sore throat, but these are generally quite mild.

“On the second week, the virus has more or less broken down and only its residue remains; this ‘debris’ however, is what triggers an exaggerated immune response in the body, known as the cytokine response syndrome. Plenty of viruses cause a heightened immune response, but somehow, we see this even more in Covid infections. It sounds odd to say it, but in the process of protecting us, the immune system also causes significant body harm.”

Ivy lists spells of forgetfulness as a symptom too, but tries to keep her mind active by recalling the line dance steps she used to do with friends. “The brain and nervous systems are organs primarily targeted by Long Covid,” says Dr. Sim Bee Fung, a consultant neurologist at Gleneagles Hospital Penang.

Dr. Sim Bee Fung, consultant neurologist at Gleneagles Hospital Penang.

“Some patients do naturally recover from brain fog or problems with concentration or memory. But as there is no specific medication available yet, I recommend doing activities to improve memory and cognition; regular exercise to manage mood swings and reduce stress, anxiety or depression (those recovered have even reported post-traumatic stress disorder); and a balanced diet. If a patient has psychosis or is suicidal, I refer them to a psychiatrist.”

A Very Long Road to Recovery

Ivy began rehabilitation in February, to relearn how to breathe. “I had to do a 6-minute walk for the oximeter to record my oxygen level, and a spirometry test for my lung strength.” She also went for more lung X-rays at Institut Perubatan Respiratori and lung scans at Hospital Kuala Lumpur.

Her insomnia made Ivy an early riser and at 7am every morning, she practised her breathing exercises in the garden. By June, her strength had also recovered enough for her to walk 10,000 steps daily.

On August 18, eight months after her hospitalisation, doctors finally gave Ivy a clean bill of health. She was delighted, “I can’t thank the doctors and nurses enough for the amount of care and attention they showed us Covid patients.” She continues to record her blood sugar, oxygen and blood pressure readings twice daily, but has mischievously confessed to indulging in a few spoonfuls of ice cream as post-recovery celebration.

Ivy has also gotten inoculated, with the Pfizer-BioNTech vaccine, and displayed minimal side effects. “I believe this is one advantage recovered Covid patients enjoy over the rest of us; for them, the vaccine acts as a booster to heighten immune response which hopefully, makes the antibodies last longer as well,” says Cheng.

Regina Hoo

is the deputy editor of Penang Monthly.