Long COVID: About time

“It’s about time,” I thought as I read the Sunday Inquirer headlines: “Gov’t now also focusing on ‘long COVID’ cases.” Dr. Ted Herbosa, an adviser to the National Task Force against COVID-19, talked about this effort at a press conference of Laging Handa, an interagency activity specific to COVID-19.

I first read about “long haulers” with COVID in the June 23, 2020, issue of the British Medical Journal, in an article written by an epidemiologist, Paul Garner, giving vivid descriptions of what he was going through, weeks after “recovering” from COVID. The bold print for “2020” highlights this report appeared only three months after COVID was declared a pandemic by the World Health Organization (WHO).

More articles were to follow in the journals and as COVID infections grew, the cases yielded more data to suggest what this long COVID was. Here’s a brief summary of the reports and trends, and this is bound to change as the number of COVID cases continues to grow:

About 10-30 percent of patients who recover from acute COVID will develop long COVID, which can linger on for months. Even using the lower estimate of 10 percent, we could have some 360,000 Filipinos with long COVID. Symptoms vary depending on which of the body’s systems are affected, and this is the problem because symptoms have been reported for all body systems.

A cause for concern are the neurological symptoms because these are likely to be dismissed or confused with other psychological conditions, for example, chronic fatigue and “brain fog” (difficulties with thinking and memory).

This is why we need to alert the health professionals and the public to this long COVID. During a recent clinical conference I had with the Philippine General Hospital’s psychiatry department, I appealed to the physicians to ask all their patients, especially new ones, if they’ve had COVID because this could affect the psychiatrists’ diagnosis.

When laypeople consult health care providers, they should, even if not asked, mention if they have been infected with COVID. Note, too, that long COVID has been reported even in people who only had mild or no symptoms of COVID so it might be useful to mention, during a medical consultation, if you have been in close contact with COVID patients, in a health care setting or in a home. Especially with the Omicron variant, there have been many more “mild” and “asymptomatic” cases.

The mild Omicron infections have contributed to apathy but think twice now with long COVID. Even if we take the lower estimate of prevalence as around 10 percent of patients who have been infected, we are dealing with millions with often undiagnosed long COVID, with serious consequences for personal as well as public health. Just think of lost days at work or in school (pediatric long COVID has been confirmed), both for patients and carers, not to mention the anxieties of not knowing what we are dealing with.

So far, the best summary I’ve found for long COVID is from this article on the American Medical Association’s website: “What doctors wish patients knew about long COVID.”

I hope that local organizations like the Philippine Society for Microbiology and Infectious Diseases (psmid.org) will start giving more attention to long COVID on their websites, with information on local cases.

I finally decided to write about the problem, which was now being called “long COVID,” in my Nov. 18, 2020 column, and have mentioned this in many of my webinars on COVID-19 but medical professionals, in the government and in the private sector, have been slow to respond. Several articles on this condition, including Garner’s June 2020 article, have complained about this unwillingness to recognize the seriousness of the problem, even dismissing it as patients’ malingering, a medical term that is better described in Filipino as “OA” (over-acting) and “kulang sa pansin” (asking for attention).

In recent months, specific website advisories from national governments and the WHO have finally appeared, using “long COVID,” as well as “post COVID.”

Last year, the American Medical Association, the national organization of physicians, recommended that the WHO assign, in its International Classification of Diseases (ICD), a specific code or codes for post-acute sequelae of SARS-CoV-2 infection or PASC.

This recognition in the ICD is important because many governments limit their reimbursement for medical expenses to conditions that are listed in the ICD. PhilHealth, which uses the ICD, reimburses for hospitalization with acute COVID but not for long COVID.

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