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17/11/2021
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A year into the pandemic: what is long Covid?
Prof. Dr. Victor Hoe Chee Wai Abdullah (L) and Dr Lim Yin Cheng.

Do you feel that you are still experiencing symptoms after recovering from Covid-19? Have you heard of long Covid?

Long Covid, also known as post-Covid syndrome, is a long-term consequence after Covid-19 infection.

According to the National Institute for Health and Care Excellence (NICE) guideline, long Covid or post-Covid syndrome is defined as symptoms developed during or after Covid-19 infection that continues for more than 12 weeks and are not explained by an alternative diagnosis.

In Malaysia, a tele-consultation service conducted by the Ministry of Health after the initial acute Covid-19 symptoms for 1,004 category 4 and 5 survivors shows that 65.9% continue to experience ongoing Covid-19 symptoms.

Based on data analyses from Hospital Sungai Buloh Covid-19 Rehabilitation Outpatient Specialized Services (CROSS) 12 databases, Covid-19 survivors who have suffered from category 4 and 5 are more likely to develop long Covid.

Thus, all patients from these categories will be followed up for further assessment of post-Covid syndrome after discharge from hospital.

Other categories of Covid-19 cases are not necessary for follow-up and they can walk in to the nearest healthcare facilities should the symptoms persist.

Long Covid usually presents with a cluster of symptoms rather than a single symptom, often overlapping and can affect any system in the body.

The five most common symptoms experienced include fatigue (excessive tiredness or lack of energy), exertional dyspnoea (difficulty breathing following activities), insomnia (difficulty sleeping at nights), cough and anxiety. Other symptoms that are important to look out for are abdominal pain, joint and muscle pain, chest pain, headache, nausea, diarrhea and reduced appetite.

Psychologically, long Covid can manifest with depression and post-traumatic stress disorder (PTSD) symptoms following an illness as well.

Picture yourself having to return to work while dealing with the symptoms mentioned above. What about performing activities of daily living?

Long Covid symptoms will cause a significant reduction in the quality of life. You won’t be able to function as well as you did before getting infected with Covid-19.

Some employees would even go to an extent where they will have to take extra leave from work because they aren’t able to complete tasks while experiencing such devastating symptoms.

In addition, they will also feel concerned about how long their symptoms will stay and when they will be able to resume their normal daily routine.

As a result, they start to feel anxious and depressed.

The persistent worries caused by the inability to foresee the future after getting Covid-19 can have a huge impact on one individual.

These feelings may also be worsened by fatigue that is often associated with long Covid.

Post-Covid rehabilitation comprises of a multidisciplinary team made up of physiotherapists, occupational therapists, speech and language therapists, psychologists, dieticians and pharmacists via a biopsychosocial approach.

Comprehensive assessments will be done beforehand in order to determine a personalized rehabilitation program and prescription under close monitoring at a safe intensity rate to address the symptoms which would impact one’s daily living as well as hasten the recovery.

Physiotherapists may start strengthening and breathing exercises for cardiopulmonary and musculoskeletal rehabilitation. Occupational therapists will focus on activities of daily living (ADL) which include dressing, grooming, toileting and hand function, to regain patients’ lost skills and independence. Psychologists will address cognitive impairment seen in anxiety and depression with neurostimulation activities and relaxation therapy incorporated in the program.

The program is currently available at several hospitals nationwide including Universiti Malaya Medical Center, Universiti Teknologi Mara Medical Center, Cheras Rehabilitation Hospital, Kuala Lumpur Hospital, Sungai Buloh Hospital as well as private facilities such as ReGen Hospital, Daehan Sunway, Prince Court and so on.

In conclusion, post-Covid syndrome is common and has a wide range of symptoms. The diverse range of symptoms is tied to the patient’s demographic and illness severity factors.

Therefore, all post-Covid recovering patients require a holistic approach for their follow up care and well-being.

The Malaysian government agencies and the public should work hand in hand to keep the epidemic under control and subsequently reduce the incidences of post Covid syndrome.

Our government should also play their role by adhering to all the SOPs.

If the government and the public can cooperate, our country will be able to overcome the epidemic.

(Nur Qamarina Mohaizi, Muhammad Luqmanul Hakim, Melvin Liew Zhen Da, Mashitah Hasan, Darshinidevi A/P Ratnam, Choong Huey Yee, Vincent Tan Xiang Pin and Wong Win Yi (Final year medical students of Group 4A Community Posting), supervised by Prof. Dr. Victor Hoe Chee Wai Abdullah and Dr Lim Yin Cheng, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya.)

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