Patient says health authorities must warn public of ‘long COVID’

Andrea (last name withheld), 44, tested positive for COVID-19 on 4 April, but despite having supposedly recovered, with two negative tests under her belt, six months on she is still suffering the long-term effects of the virus.  

“Until today, I’m still experiencing shortness of breath that has never gone away. I’m also suffering from fatigue, and muscle pain,” she said, speaking to MaltaToday.  

The aftermath of COVID-19 has put a major spoke in Andrea’s wheel, who before contracting the virus, had been an active person.  

The mother of two said she was disappointed with the reaction from the health authorities and their failure to make the public aware of the long-lasting effects of the virus. “We can’t carry on the way the way we are, acting as if all is okay... the health authorities must come forward, and warn people, or else the situation will only continue to spiral out of control, and people will pay the price.”

The UK’s National Institute for Health Research recently coined the term “long COVID” in a report on people living with the long-term ramifications of COVID-19, finding an ongoing COVID effect among them, and that that number was likely to increase in the coming months.  

According to the report, the symptoms include permanent organ damage to the lungs and heart, post-intensive-care syndrome, post-viral fatigue syndrome and continuing COVID-19 symptoms.  

Malta is currently experiencing an exponential increase in COVID-19 cases. According to the health authorities, they hail mainly from family and work clusters however, at least 30% are now sporadic, which means they are not linked to any known clusters within the community.  

Speaking to MaltaToday, respiratory physician Dr Josef Micallef said that up to 90% of hospitalized COVID-19 patients that are discharged with a negative swab test continue to experience either fatigue, lack of concentration, cough, breathlessness, headache and or muscle aches for several weeks and or months.  

“We also observe a significant number of patients who survive intensive care and who continue to suffer from post-traumatic stress disorder after this nasty experience,” Micallef said while speaking to this paper on the long-lasting effects of COVID-19.  

Micallef referenced SARS, in layman’s terms referred to as the “cousin” of COVID-19. “Many patients who have recovered from the SARS outbreak in 2003 have gone on to develop chronic fatigue syndrome, characterized by extreme fatigue that worsens with physical or mental activity but doesn’t improve with rest. The same may be true for people who have contracted COVID-19,” he said.  

Micallef said that COVID-19 is still a relatively new virus with several reports of complications, which may affect many vital organs. “The extent and severity of these complications are still under investigation as joint worldwide efforts are being made to gather data and publish them.”

However, Micallef said that in severe COVID-19 cases, the lung appears to be the main target organ of this virus.  

In many patients, CT scans have shown ground glass opacity, a term used for typical changes in the lungs “This is seen in various conditions including heart failure, ‘bird fancier’ lungs, types of fibrosis, and other lung parenchymal diseases. However, the peripheral, symmetrical ground glass consolidations in both lungs are very typical of COVID pneumonia,” he said.  

Micallef said that they have seen typical signs on chest X-rays even on patients that have tested negative. “We have had patients getting a positive swab up to eight days after hospital admission. Swab tests are only positive in up to 70% of COVID cases. That is why we repeat swabs,” he said.  

The treatment, Micallef said, involved oxygen, as well as the steroid, dexamethasone to reverse the changes, as well as antibiotics to prevent other bacteria, which can “opportunistically, attack COVID affected lungs.  

“Our main concern is when patients develop respiratory failure. Typically, oxygen levels in the blood go down to below 92% and some end up on a ventilator. The most worrying is Acute Respiratory Distress Syndrome (ARDS) where the lung tissue is severely damaged and fluid accumulates. This has a very high mortality rate,” Micallef said, adding that another complication was blood clots of the lungs, also known as a pulmonary embolism.  

“In any severe pneumonia (be it COVID, other viruses or bacteria) with respiratory failure and ARDS requiring intubation and intensive care treatment, some scarring or fibrosis of the lung is common,” he said.  

However, Micallef that from his experience, the lungs can heal though it might take months. “We still do not know the long-term effects of COVID pneumonia. To again, quote data from the SARS outbreak, up to 30% of patients intubated who survived remained with some lung scarring,” Micallef said.  

‘It’s time to take COVID seriously’  

Micallef warned that while in most cases, COVID does not permanently damage the lung, and that a full recovery is expected, “some patients develop serious lung complications.”  

“Scientific evidence is showing us that certain individuals are more at risk if more of the virus is inhaled and deposited in the lungs and elderly people seem to be even more vulnerable. This is why we should follow local and international public health guidelines by washing our hands, social distancing, wearing masks, avoiding gatherings and so on,” Micallef said.  

Micallef said that while COVID-19 has become the centre of everything, many individuals are experiencing other diseases, like heart conditions or early cancer, who are afraid to seek medical attention because they are afraid of contracting COVID-19 from hospitals, health centres and GP clinics.  

“I am convinced I can contract COVID more from the community than working daily in hospital attending to patients with respiratory conditions. Patients have died, and we expect many more in the coming years due to these common diseases, which we deal with daily, saving lives.  

“These preventable, premature deaths will by far outnumber COVID deaths. Please come for help,” Micallef said.