‘Long COVID’ wreaks devastation on lives and livelihoods

When Cape Town opera singer Belinda Silbert caught COVID-19 in March 2020, she says she was in “excruciating agony that was indescribable”.

“I was screaming constantly. My skin was on fire, my back pain was incapacitating, it was impossible to walk to the bathroom, my blood pressure was all over,” she told the SA Jewish Report this week. “The sinus pain and headaches were horrendous.”

Silbert, who is 55, has never been the same since. After slowly regaining her strength and a brief “honeymoon period”, she was hit by the virus for a second time in December. “It was even worse this time, affecting my breathing very severely. I also had heart palpitations. It’s been three weeks, and I’m coming off the cortisone only now. I also had antibiotics. I think it will be a long and slow journey ahead. I don’t remember what it’s like to feel normal, to speak without being breathless, to drive without my leg shaking.”

Both of her children were also affected by the virus. Her teenage son in Cape Town had uncontrollable temperatures and vomiting, and her daughter overseas (in her 30s) landed up in hospital and is still battling with recovery nine weeks later.

As an opera singer and consultant, she hasn’t been able to work, and fears for the future. “I’m doing breathing exercises, but I’m not sure what the long-term repercussions will be for my career.”

She’s certainly not alone in having what has become known as “long COVID”.

Cape Town resident Rebecca Bryer, 58, tested positive five and a half months ago, and she still can’t smell a thing. “If my husband makes a braai, I wouldn’t know about it. I can’t even smell garbage, and changing babies’ nappies is a pleasure! The other day I was cooking something and forgot about it. I never smelled the burning smell,” she says.

Bryer tested positive for the virus on 22 July 2020, and spent 28 days in isolation as her symptoms refused to let up even after the mandatory 10 to 14-day quarantine period. Generally fit, healthy and full of energy, the virus attacked her energy levels, digestive system, appetite, and senses of taste and smell. She battled with coughing and lay only on her stomach to assist her lungs.

Now, her sense of smell shows no signs of returning. Her sense of taste has returned weakly. “I need to add a lot more salt or chilli to my food to taste it.” Her energy and fitness levels aren’t what they were, and she struggles with strength in her fingers. She still battles with what she calls “porridge brain” and memory.

Like Silbert, other family members have also suffered devastating effects. Her brother, a dentist and orthodontist in Jerusalem, caught COVID-19 in March. After a harrowing time in hospital, he was discharged to a rehabilitation facility with the expectation that he would make a full recovery. But while there, he suddenly suffered a stroke as a result of the virus’ insidious effects. He is now completely paralysed on his left side. Unable to work and support his wife and five children, he requires full-time care and his life has been destroyed by the virus.

The “long COVID’ or “COVID long-haulers” are a source of concern and investigation in the pantheon of COVID-19,” says Dr Darren Levin, a general practitioner (GP) practicing in Camps Bay, Cape Town. “I have a few patients in my practice who haven’t yet returned to their baseline health after COVID-19, but based on the numbers we have seen in the second wave, I’m expecting many more.

“The global literature varies, but it seems to show that anywhere from 35% to 50% of people who have had COVID-19 take longer than two to three weeks to return to baseline health and a fairly high proportion of those people report ongoing problems with reduced exercise tolerance and post-exercise fatigue for a number of months,” he says.

Ongoing fatigue seems to be the most common problem for COVID long-haulers, in which “normal amounts of work, mental effort, daily household and parenting duties, and even mild exercise result in extreme fatigue,” Levin says.

“Some people experience ‘brain fog’, with a prolonged effect on their cognitive abilities. They struggle to focus for as long as they did before, to plan and conceptualise complex tasks, and often struggle to return to normal capacity at work. Many people still experience shortness of breath, muscle aches, and headaches for weeks after their illness.”

There are no clear-cut ways to avoid the long-term effects of COVID-19. “At the moment there is no specific recipe that can help everyone, and no specific treatment other than rest and reducing responsibilities and stressors,” he says. “In general, it’s always a good plan to try and maximise the healthy lifestyle factors you can, so eating “clean” – less processed foods, following a more plant-based or Mediterranean diet – and reducing or stopping alcohol intake. Also, have a health check with your GP to make sure that COVID-19 hasn’t unmasked an underlying health problem or worsened an existing one,” he says.

Dr Solly Lison, a family physician in Cape Town, says, “This virus is very devious and unpredictable. Long COVID happens with no pre-warning.

“It usually presents as fatigue, and taste can take weeks before it returns. People even need ‘taste training’ occasionally. Brain fog and mental and emotional changes can be problematic. Residual cardiac effects may occur, like inflammation of the cardiac muscles, requiring long-term treatment,” he says.

“Lung damage may result in chronic respiratory symptoms. Chronic coughing, shortness of breath, nausea, abdominal pains, bowel disturbances, and chronic renal failure may occur. Some abnormal liver changes and possibly diabetes may spring up unexpectedly. Being too active too soon can strain muscles, including cardiac muscles.”

While some shrug off COVID-19, Bryer and Silbert beg others to take it seriously. Bryer says that because she wore a mask around others in the days preceding her positive diagnosis, none of her close contacts became infected.

Silbert says that support groups for COVID long-haulers will be essential in future. Many such groups have emerged on social media, but she emphasises that “people tend to focus on the negative [on these groups]. It’s important not to be ‘mutually traumatised’. Support groups must be there to uplift and offer supportive information, but they must not replace doctors. However, I’m glad these groups exist.”