More than 10 per cent of those infected have residual symptoms after three months, writes Tony Farrell. Photo / Getty Images
More than 10 per cent of those infected have residual symptoms after three months, writes Tony Farrell. Photo / Getty Images
OPINION
I loathe fatigue. It is probably the curse of the modern GP, but lack of energy turns life into a grind.
I am particularly concerned about being afflicted with long Covid.
A patient in recently with a cough and sore throat had evaded all screening processes and sat faceto face with me with her mask precariously perched on the end of her nose, leaving viral particles to escape through the gaps.
She told me her RAT was negative, and that she "just had a cold".
There's a lot of talk about Omicron being a mild infection.
While most patients do not require medical or hospital resources, I am less convinced it is a trifle when I see ailing patients after Covid-19 infection.
They present with a range of complaints, including significant fatigue, breathlessness, chest discomfort, aching muscles, racing heart, feeling faint, and brain fog.
They look pale and washed out, and a bit shellshocked.
Examination findings and investigations usually reveal minor abnormalities and I attempt to reassure them and advise rest as much as possible.
I don't envy them because if their symptoms are ongoing, they may have associated organ damage or immune system problems as well as psychological issues.
Doctors will have to sort out patients who have more significant medical impairment after infection - a difficult and novel task.
Long Covid is not a single entity. It encompasses an intriguing array of multiple symptoms.
The suffering is intermittent, frequently getting worse after mental and physical activity.
New symptoms not experienced during acute infection can occur some weeks after initial recovery.
Young people and females are more at risk, and it occurs in children as well.
The cause is not well understood. It is possible that residual virus in various organs, inflammation of arteries and nerves, plus autoimmune activation play a part in this relatively common syndrome.
More than 10 per cent of those infected have residual symptoms after three months, writes Tony Farrell. Photo / Getty Images
More than 10 per cent of those infected have residual symptoms after three months.
Evidence shows that adequate immunisation is most important but is not entirely protective.
The severity of infection does not necessarily correlate with the development of the syndrome.
So, you may be playing Covid roulette if you feel you should "just get it over with".
Long Covid is one of the first illnesses named by patients connecting through social media, later gaining the attention of scientists and medical doctors.
The term was coined by Elisa Perego from Lombardy after her experience with Covid-19.
At that time the scientific world was intent on reducing the spread of the virus and preventing deaths, lacking focus on those with prolonged symptoms after infection.
Now the New England Journal of Medicine is talking about a long Covid as being a national disaster.
Overseas, patients have experienced stigma, anxiety and depression while struggling to navigate already stretched health systems.
They describe receiving conflicting information from their physicians as knowledge about long Covid was patchy or absent.
Long Covid sufferers lamented that their identity had been "spoiled" often referring to "how they used to be".
Doctors with long Covid worried about cognitive effects and poor energy on their job performance.
However, these doctors were regarded as great support for sufferers as they felt believed and understood.
Treatment of long Covid will require multidisciplinary teams, consisting of occupational therapists, exercise physiologists, and psychologists all complementing primary care teams with good access to specialists if required.
Paramount to recovery is optimising the gut microbiome, managing sleep, exercise and energy in an incremental fashion. Rest is nature's gentle nurse.
Consider the strain on our health system if the number of long Covid cases rises into the thousands and the impact on our nation's already limited workforce at a time of vital economic recovery.
We can counter this by getting vaccinated, following public health measures, and staying home if we have symptoms of Covid-19.
Given what I have read and seen, I'm avoiding infection as best I can.
- Tony Farrell has been a general practitioner for 30 years. He is a Mount Medical Centre director and a Fellow of the Royal New Zealand College of General Practitioners. Tony has a special interest in mental health and addiction and is a trustee of Hanmer Clinic and chair of Alcohol Action NZ.
