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When Symptoms of Covid-19 Don’t Go Away

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Trump is doing better than his wife


Melania Trump delays return to campaign trail with husband US President Donald Trump due to lingering cough from COVID-19
Posted 17hhours ago, updated 16hhours ago
Melania Trump in an olive suit speaking at a lectern behind a row of American flags

The announcement is a reminder for Mr Trump that COVID-19 remains a powerful presence in everyday life, including his.(Reuters: Kevin Lamarque)
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Melania Trump's return to the campaign trail has been put on hold because of a lingering cough from her bout with COVID-19.
Key points:
  • Mrs Trump decided against accompanying husband President Donald Trump to a campaign rally in Pennsylvania
  • Donald Trump said people are tired of hearing about COVID-19
  • More than 58,000 Americans a day are testing positive for the virus, and more than 700 a day are dying from the disease
The US first lady decided against accompanying husband President Donald Trump to a campaign rally in Erie, Pennsylvania, according to her chief of staff, Stephanie Grisham.
It was to be Mrs Trump's first public appearance since recovering from coronavirus, and her first time out on the campaign trail in more than a year.
The first lady's announcement served as yet another reminder for the President that, as much as he said he wishes the virus would "just disappear", it remains a powerful presence in everyday life.
This week Mr Trump said people are tired of hearing about COVID-19.
Catch up on the main COVID-19 news from October 21 with our coronavirus blog.
More than 58,000 Americans a day are testing positive for the virus, and more than 700 a day are dying from the disease.
Mrs Trump continues to feel better every day.
"But with a lingering cough, and out of an abundance of caution, she will not be travelling today," Ms Grisham said.
Read more about coronavirus:
The first lady last appeared in public for the September 29 debate in Cleveland between Mr Trump and Democratic presidential nominee Joe Biden.
She and the President tested positive two days later.
Mrs Trump announced in a blog post last week that she had tested negative to her bout with COVID-19, which included headaches, body aches and fatigue.
She also revealed the couple's 14-year-old son, Barron, also had contracted the virus, but never had symptoms. He has since tested negative.
Mr Trump spent three nights at a military hospital outside Washington receiving treatment for his case of the disease.
He was released on October 5 and returned to active campaigning last week.
How fast is coronavirus growing around the world?
Data sources: Johns Hopkins Coronavirus Resource Center, Our World in Data, The COVID Tracking Project, ABC
Tuesday's rally in Pennsylvania was to be the first campaign trail appearance for Mrs Trump since she spoke briefly at a June 2019 event in Orlando, Florida, where the President launched his re-election bid.
She addressed a mostly virtual Republican National Convention in August from the White House Rose Garden.
Mrs Trump had planned to headline Trump campaign fundraisers back in March, but those appearances were cancelled due to the coronavirus outbreak.
She is expected to accompany the President to Nashville, Tennessee, on Thursday for his second and final debate against Mr Biden before the November 3 election.
AP
Posted 17hhours ago, updated 16hhours ago
 

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Better to be dead than b a long hauler. For serious cases it is better to be soylent Green than to be saved . No point surviving n being disabled

From breathlessness to lacking sense of smell, COVID-19 full recovery a long road for some Indonesians
Health workers wearing protective suits gesture from the isolation room for the coronavirus disease (COVID-19) patients after taking swab samples, at the emergency unit at Persahabatan Hospital in Jakarta, Indonesia, May 13, 2020. REUTERS/Willy KurniawanBookmark
JAKARTA: More than a month ago, Lilis felt unwell. She had a sudden headache and was nauseous.
Lilis, not her real name, initially thought she was simply tired and regarded the symptoms as signs she was near her menstrual cycle.
But after three days, the 37-year-old Jakarta-based housewife did not feel better.
She visited several doctors. A computed tomography (CT) scan, X-Ray scan and polymerase chain reaction (PCR) test showed that she had meningitis and COVID-19.
The doctors assumed the meningitis was a result of the Sars-COV-2 virus, which they say is very rare but has been identified before in a patient in Wuhan.
Lilis was hospitalised at a private hospital in Jakarta, as the COVID-19 referral hospitals were unavailable amid a surge in infections in the capital.
She received several medications, including dexamethasone, the steroid which American President Donald Trump also received.
After having tested negative twice for COVID-19 and given 10 doses of antiviral drugs, Lilis was discharged.
A health worker wearing protective suit and patients exercise at the Patriot Chandrabhaga Stadium which has been converted into a quarantine house amid the coronavirus disease (COVID-19) outbreak, in Bekasi, on the outskirts of Jakarta, Indonesia, September 28, 2020. REUTERS/Ajeng Dinar Ulfiana
However, the two weeks of hospitalisation did not mean she was 100 per cent fit and healthy.
"I still have recurrent headaches, and if I perform certain activities for too long, I will feel tired. I also feel short of breath,” Lilis told CNA.
For example, she has to lie down for two hours after doing chores for three hours before she feels better.
Her doctor told her: “This will persist for the next nine months.”
READ: Six months after COVID-19 strikes Indonesia, questions linger over healthcare capacity and equipment
Other COVID-19 patients who have tested negative told CNA they still feel a bit unwell, even though they have been declared free from the disease.
Doctors noted that COVID-19 can have a long impact on patients' health and cannot be taken lightly.
LACKING SENSE OF SMELL
Another COVID-19 survivor, who only wanted to be known by her first name Ika, also told CNA she is not completely well after testing negative for the disease on Oct 7.
Prior to being tested positive, Ika had a fever for two days, a sore throat and bodyaches. She also felt dizzy, lost appetite and suffered from a loss of smell known as anosmia.
While she has now been declared COVID-19 free, her sense of smell is still not 100 per cent back. Sometimes, she feels easily tired if she has performed certain activities like household chores and looking after her children.
“I am not as strong as I was before having COVID-19,” the 31-year-old housewife said.
FILE PHOTO: A medical worker wearing personal protective equipment (PPE) collects a swab sample from a woman to be tested for the coronavirus disease (COVID-19), as the outbreak continues in Jakarta, Indonesia, September 29, 2020. REUTERS/Willy Kurniawan
Her doctor told her it is normal since she is in her post-viral infection period.
“I just have to continue to maintain and increase my immunity so that I can recover quickly. I can recover from the anosmia 100 per cent, but it takes time and the nose must continuously smell all kinds of odours to get itself used to,” she said.
According to her doctor, the time needed to fully recover varies from one patient to the other.
Some can fully recover two weeks after having tested negative, and there are others who need about a month, she was told.
While she does not know for sure how she contracted the disease, four people in her household of six tested positive.
READ: Indonesia aims to produce 70% of required medical supplies as part of self-reliance efforts: Coordinating minister
They have all been declared COVID-19 free and are now on their way to a full recovery.
Her live-in maid, who was most affected by the symptoms, currently has the most complaints. She still suffers from a cough, is easily tired and occasionally feels dizzy.
SHORTNESS OF BREATH
A Tangerang resident who only wanted to be known as Joni, tested positive for COVID-19 early September.
Prior to getting himself tested for the disease, he displayed some symptoms such as a fever, chills and inflammation in the throat.
He believed the virus may have originated from his neighbours who were diagnosed with COVID-19 a few days before him.
As all hospitals he contacted were full, Joni had to undergo home quarantine while displaying symptoms.
READ: Premature reopening, gatherings among factors that led to COVID-19 clusters in Jakarta workplaces
When he was quarantined at home with his wife who also had the disease, three people in his family passed away due to COVID-19.
Joni had not seen them for a while and knowing what had happened was tough psychologically for him.
After three PCR tests in one month, Joni tested negative in early October.
However, the 36-year-old entrepreneur still complains about shortness of breath after attempting simple sporting activities. This is something he has never experienced before.
“I’ve tried to do sports a couple of times and I felt a bit out of breath. I felt a shortness of breath,” he said.
Joni noted that prior to COVID-19, he was in good shape and he had no comorbidity.
An Indonesian nurse takes a blood sample from a woman during a mass rapid test amid the COVID-19 coronavirus pandemic in Jakarta on April 23, 2020. (Photo: AFP/Adek Berry)
Marine Affairs and Fisheries Minister Edhy Prabowo, who tested positive for COVID-19 in early September, has a similar experience.
The 47-year-old was warded in an Intensive Care Unit (ICU) room at a Jakarta COVID-19 referral hospital. He was declared free from the disease at the end of September and started working again early this month.
In a video posted on his instagram account last week, he said: "I haven't fully recovered yet. Frankly speaking, I still have to practice breathing."
"That's why I said: Don't get COVID-19. Especially (so severe) that you must be treated in an ICU room. Why? Because afterwards, it is not good. My lungs are not so normal yet."
The minister added: “If I walk for a long time, I gasp. If I climb the stairs, I also gasp."
READ: Why Indonesia has the highest COVID-19 fatality rate in Asia
He said that he was in good physical shape prior to contracting the disease, citing his ability to ride a bike for three hours or about 100km non-stop.
Mr Prabowo also said he was able to play football as well as two straight sets of badminton.
POSSIBLE PERMANENT DAMAGE TO BODY ORGANS: EXPERTS
What do medical experts know about the COVID-19 post-recovery process?
Pulmonologist Dwi Bambang said that COVID-19 can cause permanent damage to many organs.
He further noted that there are different cases because not every COVID-19 patient has the same viral load and immunity.
“Sometimes patients will still feel sick even though they have recovered or tested negative because there is damage at the alveoli (tiny air sacs in the lungs which regulate the oxygen one breathes and the carbon dioxide one expels) – there is fibrosis,” he explained.
The time needed to fully recover from COVID-19 depends on how damaged the organs of the patients are and their nutritional intake, Bambang noted.
READ: Indonesians seek to get tested for COVID-19 as tally rises; govt says unnecessary to test everyone
Internist and cardiologist Eka Ginanjar concurred.
“COVID-19 can cause damage to several important organs such as the lungs and heart… It takes time to restore their functions ranging from a month until even nine months, depending on the damage or the response of the body,” he said.
He revealed that a longer full recovery period is quite common, especially among those who suffered severely or were in a critical condition.
But the doctor, who is also a member of the Indonesian Medical Association risk mitigation team, believed a full recovery is possible.
“Get enough rest, perform physiotherapy (light physical exercise), consume healthy food, think positively, and if the doctor prescribes some medicine, consume them according to the prescription,” advised Ginanjar.
Indonesian medical staff prepare a room for patients at the 2018 Asian Games athlete's village which has been converted into a hospital for COVID-19 coronavirus patients in Jakarta on Mar 23, 2020. (Photo: Hafidz Mubarak A/Pool/AFP)
Furthermore, the head of the Indonesian Association of Pulmonologists Agus Dwi Susanto asserted that being able to recover from COVID-19 is an achievement. But recovery sometimes also means the beginning of a long-term health problem, said Susanto.
“For some people, especially those who were warded in an ICU room, lung problems, kidney and heart damage are what they need to deal with,” he said.
He highlighted that the lungs must receive extra attention because a number of patients will have chronic lung disease as a result of COVID-19 and will require further treatment.
“Viral infection can cause persistent symptoms like coughing for a few weeks to several months or having persistent symptoms of shortness of breath as if one is wheezing or has asthma,” he said.
He also acknowledged that recovered patients can experience a decrease in their lung function by 20 to 30 per cent which will result in breathing difficulty when walking.
“Patients with mild symptoms can recover more quickly and not need extra oxygen but usually will become weak and easily fatigued,” he noted.
Those interviewed by CNA said they wanted to send the message that everyone must always follow the COVID-19 health protocols and stay at home as much as possible.
Joni especially added: “Don’t be selfish. Perhaps you’re fine, but you can be a carrier. And it can be deadly.”
 

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Doctors warn of lasting effects of COVID-19 after struggling to recover from virus
Nathalie MacDermott in Sierra Leone
Dr Nathalie MacDermott has been active in the fight against diseases like Ebola but since long COVID, she now has trouble walking.
Nathalie MacDermott is no stranger to deadly diseases.

She's worked on the front line of the Ebola epidemic in Liberia, Cholera in Haiti, and this year, treating children critically ill with COVID-19 in London.

But now she's fighting on a more personal front line.

Nathalie McDermott in PPE during an Ebola outbreak in 2014
Dr MacDermott (centre) in PPE during the Ebola outbreak in Liberia in 2014.(Supplied)
Dr MacDermott is suffering serious, ongoing symptoms after contracting COVID-19 back in March.

When her feet went numb while driving, she knew something was seriously wrong.

Then came the searing pain in her back, radiating down her arms and legs, when she walked up stairs.

"The further I try to go, the more that my feet start to kind of scuff and drag along the ground," the paediatric infectious diseases physician says.

Dr MacDermott had an MRI scan which appeared normal but is still undergoing tests. She and her doctors suspect coronavirus — or inflammatory processes triggered by the virus — have attacked her nerve cells and affected the function of her spinal cord.

Push to #CountLongCOVID
Dr MacDermott is one of a growing number of previously healthy people who identify as having 'long COVID', a bewildering array of symptoms that continue months after the initial, acute signs of infection.

"The concept of long COVID has been dismissed ... even in the medical sphere," she says.

But now Dr MacDermott is part of a group of UK doctors affected by persistent symptoms of suspected or confirmed COVID-19, who are calling for more research, better monitoring, and medical support.

They've joined a growing chorus on social media and in online support groups campaigning for health authorities to #CountLongCovid, and to take the plight of self-described #LongHaulers seriously.

Amy Small with a running medal
Dr Amy Small was a committed runner and a picture of good health before long COVID struck her.
"I have seen too many cases of people not being listened to, and their symptoms and concerns not being validated," Amy Small, a 39-year-old GP in Edinburgh who has been struggling with COVID-19 symptoms since April, says.

"I've seen heartbreaking stories of people losing their jobs."

One estimate suggests more than 10 to 20 per cent of people infected with coronavirus have ongoing symptoms in subsequent months — according to data collected by the COVID Symptom Study app in the UK.

"Anyone, it seems, can potentially get ongoing long COVID symptoms," Dr MacDermott says.

Overlap with chronic fatigue syndrome
Striking parallels are emerging with another disabling condition, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which has similar symptoms, and also receives a mixed response from the medical profession.

ME/CFS is a chronic and relapsing condition which can occur after a viral infection. The illness is characterised by extremely debilitating fatigue, "brain fog", muscle aches and pains, memory problems, headaches, and unrestful sleep.

There is some crossover too with another condition called fibromyalgia, in which people experience ongoing musculoskeletal pain all over their body.

Dr Ian Frayling donating antibodies and serum to studies
As a patient himself now Dr Ian Frayling hopes to help research into long COVID.
Those suffering with long COVID also speak of crushing fatigue, brain fog, and muscle aches and pains.

"You struggle to even think about thinking about something," Ian Frayling, a genetic pathologist and medical practitioner in Wales who contracted COVID-19 in March, says.

"[It was] the worst five or six days of my life.

"There was this cough that was like no other."

Dr Frayling describes the months since as like living with a "cyclical chronic fatigue syndrome".

Some days he feels okay, but then he crashes. He struggles with language, breathlessness, disrupted sleep, tachycardia (excessive heartbeat), and a debilitating exhaustion.

The symptoms can flip from hour to hour.

Long COVID research could help those with ME/CFS
Dr Small said many in the ME/CFS community are connecting with her on Twitter, hopeful that any research done on long COVID may also help them.

"They have been gaslighted by medics for a long time [and] told that their symptoms are psychological," she says.

"Chronic fatigue syndrome and all of the related syndromes that go alongside that population have been deeply let down by medicine.

"[But some with ME/CFS ask] 'why are you so special with your long COVID when we've had this for years and no one's believed us?'.

"I think we have so much to learn from each other, and a lot to gain from working together."

Difficult to diagnose
As with ME/CFS and fibromyalgia, long COVID is proving difficult to diagnose because of the confusing range of symptoms.

In April, Dr Small experienced the classic symptoms of COVID-19 — fever, extreme breathlessness and falling oxygen levels, a splitting headache, body aches, and then a persistent cough.

Her husband and 2 small children experienced COVID-19 symptoms too. But in the six months since, Dr Small is still experiencing recurrent fever, elevated temperatures, dizziness, and other perplexing symptoms.

When she tried to go back to work at her Edinburgh clinic in June, she got a shock.

"I was feeling a bit better physically ... [but] ... that afternoon I started to feel a fatigue that I've never experienced.

"Just doing a half day's work using my brain left me bed-bound for about 10 days."

"My speech was slurring. I couldn't find my words. I had a day when I couldn't speak."

New symptoms continue to keep surprising Dr Small. In August, she suddenly lost her sense of smell.

"I don't understand how it's affecting our bodies."

Like others, Dr Small wonders whether her immune system has been triggered to respond as if she still has the active coronavirus.

"This is something that just needs so much more research and investment," she says.

Dr MacDermott agrees.

"The medical profession has an inclination, when it can't explain something, or when initial basic tests appear normal, [to] dismiss things as being anxiety related or psychosomatic."

Research needed to make sense of long COVID mystery
Long COVID doesn't appear to discriminate by age or health status — even those who experienced mild or asymptomatic COVID initially are reporting prolonged symptoms.

"We're now discovering that many ... actually have got evidence of underlying organ damage secondary to COVID that's only now being picked up," Dr MacDermott says.

"It simply wasn't possible to be seen in an outpatient department until fairly recently."

If people had mild symptoms of infection the message early in the pandemic was to isolate and recover at home.

"Those who weren't hospitalised with the illness were just sort of left to get to get on with it," Dr MacDermott says.

This has meant many have suffered in isolation. Others have banded together in their thousands online to drive a patient-led movement calling for their symptoms to be taken seriously by medicine.

There is now mounting interest in their plight.

For example, the UK's National Institute for Health Research is using patient testimonies to investigate long COVID. One suggestion is the condition could in fact be multiple syndromes, including post-intensive care syndrome and post-viral fatigue syndrome.

"Given the volume of people affected by long COVID in a short space of time, and the likely link to an infection with COVID at some stage, I hope that means it's much harder to dismiss this," Dr MacDermott says.

Dr Frayling is struggling to understand his symptoms, but he feels like he has got off relatively lightly compared to others he's heard about.

"Their breathing [is] affected in a much more serious manner. They have permanent changes to their lungs. Some people have permanent changes to the conduction pathways in their hearts," he says.

"There's all sorts of other things going on."

The respiratory system, heart and cardiovascular system, the brain and nervous system, the kidneys, and the gut all appear to be affected differently in different people.

"We need to realise it's a spectrum of disease, and it is also a multi-system disease," Dr MacDermott says.

Avoiding a second pandemic
There are other signs that people with long COVID are being listened to.

The National Health Service in England has set up a new Long COVID taskforce and announced that specialist clinics will be available to people with ongoing health problems from coronavirus, including those who weren't hospitalised or didn't receive a positive COVID test but who meet the clinical case definition for infection.

Dr Frayling is concerned about a second pandemic — of long COVID — one that is silent, disabling, and difficult to diagnose.

"In terms of the total health burden, that will way exceed whatever acute COVID did to us by the time a vaccine comes on."

Dr Small, active in the British Medical Association and the busy mother of two, is worried about whether she'll be able to continue working as a busy GP.

"I worry about the future. I worry about the impact on every aspect of my life," she says.

"It's absolutely heartbreaking to see a four-year-old look at his mum and think, 'oh, I must help Mommy'."

It's changed the way she sees her role as a doctor too.

"As a GP prior to all of this, I was pretty sceptical of things.

"I certainly had sympathy for conditions like fibromyalgia, but I didn't have the empathy that I have now. I didn't understand it. I really didn't get it.

"If I could go back and speak to myself as a GP prior to all of this, I would have been a much better doctor then, and I will hopefully be a much better doctor now."
 

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New post-coronavirus clinic to focus on lingering symptoms in patients
Fox News Flash top headlines for October 29
Fox News Flash top headlines for October 29
Fox News Flash top headlines are here. Check out what's clicking on Foxnews.com.
Physicians who saw a growing number of patients struggling with post-coronavirus respiratory issues and lingering symptoms hope that a new clinic specifically designed to promote recovery will address this population’s needs. The Post-COVID-19 Clinic, launched by doctors at UC Davis Health, will be open to anyone who is at least one month past the start of coronavirus symptoms.
The clinic is comprised of pulmonary, neurologic, immunologic and cardiovascular specialists.

The clinic is comprised of pulmonary, neurologic, immunologic and cardiovascular specialists. (UC Davis Health)
“It’s frustrating and frightening for them,” Mark Avdalovic, a pulmonary and critical care medicine specialist at UC Davis Health, said in a news release. “There are many who are still suffering a wide array of symptoms despite being many weeks out from their initial infection, and they don’t know why. They deserve to have these symptoms evaluated in a systemic fashion.”
The clinic, which will open near UC Davis, which is west of Sacramento, and at regional centers in California, will be comprised of pulmonary health specialists, as well as cardiovascular, immunology and neurologic teams as not all patients experience the same lingering issues. The clinic will also be paired with UC Davis Health research to study the impact of so-called “long-COVID.”
“They’re anxious and confused, and they want to know if anything is really wrong with them,” Avdalovic, said, of the clinic’s potential patients. “Rather than going from doctor to doctor and not getting all of their issues examined at once, our goal is to evaluate them comprehensively, find the causes and add other UC Davis specialists to their care teams as needed.”
UC Davis is among a growing number of medical facilities turning its attention to post-COVID recovery. A recent study out of U.K.’s King’s College London claimed to identify risk factors that can lead to “long-COVID.” They found the most common lingering symptoms reported were fatigue, headache, dyspnea and anosmia, and that they were most likely to occur in older patients, those with a higher BMI and in patients who were female.
Long-COVID patients were also more likely to report heart symptoms or trouble concentrating, the researchers said.
“COVID-19 is a mild illness for many, but for one in 50 symptoms can persist for longer than 12 weeks,” the study’s lead author wrote. “So it’s important that as well as worrying about excess deaths, we also need to consider those who will be affected by long COVID if we don’t get the pandemic under control soon. As we wait for a vaccine, it is vital that we all work together to stem the spread of coronavirus via lifestyle changes and more rigorous self-isolating with symptoms or positive tests.”
 

waitifcuk

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Don't believe all this crap about long haulers and ignore all the doomsday scenarios. Covid is just a minor infection for the vast majority of those that catch it just like most other diseases.

Singaporeans should worry more about dengue fever and influenza which is killing many more people compared to Covid.

....and reckless drivers.
 

waitifcuk

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KNN my uncle suspect she at 55 is time to have all the mentioned then she point it to covid leelated KNN pre diabetes high cholesterol high BP ventricular contractions etc KNN my uncle also have all these KNN

long live your uncle

long live your uncle

long live your uncle
 

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Basically...better off dead than being a long hauler

Don't let Long COVID 'fall through the cracks', WHO warns
The WHO held the first in a planned series of seminars aimed at expanding understanding of
The WHO held the first in a planned series of seminars aimed at expanding understanding of post-COVID conditions, which heard not only from scientists and doctors but also from sufferers themselves. (Photo: AFP/Fabrice Coffrini)
10 Feb 2021 04:40AM
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GENEVA: The World Health Organization called on Tuesday (Feb 9) for greater research, recognition and rehabilitation for Long COVID sufferers as it brought experts together to share insights into the little-understood condition.

The WHO held the first in a planned series of seminars aimed at expanding understanding of post-COVID conditions, which heard not only from scientists and doctors but also from sufferers themselves.

Little is known about why some people, after coming through the acute phase of COVID-19, struggle to recover and suffer ongoing symptoms including tiredness and brain fog as well as cardiac and neurological disorders.

Studies suggest that potentially one in 10 cases may have prolonged symptoms one month after infection - meaning millions may be suffering from ongoing illness.

WHO director-general Tedros Adhanom Ghebreyesus said that with attention turning in the coronavirus pandemic towards vaccination campaigns, "Long COVID should not fall through the cracks".

He said the impact of Long COVID on society and the economy was starting to become clear, and for those reasons, "people start to listen" beyond the medical community.

Though the level of research is growing, it is "still not enough", he said.

British doctor Gail Carson, from the International Severe Acute Respiratory and Emerging Infection Consortium, warned that "Long COVID could become the pandemic on the pandemic".

Presenting findings from a post-COVID support forum, she raised the plight of under-the-radar sufferers.

Even for many who never had to be hospitalised with the virus, their condition "has been life changing".

"People are losing jobs, they're losing relationships. There's a real urgency to try and understand this," she said.

Carson said that Long COVID in children was "even less well recognised or counted" than it is in adults.

She said it was "staggering" that only 45 out of more than 5,000 funded COVID-19 projects were looking at Long COVID.

Maria Van Kerkhove, the WHO's technical lead on COVID-19, said the organisation was continuing to learn about this aspect of the pandemic.

"We know that much more work needs to be done," she said.

"We need to show compassion with each other but we also need to be persistent in getting to the answers."
 

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a public health expert’s campaign to understand the disease
Illustration of a pocket watch against clouds.
DreamcatcherDiana/Shutterstock
Nisreen Alwan, University of Southampton
February 16, 2021 4.01pm GMT
On March 20 2020, while the UK was anticipating its first national lockdown to control the coronavirus pandemic, I started feeling unwell with what felt like a COVID-19 infection.

Over the next couple of days, I developed a collection of symptoms: fever, chills, cough, chest heaviness, exhaustion, diarrhoea, abdominal pain and bad muscle aches, particularly in my legs. Since the UK government had stopped lab testing for those who were not hospitalised for COVID-19 on March 12, the vast majority of community infections in March remained unconfirmed by testing, including mine. The instruction then was that if you were not ill enough to go to hospital, you should stay at home and wait to get better.

While I isolated at home with my three children, I was optimistic that the infection would pass, like other flu-like illnesses I’d had in the past, because I had no underlying risk factors for severe COVID-19. But I became nervous with every new day that passed while I was not recovering.

At the end of the third week, I was still concerned, but consoled by others posting on social media describing their frustration with an illness that would not go away. They were describing a fluctuating experience like mine. One day you would feel like you were on the mend, the next day, symptoms hit you badly again. Little did I know at the time that these relapsing symptoms would stick with me for the next nine months.

COVID-19 is not black and white
By summer 2020, I was struck by how coronavirus risk was still communicated as a black and white picture. As a public health researcher, I could see that there was a clear oversight in how this new disease was being classified: the public messaging was that you either have a high risk of severe initial infection, or it hardly affects your health. This was certainly not my experience nor that of the thousands of others in long COVID social media support groups.

A man wearing on oxgen mask is wheeled into hospital by paramedics.
There is more to COVID-19 than hospitalisations and deaths. Andy Rain/EPA
So how common is long COVID? This is the million-dollar question, and for a long time we had no idea. But in recent months, studies of the conditions have been trickling in.

Today, there are a number of estimates out there, which vary because of different definitions of the condition, the length of follow up, a different range of methods of measurement and groups of people who were studied.

We know that recovery is not guaranteed for those who were treated in hospital for COVID-19. In a large study in England where the average follow-up period was 20 weeks, almost one in three patients got re-admitted to hospital and one in eight died after discharge from hospital.

Long-term illness is not restricted to people who experienced severe symptoms when they first got infected with COVID-19. The UK’s Office for National Statistics (ONS) has published estimates based on its COVID-19 Infection Survey, which measures the rate of coronavirus in the general population. These estimates can be considered more reliable than others as the survey is based on a random sample of people.

A woman sits on bed holding a pillow and touching her chest.
One in five people with coronavirus still have symptoms five weeks later. Twinsterphoto/Shutterstock
The survey estimates that one in five of those who tested positive for coronavirus were still symptomatic by week five, and one in ten by week 12.

The ONS further broke down the five-week figures by age and sex. They found that about one in four women and one in five men have at least one symptom five weeks after testing positive. Although long COVID was less prevalent in children (around one in seven) than adults aged between 25 and 69 years (one in four), the figures still did not fit with the narrative that this a hardly noticeable illness for the youngest cases.

Counting long COVID
Over the past year, government pandemic responses have been designed around monitoring the number of deaths, hospital admissions and lab-confirmed cases of COVID-19. But without national surveillance systems to track prolonged illness and organ damage due to COVID-19, how will health and care systems prepare and accommodate for the sheer demand on services? How will the economy accommodate for the loss in productivity due to sickness?

It is also essential for prevention efforts to convey the reality of prolonged illness as a quantifiable outcome in those infected, even if they were previously healthy and of younger age. People need facts to inform their decisions.

That’s why I have been calling for illness caused by coronavirus to be measured in the same way as deaths and for national and international surveillance systems to monitor recovery from COVID-19. I have also argued for the use of long COVID patient registers. Otherwise, how can we address what we are not measuring?

By properly measuring recovery, taking into account the relapsing nature of the illness, we can find out how many of us have not fully recovered and come up with ways to support people living with long COVID.

The road to recovery
So what next? I am hopeful that complete recovery is possible for many with long COVID. I am thankfully feeling better now, as I was able to adapt my life to avoid triggering my symptoms.

But there will be many who are not able to do so due to their work or personal circumstances, and there are those who will require long-term medical attention and care. They will also need the welfare system to support them – they should not live with the threat of losing their livelihoods due to a poorly understood disease.

Our pandemic response must be informed by the amount of chronic illness it generates, not just deaths with COVID-19 and hospital capacity. We must count long COVID if we truly want to know what we are up against.
 

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Learning from doctors with long covid - The BMJ
February 26, 2021
When Sarah Burns and Sue Warren started a support group for doctors with long covid, they found a number of people struggling with new experiences, losses, and vulnerabilities

Long covid has emerged as a serious, yet poorly understood, sequelae of acute covid-19 infection. We do not yet know why some people develop long covid, while others do not, but it appears that rates of long covid are more prevalent in healthcare professionals due to increased exposure to covid-19.1

In July 2020, a Facebook support group for medical practitioners affected by and suffering from long covid was set up to provide an opportunity to share experiences. Subsequently, we established a confidential space where doctors could come together for further support, under the auspices of the charity Doctors in Distress. Over 80 doctors, across all grades and specialties, joined the first webinar and were subsequently divided into smaller groups of 10-15 members with experienced facilitators leading each group. Sessions ran for eight weeks, with a final group webinar to share learning.

Common themes emerged, including living with prolonged symptoms, challenges accessing physical healthcare, uncertainty about the pathophysiology and duration of illness, concerns over future fitness to work, loss of personal and professional identities, and the stigma associated with symptoms such as fatigue.

Becoming unwell has long been recognised as a challenge to doctors.2,3 Having a new, poorly understood disease has made the transition from professional to patient harder and many doctors have struggled with the vulnerability of being “on the other side.” While some participants have eventually received diagnoses (for example, autonomic dysfunction, pericarditis, myocarditis, microvascular angina, pulmonary embolism, and neuropathy), several have not and feel dismissed by their clinical colleagues. For many, the most important factor was feeling heard by other clinicians.

Loss (including the inability to work and professional identity) was a pervasive theme, although given how central work is to doctors this is hardly surprising.4 Doctors described intense feelings of failure and guilt for leaving colleagues with increased workloads and not personally contributing to the “fight against covid.” This self-stigmatisation and shame is common among sick doctors.5,6

The diffuse nature and severity of symptoms has led some to question whether they would be able to return to working as a doctor again. Neurocognitive dysfunction is a common symptom of long covid and is in sharp contrast to the high function essential for managing the complexities of medical work, which doctors will have been used to pre-covid. Other symptoms, including exertional chest pain, shortness of breath, and severe fatigue, have pervaded and limited every aspect of life. These doctors’ worlds have shrunk and changed considerably.

Many felt angry that they had, almost certainly, contracted covid-19 in their workplaces, but now felt abandoned or even penalised by colleagues—a small but not insignificant number have been asked to leave roles due to prolonged sick leave.

While long covid has many physical presentations, this is not to dismiss its psychological manifestations. For some, mental illness has been obvious: depression, anxiety, and post-traumatic stress disorder. Fear that their treating clinicians would attribute physical symptoms to their understandable psychological distress is a common concern. The Doctors In Distress groups were the only place some could talk freely about their experiences, losses, and vulnerabilities, and reach a deeper understanding. The therapeutic power of belonging to a group, being able to share experiences, receive support, and provide hope have been described as universal features of groups in different settings.7

Moving forward

Participants realised they needed to find other ways to help healing. Disappointingly, medicine (despite all its technological advances) seems unable to provide all the answers. Participants in the groups recognised improvement is likely to occur with the passing of time, but this means accepting and making space for self-care, rather than constantly striving to perform.

Many are going through a period of loss for their old self. With acceptance, facilitated by belonging to the group, some gave themselves permission to be truly self-compassionate, which, not unexpectedly, has resulted in improved self-care and subsequent improvement in their physical health.

None of these doctors expected to have these sequelae to acute covid. They have become sufferers of a new, complex disease, and yet in this process of recovery (helped by the group) they have grown in their understanding of what true caring means—the value of kindness and true self-compassion and the importance of feeling heard.

Almost all described that the process of becoming unwell has changed them, not only as people, but also as doctors. Not being heard themselves, they pledged to listen more closely to their patients, be more open minded about symptoms that do not fit a clearly recognised pattern, have a deeper understanding of the impact of disability and chronic illness, and be kinder both to themselves and their colleagues and patients.

Some have also used their experience to escape stressed NHS workplaces and explore other opportunities. Others have made long planned changes in their personal lives—getting dogs, exploring artistic talents, making more time for simple pleasures.

These doctors have learnt from long covid. We can learn from these doctors too.

Sarah Burns is a GP based in Southampton, who had long covid. She was a co-founder of the UK doctors #longcovid Facebook group and put the proposal for these groups to Clare Gerada.

Sue Warren is a locum GP (and ex-partner) in Dorset and also works for Practitioner Health and Wessex Professional Support and Wellbeing Unit. She is an appraiser and Wessex LMC rep and was a facilitator for the Doctors in Distress long covid support group.

Competing interests: none declared.

With thanks to Clare Gerada for leading this programme and her support with this article. Many thanks to “Doctors in Distress” for funding and delivering the free support accessed by these doctors. Themes discussed in this article can be explored further in Gerada G. (Ed) 2020. Beneath the White Coat: Doctors, Their Minds and Mental Health.

References:

Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo C-G, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health 2020 Sep 1;5(9):e475–83.
McKevitt C, Morgan M. Anomalous patients: the experiences of doctors with an illness. Sociol Health Illn 1997;19(5):644–67.
Thompson W, Cupples M, Sibbett C, Skan D, Bradley T. Challengers of culture, conscious and contract to general practitioners’ care of their own health: qualitative study. BMJ 2001;323:728.
Gerada C. Work is central to doctors’ identity, and those unable to work need support. BMJ 2016;353:i2014.
Henderson M, Brooks SK, Busso L del, Chalder T, Harvey SB, Hotopf M, et al. Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study. BMJ Open 2012 Jan 1;2(5):e001776.
Miles S. Addressing shame: What role does shame play in the formation of a modern medical professional identity? Br J Psychiatry Bull 2020;44(1):1–5.
Yalom I, Leszcz M. The Therapeutic Factors. In: The theory and practice of group psychotherapy. 5th ed. Basic Books; 2005. p. 1–2.
 

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Indonesians open up about the impacts of long COVID, one year since the country's first case
By Natasya Salim and Hellena Souisa
Posted SatSaturday 6 MarMarch 2021 at 3:56am
A woman holds a pink umbrella over a man on a stretcher, and they're accompanied by two medics.

In Indonesia, long COVID has both physical and social impacts.(
Supplied: ANTARA FOTO/Fauzan
)
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Juno Simorangkir was supposed to leave the emergency COVID-19 hospital in Jakarta after he tested negative, but his journey with COVID-19 didn't end there.
Key points:
  • Long COVID symptoms were experienced by 63.5 per cent of 463 surveyed patients in Indonesia
  • Many have faced stigma at work or from neighbours during their recovery
  • One expert says using the recovery rate as a parameter of success is fraught
Mr Simorangkir experienced COVID-19 symptoms 11 days after Indonesia announced its first case on March 2 last year.
After almost two months of hospitalisation and isolation, he thought his health would go back to normal, until his body "became suddenly limp" and he nearly fainted.
"My [stamina] dropped and when I was about to eat, I could feel my body flushing, shivering ... my heart pounding until I couldn't sleep and I felt a piercing sensation all over my body," he told the ABC.
After being released from hospital, he tried to find some clues about his condition and stumbled upon a patient-led group of COVID-19 survivors.
A portrait of Juno Simorangkir standing on the street, in front of a car.

Juno Simorangkir left hospital almost a year ago, but his journey with COVID-19 did not end there.(
Supplied
)
It was here that Mr Simorangkir learned about long COVID, an illness where people who have recovered from COVID-19 still report lasting effects.
"If I tell my story to healthy people, they will empathise, but how much do they know about the condition? How much do they understand what it feels like?"

This thought spurred him to create a community called Covid Survivor Indonesia (CSI) on social media.
The group has more than 6,000 followers on Instagram and over 1,800 followers on Facebook since its creation in January this year.
They have received hundreds of questions about long COVID, as well as messages from survivors reporting discrimination.
He said survivors had reported being fired because they were no longer considered productive, while many were still considered infectious.
Others saw their pay cut or said they were not paid by their employer because they needed a long time off work for treatment.
Losing work over long COVID
Long after testing negative, Daulat, who asked to be only known by his first name, said he continued to suffer the lasting effects of COVID-19 and lost work because of it.
At one point, Daulat, a content maker, could only complete half of his daily target at work.
"Usually from 7:00am to 10:00am, I could rewrite five articles, but at the time, I couldn't even remember why I opened my laptop," he said.
"I often got a headache and couldn't even decide what words I wanted to use."
Daulat said he was asked to rest for a month and a half, but when he was ready to return to office, he said he was let go.
Up to October last year, more than 6.4 million Indonesians had either been stood down or were fired due to the pandemic, according to data from Indonesia's Chamber of Commerce and Industry.
A Ministry of Manpower survey released last month showed 17.8 per cent of companies had fired their workers, 25.6 per cent had stood down their workers, and 10 per cent had done both.
A medic shows a patient an ipad displaying an image of a waving family.

COVID-19 symptoms can linger long after a patient leaves hospital.(
Supplied: Shuttershock/ Pordee Aomboon
)
Daulat said he received a compensation fee, but he was still under financial strain as he had to provide for his wife and three children.
But there's been a psychological toll as well — he said he often "felt useless", although his neighbours had been a source of support.
"Almost everyone was supportive, although there are one or two people who would avoid walking in front of my house and chose to cross the street," he said.
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Mr Simorangkir often receives messages about survivors being avoided by their neighbours.
"I told them it's good that they are keeping their distance ... today's situation is not normal, so if they distance themselves, just let them be."
'We can't go back to the way we were'
Marking the anniversary of the first case in Indonesia this week, the Indonesian Doctors Association said as many as 21 per cent of recovered patients will experience long COVID.
However, based on a survey of 463 people conducted by Dr Agus Dwi Susanto, a pulmonary specialist and the chairman of the Indonesian Society of Respirology, the number is much greater.
"We conducted a study on long COVID-19 patients in Indonesia from December to January 2021, and our initial findings showed that 63.5 per cent of the entire population we surveyed had long COVID symptoms," he said.
The symptoms can include persistent fatigue, headaches, shortness of breath, and coughing.
Post-COVID symptomsNumber of patientsPercentage (%)
None16936.5
Fatigue14030.2
Cough7816.9
Muscle pain5211.2
Headache5211.2
Sleeping disorder459.7
Dyspnea439.3
Joint pain429.1
Anxiety398.4
Heart palpitations367.8
Concentration disorder326.9
Nausea275.8
Blocked nose245.2
Anosmia194.1
Sore throat163.5
Depression122.6
Intermittent fever102.2
Diarrhea91.9
Vomiting71.5
Source: Susanto, et al. 2021. Clinical picture and quality of life of post-COVID-19 patients in Indonesia. Department of Pulmonology, Faculty of Medicine, University of Indonesia - Persahabatan Hospital, as presented in the 18th Scientific Respiratory Medicine Meeting, February 11th 2021.
Dr Susanto said his patients had also reported "marked limitation of physical activity, and inability to do regular activities like they used to do before they had COVID".
"Thus, they may have recovered from the infection, but they have not recovered functionally," he said.
To this day, Mr Simorangkir still experiences long COVID symptoms, like phantosmia — a condition that causes people to smell something that isn't there — swollen lymph nodes, ringing in his ears and pain in his urethra.
"We shouldn't be fixated on recovery ... [because] like all my fellow survivors said, 'We can't go back to the way we were,'" he said.
Using recovery rate as a parameter of success is 'problematic'
Dr Dicky Budiman, an epidemiologist from the Centre for Environmental and Population Health at Griffith University, said the term "recovery" among COVID-19 patients had epidemiological, social and clinical definitions.
"From a clinical aspect, we know that there are a number of long COVID cases [in] which the long-term impact is still unknown," he said.
"And when there are people who have tested negative and yet are not allowed to work or do their activities as usual because of the stigma, the social aspect of recovery is not fulfilled."
A portrait of Agus Dwi Susanto in a white jacket.

Dr Agus Dwi Susanto is optimistic about the possibility of long COVID patients returning to normal.(
Supplied
)
Indonesian President Joko Widodo has lauded the country's COVID-19 recovery rate, as total cases rise above 1.3 million, with more than 36,000 deaths.
"The average recovery as of March 3, 2021 [in] Indonesia is at 86.18 per cent. The world average is at 78.93 per cent. This means that we are better than the average world recovery rate," he said.
However, according to Worldometer, the world's recovery rate is 97 per cent, meaning Indonesia's recovery rate is lower than the world average.
The ABC has asked Indonesia's National COVID-19 Task Force where Mr Widodo got the world recovery figure.
Woman wearing face covering has nasal swab taken

Indonesia has recorded more than 1.3 million COVID-19 cases, with more than 36,000 deaths.(
AP: Tatan Syuflana
)
But Dr Budiman said using the recovery rate as a parameter for success in handling COVID in Indonesia was "problematic".
"Referring to the recovery case is scientifically inaccurate because it is not based on scientific operational definitions," he said.
"Hence it would also be misleading in the pandemic control strategy, which creates a false sense of security."
Indonesia's national COVID-19 Task Force spokesperson, Professor Wiku Adisasmito, said their definition of recovery followed WHO standards.
"We cannot deny that there are very many determinants of a person's recovery status, but for now the standards used are based on many findings in the field and have been through various reliable studies," he said.
Coronavirus questions answered
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Mr Simorangkir doubts he'll ever get back to the level of health he enjoyed before.
But Dr Susanto is optimistic about the possibility of long COVID patients fully recovering.
"There was a patient who had a pulmonary function value of around 48 per cent, had difficulty walking [and] speaking because of shortness of breath," he said.
But after two months of treatment and medication, he said their lung capacity rose to 78.9 per cent, close to the normal level of 80 per cent.
He said it wasn't a guarantee, but there were studies that showed a majority of patients could fully recover from long COVID.
"But unfortunately, we don't have the data yet on Indonesia."
Posted 6 MarMarch 2021
 

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‘I’ve aged 30 years’: long COVID patients battle acute symptoms
"I don't recognize myself, my family doesn't recognize me either. I'm not the person I was."
by The Online Citizen
12/03/2021
in Health, People
Reading Time: 3min read
1
‘I’ve aged 30 years’: long COVID patients battle acute symptoms
Violaine Cousineau, 47, who suffers from long-term effects of COVID-19, poses at her home in Montreal, Canada (Source: AFP)



by Anne-Sophie Thill
Difficulty breathing, concentrating and even walking: five months after being diagnosed with COVID-19, Violaine Cousineau continues to suffer severe symptoms that prevent her from resuming normal life.
“I feel like I’ve aged 30 years in a few months,” the 47-year-old Canadian tells AFP.
Sitting in her kitchen and wearing a mask, Cousineau gestures with her hands as she speaks, as if to accentuate her words as her voice has been reduced to a whisper.
“I don’t recognize myself, my family doesn’t recognize me either. I’m not the person I was,” says the Montreal resident, noting that she walks with a cane to avoid falling.
A mother of two girls aged 12 and 15, she is one of hundreds of expected patients of a new clinic in Montreal specializing in long-term health impacts of COVID-19, or “long COVID.”
She had no preexisting health problems and even enjoyed “super cardio” hiking on nearby mountains on weekends.
After contracting the illness in October, she spent a trying first week, including being bedridden for three days.
“I could never have thought for a fraction of a second that it would go further than that,” she says.
Now, cooking has become difficult — and going down the stairs? “I’m going to be slammed for the day,” laments the literature teacher who is no longer able to turn the pages to read a novel or return to work.
“Everyday life has been turned upside down,” she says. “It’s the ordeal of a lifetime.”
10 to 30 per cent afflicted
A significant number of patients who contract the novel coronavirus mysteriously suffer debilitating symptoms long after others recover. The European branch of the World Health Organization says the seemingly chronic condition must be “of utmost importance” to health authorities around the world.
In Quebec, which has recorded more than 294,000 cases of the coronavirus, “it could be 10 to 30 per cent of patients who have complications,” says Emilia Liana Falcone, director of the new clinic set up by the Montreal Clinical Research Institute (IRCM), which is affiliated with the University of Montreal.
Opened in February, the clinic’s doctors aim to understand the long-term complications of COVID and their duration in order to then determine the causes and develop treatments.

Falcone says there are patients still showing symptoms one year after getting infected.
The clinic, she says, has so far examined about 15 patients and expects several hundred more with complications that can affect people “aged 19 years as much as those 69 years old.”
“Fatigue is definitely very common,” says the infectious disease specialist, as is shortness of breath, muscle pain or sleep disorders.
Cousineau says she “does not expect miracles.” Blood tests, cardiac ultrasound, chest x-ray: all tests have come back normal.
“I almost feel like a mutant, a new species which has appeared and which must be successfully decoded,” she says with a smirk.
The only relief from her symptoms: spending very long hours in the brisk air of the Canadian winter, outside the city.
Anne Bhereur, 44, another patient at the clinic, finds it “very reassuring to be supported by people who are competent and interested in understanding what is happening.”
“What is it that makes breathing so difficult?” wonders the family doctor afflicted with long COVID, explaining in a whisper that her colleagues are “just as baffled” by her symptoms.
After contracting COVID-19 in December at the hospital where she worked in palliative care, Bhereur thought she would return ten days later “with immunity against the virus, while being a little safer.”
But she still feels very tired and has difficulty breathing and concentrating, forcing her to break up each daily task.
“It takes me 30 minutes to go around the block when normally it would not even take 10,” she says, adding that she tries “hard to remain optimistic.”
She adds: “Laughing or crying, I become too short of breath, so we take things one day at a time.”
— AFP
 
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