Most patients recover with time, but those with severe or persistent symptoms should see a doc

Most COVID-19 patients who continue to suffer symptoms after recovering from the disease – a condition known as long COVID – will recover naturally with time, but experts say a small group that continues to experience severe symptoms should seek medical help.

Dr Barnaby Young, head of the Singapore Infectious Disease Clinical Research Network at the National Centre for Infectious Diseases (NCID), said the main cause
of long COVID is a severe infection.

“Protecting oneself against this is the most important thing to do – and this can be done by getting vaccinated and (getting) boosters,” he said.

In addition to severe infection, Dr Edgar Tay, consultant and cardiologist at the Asian Heart & Vascular Centre in Mount Elizabeth Hospital,
cited a recent study that highlighted four key factors that increase the risk of long COVID: the viral load during infection, the presence of diabetes, the presence of auto-antibodies, and the reactivation of the Epstein-Barr virus in some patients.

Noting that some develop long COVID despite being vaccinated, Dr Young said the reason for this is not clear but is most likely due to a combination of genetic, microbiome and environmental factors.

He said most patients will recover from their symptoms within four weeks. Others may find their symptoms persisting for four to 12 weeks, with an even smaller number having symptoms that go beyond this period.

Dr Young expects the proportion of patients who experience long COVID from the recent Omicron surge to be low, as most were infected after getting vaccinated and also because Omicron tends to produce less severe infections.

But patients should seek help if they have symptoms that may suggest a serious medical condition, including chest pain, breathlessness and persistent fever.

“Most symptoms from long COVID are not so alarming, and it is okay to self-monitor these symptoms. However, if they are interfering with your ability to do your usual activities, if they are not improving or if you are otherwise concerned, then it is best to see your local GP (general practitioner) or polyclinic for advice,” Dr Young said.

Dr Tay said three groups of patients ought to go for post-COVID-19 evaluation – those who have persistent symptoms, or develop new or worse symptoms after recovering; patients whose symptoms have an impact on them, such as by affecting their sleep; and those planning to start strenuous exercise but still have chest pain or tightness, breathlessness, palpitations or light-headedness.

Dr Adrian Chan, a respiratory specialist at Respiratory Medical Associates in Mount Elizabeth Novena Hospital, said that patients with a pulse oximeter reading of 94 per cent and below should also seek medical advice, as this may be a sign of residual issues in the lower respiratory tract.

Both Dr Tay and Dr Chan said they have seen an increase in patients seeking help for long COVID over the past few weeks, which they did not observe during previous waves of infection.

In the light of the rising number of such patients, Gleneagles, Mount Elizabeth and Mount Elizabeth Novena hospitals have launched a post-COVID-19 evaluation for patients to ensure a smoother recovery. It will include a consultation with a respiratory physician, a CT lung scan and an electrocardiogram.

Professor Dale Fisher, senior consultant with the National University Hospital’s Division of Infectious Diseases, who is not affiliated with the three hospitals, noted a lot of merit in such an evaluation.

He said there is still a lot to learn about the long-term effects of COVID-19, and if the information from the evaluations is collated as research, it would be good to analyse it to find out more about long COVID.

“I would suggest it only for those who have relevant symptoms. I would not recommend such a package as a routine as most will recover without these symptoms,” he said, adding that patients should first ask their primary care doctor if the evaluation is right for them.

Dr Young said that as the coronavirus transitions from being a novel virus to something that people’s immune systems are used to encountering, long COVID should become increasingly less common.

Nevertheless, it is still important to protect oneself from the virus.

Professor Leo Yee Sin, NCID’s executive director, said: “Although the clinical illness from Omicron is milder in comparison with earlier variants of concern, it is not a mild disease as we do witness fatal cases among older vaccinated individuals...It is important that we exercise reasonable precaution against getting (infected).”

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