Most people who have coronavirus disease recover completely within a few weeks, but some continue to experience health problems long after recovering.
What are the post Covid-19 conditions?
These are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes Covid-19.
Common symptoms of the Post Covid Syndrome include :
fatigue
difficulty in breathing
joint pain
chest pain
brain fog
inability to concentrate
impaired memory
loss of taste and/or smell and sleep issues.
Older people are more likely to experience lingering post-Covid symptoms, just as they are more likely to get the disease.
Why are the elderly more likely to be affected by Covid-19?
With age comes a weakened immunity making the elderly prone to many types of infectious diseases including pneumonia.
Covid-19 in most cases unmasks the underlying conditions and older people suffer more from chronic diseases such as diabetes, hypertension and cardiovascular diseases. In many elderly people, these conditions are not properly managed, or diagnosed.
Settings such as nursing homes, churches, and family gatherings which are meant to make the elderly more sociable become hotspots for Covid-19 infections.
Which organs are at risk of long-term damage after Covid-19?
Although Covid-19 primarily affects the lungs, severe disease can damage many other organs as well. This may increase the risk of long-term health problems. Organs that may be affected include:
Lungs:
Pneumonia is the major cause of breathing problems in Covid-19 patients and the reason why patients are on oxygen or ventilators. The type of pneumonia can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue known as lung fibrosis can lead to long-term breathing problems.
Heart:
The risk of heart failure or other heart complications arising after Covid-19 is the result of damage to the heart muscles. Imaging tests taken months after recovery from Covid-19 have shown lasting damage to the heart muscle, even in people who experienced only mild symptoms. This is worse for people already suffering a form of heart disease.
Brain:
Covid-19 can cause strokes and seizures and there is also worsening of symptoms for those with Parkinson's disease and Alzheimer's disease. Covid-19 interferes with cognition and micro-strokes which are common during the acute phase of Covid-19 contribute to worsening dementia post-Covid-19. The elderly person's brain is already compromised by age so these effects on the brain remain and worsen their cognitive functions.
What other problems could arise after Covid-19?
Blood clots resulting from Covid-19 can lead to arterial occlusion and hence increased risk of heart attacks, stroke, and sudden. The increased clot formation may also lead to deep vein thrombosis (DVT) which can dislodge the lung (pulmonary embolism). Clot formation is a life-threatening process and results in serious health problems in elderly people.
Post-traumatic stress syndrome (PTSD), depression, and anxiety are often seen in people recovering from severe Covid-19 especially those admitted to ICU. Elderly people going through this near-death experience have been shown to have more episodes of PTSD.
They may never recover fully from depression, due to stigma, assumptions that their changed mood is due to old age, and their lack of coping skills. The elderly rarely seek help for mental problems and Covid-19 has further worsened this problem.
Do the drugs administered in the treatment of Covid-19 have side effects that affect the elderly more?
Steroids frequently used to treat severe Covid-19 may reduce bone density and hence increase fracture risk. Steroids also increase blood sugar and temporarily cause a diabetic state or worsen glucose status for those already diabetic. Newer treatments have been known to compromise the liver and blood count. Some drugs have been associated with abnormal mental behaviour such as hallucinations and flashbacks.
What can be done to protect the elderly from these long-term adverse effects?
We must educate the public about the merits of vaccination as this is a very critical intervention in fighting Covid-19. Although vaccinated people might suffer from Covid-19, they are unlikely to experience severe disease and therefore need less hospitalisation. They also do not experience clot formation, will require fewer drugs and do not experience worsening of pre-existing conditions.
Secondly, people need to avoid overmedication. Stay away from antibiotics and unnecessary medication including supplements and only take drugs for existing chronic illnesses. Drug-to-drug interaction may sometimes cause more harm than good to the patient.
Thirdly, people suffering from Covid-19 need to continuously monitor their oxygen levels. Those recuperating at home need to interact closely with doctors to get proper guidance on how to manage the disease at home. The key in managing the disease from home is monitoring oxygen levels as low oxygen is an indication of the severity of the disease. The earlier you get started on oxygen, the better the outcome. This will lower the risk of the long-term post-Covid effects.
Dr Shabani is the chair, Department of Family Medicine and Consultant Family Physician at Aga Khan University Hospital, Nairobi.
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