The Science of COVID-19: COVID-19 and Post-COVID Syndrome

Dr. Ariane Mangar
Director of Disability and Rehabilitation
Ministry of Health

The COVID-19 pandemic continues to be a major concern all over the world. To those who believe that once you have already recovered from the deadly virus you are completely safe, it might not be so.
According to the Center for Disease Control (CDC), about 20 to 30 percent of people who have had symptomatic COVID-19 develop post-COVID syndrome.
Post-COVID syndrome has been described as signs and symptoms that develop during or following an infection consistent with COVID-19, which continue for more than 12 weeks and are not explained by an alternative diagnosis.
Persons will no longer have the virus in them and they can’t infect anyone, but it takes them anywhere from weeks to months — and maybe even beyond — to feel perfectly normal.

Symptoms
These symptoms of long COVID can be similar to those experienced in the first few weeks of having contracted COVID-19 and could be debilitating enough to make even the most basic activities difficult to perform.
The symptoms may also be similar to those experienced after a stroke, but the age group is much younger, and given the scale of global infection, this has the potential to become a major problem. The neurological impacts of COVID-19 are unknown because the virus is and we are still working to understand the longer-term impacts of the infection.
The most common symptoms of post-COVID syndrome include extreme fatigue, shortness of breath, difficulty regulating body temperature, sleep disturbances, and problems concentrating on daily tasks. There are also reports of damage to the lungs and heart.
The condition has been likened to post-viral fatigue, or chronic fatigue syndrome, which is a disorder that causes extreme fatigue that lasts for at least six months and doesn’t improve with rest. People with this disorder often don’t have any underlying medical condition that could otherwise explain the symptoms.
Other reported symptoms include chest pain, headaches, neurocognitive difficulties, muscle pains and weakness, gastrointestinal upset, rashes, metabolic disruption (such as poor control of diabetes), thrombo-embolic conditions, depression and other mental health conditions.
Some possible theories for why COVID-19 symptoms cause more long-term symptoms include low level of inflammation in the brain, decreased blood flow to the brain, or an autoimmune condition wherein the body attacks itself.

Checks
1. Daily checking of your oxygen saturation — it should be maintained at >94 percent on room air.
2. Checking for respiratory symptoms — that is, persistence or worsening of symptoms like cough and breathlessness.
3. Checking for persistent rise of body temperature above 100 degrees F.
4. Watching for signs of lethargy, drowsiness and fatigue.
5. Regular monitoring of blood sugar if you are a known diabetic; COVID-19 infection (as any other infection) alters blood sugar levels of the body.
Referral to a specialist rehabilitation service, such as physiotherapy, does not seem to be needed for most patients, who can expect a gradual, if sometimes protracted, improvement in energy levels and from breathlessness, aided by careful pacing, prioritization, and modest goal-setting.
In our experience, most but not all patients who were not admitted to hospital recover well with four to six weeks of light aerobic exercise (such as walking or yoga), gradually increasing in intensity as tolerated. Those returning to employment may need support to negotiate a phased return.
Anyone who had severe illness or was hospitalized with COVID-19 needs to consult a doctor about whether it’s safe to exercise. But even people who experienced mild illness or no symptoms need to take precautions before exercising again.

Recommendations
1. Don’t exercise if you’re still sick. Do not exercise if you have active symptoms, including a fever, cough, chest pain, shortness of breath at rest, or palpitations.
2. For sportspersons returning to exercise:
— after recovery from mild illness: one week of low-level stretching and strengthening before targeted cardiovascular sessions.
— very mild symptoms: limit activity to slow walking or equivalent, increase rest periods if symptoms worsen, avoid high-intensity training.
— persistent symptoms (such as fatigue, cough, breathlessness or fever): limit activity to 60 percent maximum heart rate until two-three weeks after symptoms resolve.
— patients who had lymphopenia or required oxygen: need respiratory assessment before resuming exercise.
— patients who had cardiac involvement: need cardiac assessment before resuming.
Even if you’ve never been diagnosed with COVID-19, be mindful of how you are feeling. Many people with COVID-19 don’t know they have it, or have general symptoms like gastrointestinal upset, fatigue, or muscle aches. So, if you’ve been feeling “not your usual self” during exercise, listen to your body, ease up, and check with your doctor.
COVID-19 is an aggressive virus that spreads easily and carries significant morbidity and mortality. Cardiac risk in particular is greater with COVID-19 than with other viral diseases, so it makes sense to return to activity with caution.
From the limited current evidence, we anticipate that many patients who suffer from post-COVID will recover. It is of utmost importance to monitor such cases, and a proper post-discharge rehabilitation plan is put in place to monitor the patient’s health, so that timely intervention could be done.
At present, the unknowns about long-term consequences of this potentially devastating viral infection far outnumber the knowns.
One fact already known: a person does not need to have suffered severely from the disease to experience symptoms that persist for months and, time will tell, possibly for years.
Even some young people who had mild COVID-19 infections continue to experience symptoms long after recovering from the acute illness, and some even require re-hospitalization due to the lingering effects of COVID-19. COVID-19 is essentially less than one year old, and, as such, is characterized as a brand-new disease.
We need three things: we need research to understand it; we need guidance for the clinical teams who will treat it; and, at the high end, we’ll probably need rehabilitation specialists.
In these uncertain times, one key role that we all must play is that of witness, or “listening to the story” of the person whose protracted recovery from the COVID-19 disease was unexpected, alarming, and does not make sense.
There are rehabilitation departments in every region in Guyana, and for more information, please call the Georgetown Public Hospital Rehabilitation Department, 225-3294.
Article submitted as part of the Ministry of Health’s COVID-19 public information and education programme. For questions, email [email protected].