Battling 'Covid' two years after being declared healed

On September 18 last month, USA's president Joe Biden said, "the pandemic is over." Kenyans might as well have been ahead of the president.

A spot check by The Standard in major towns like Nairobi, Nakuru and Eldoret confirmed that only a few folks still wear masks. As for social distancing, social joints are full to the brim.

As the world moves on evidence shows that millions - Kenyans included - are wallowing in the aftershocks of covid-19 infections almost unrecognized.

Take Leah Chebitwey for instance. She says: "I have had to undergo physiotherapy to learn, again, how to balance and walk."

It has been over a year since she tested positive for Sars-Cov-2, the virus that causes Covid-19. The disease has left her struggling to be healthy again.

Her biggest struggle today is with flailing memory. "I have lost some memory. I meet people who know me and I can't figure out how I know them," she says.

Chebitwey spent close to three months in Intensive Care battling the virus. She was discharged after testing negative and regaining the ability to breath on her own. However, it was after the discharge that real work to becoming healthy again began.

"I struggled to converse. I had forgotten how to say some words. Sometimes I couldn't even open my mouth to talk. I had to write on paper to communicate.

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"I have lost some of my memory. For instance, I don't remember some critical events in my life before I was taken ill. I also don't remember some faces. It is common for me to lose my trail of thought.

"I have been getting better though. There are days I feel too tired to even take a walk: I just want to eat and sleep," she says.

The phenomenon of surviving Covid-19 patients struggling to get back to pre-infection levels of health and fitness has been referred to as long covid.

As the pandemic raged, World Health Organization (WHO) advised that those who tested positive should isolate for 21 days: the period of active infection.

"After four weeks we do not expect the patient to test positive for the virus," says Dr Salim Masoud, a chest specialist and pulmonologist at Nairobi South Hospital.

It is, therefore, strange that someone who is testing negative for the virus continues to be unwell months - or even years - after healing.

"The phenomenon of long covid is still being studied," says Masoud. "As doctors, we are still learning more about it as we go."

WHO defines long covid as post COVID-19 condition, usually 3 months from the onset of symptoms, lasting for at least 2 months and cannot be explained by an alternative diagnosis.

In a recent interview on statnews.com, Dr Wes Ely, a pulmonary and critical care specialist at Vanderbilt University Medical Center in Tennessee, USA, had a humbling appreciation of long covid.

He said: "What happens is that over ensuing weeks and months, your body takes on a new set of diseases that you did not have at the end of acute Covid."

Dr Shamsa Ahmed, the Head of Infectious Disease Unit at MP-Shah Hospital in Nairobi, aptly applies a knife-on-flesh analogy.

"Long covid is real. The patient is sickly but has no active virus. I know it is confusing to laymen. But think of it as getting stabbed and the knife being thrown away.

"The knife may no longer be in the flesh but the damage is visible. The virus attacks different organs in the body. Even after the virus clears, the organs do not necessarily go back to their original healthy state instantly."

When Wachuka Gichohi went back to her doctor, with a slew of symptoms, among them migraines, heart palpitations, hallucinations, buzzing noises, panic attacks, memory loss, severe fatigue and insomnia, among others, the medic told her to seek psychological help.

'In other words, it was "all in my head,"' she wrote on her social media timeline in December 2020.

Gichohi says she contracted the virus early March 2020 after a trip abroad in Europe. "I developed a sore throat, fatigue, acid reflux, a headache, body aches and chest pain," she writes.

It was, therefore, a shock for her that in May, weeks after seemingly having healed from the initial bout of Covid, she was getting hit by a confluence of egregious symptoms.

According to Gichohi, not many doctors, today, understand long covid for what it is and are therefore dismissive.

She founded 'Long Covid Kenya Support Group' on Facebook, which by the time of going to press had 128 members.

The true anatomy of long covid is yet to be deciphered. In fact, there is no test for long Covid. At least one certified by WHO.

However, emerging data from around the world offer valuable information.

For instance, in 2022, the Center for Disease Control and Prevention (CDC) used data to estimate that one in five adults in USA, with a known prior case of covid-19, had symptoms of long covid.

New modelling by the Institute for Health Metrics and Evaluation (IHME) shows that in 2020 and 2021 at least 17 million people in the 53 Member States of the WHO-European Region may have experienced at least one long covid symptom.

The most common symptoms of long covid, according to WHO, are fatigue, shortness of breath and cognitive dysfunction.

However, many long haulers (those with long covid symptoms), present with different sets of symptoms running into hundreds.

Dr Masoud says: "Every patient is different. One patient's set of symptoms may be different from another's."

Patrick Kirimi, who was hospitalized for over two months with covid-19 in March of 2021, says he has become increasingly forgetful after the ordeal.

"First, the process of healing was slow. Even after I was discharged I was constantly fatigued. I am still struggling with severe exhaustion. I am also very forgetful - something I did not experience before covid," he says.

One would expect long covid to affect those who were severely ill with the virus. But Dr Shamsa says the condition can affect anyone who got infected.

"You may have been asymptomatic but then suddenly you are experiencing extreme malaise from long covid," she says.

She also adds that some categories of people have a higher probability of developing long covid.

"If you are obese, are older, have an underlying condition or are a woman, your chances of developing long covid are higher than average," she says.

The US Census Bureau conducted a Household Pulse Survey 2022. A meta-analysis of data shows that women were more likely than men to currently have long COVID: 9.4 per cent versus 5.5 per cent.

Evidence also suggests that vaccination against the virus resulted in good outcomes; including reduced possibility of a patient developing long covid.

Another meta-analysis of 15 studies, done by the UK Health Security Agency, found that vaccinated people who are subsequently infected with COVID-19 are less likely to report symptoms of long COVID.

The 2022 World Population Data Sheet (WPDS 2022) shows that in Seychelles - where 82 per cent of the population got fully vaccinated - there were no excess deaths that could be blamed on covid-19.

Published on September 8 by Population Reference Bureau (PRB), WPDS 2022 shows that Kenya experienced a 2 per cent jump in annual deaths during the pandemic than would have been expected in the pandemic's absence. As at July 2022, just 32.3 per cent of Kenyan adults had been fully vaccinated.

"That is why I have advised my patients and Kenyans generally to get full dose vaccines, and if possible, booster shots too," says Dr Shamsa.

Gichohi is currently working with alternative medicine specialists, with experience in alternative therapies, to battle long covid.

"Things have never been the same again. I can't say there are good days. But some days are better than others," she says.

Kirimi is back to his exercise routine before covid. Despite feeling tired and worn out on many days, he is running 12 kilometers every morning.

The pandemic is now in its third year. It has thus far led to 12 per cent more deaths globally - according to PRB's WPDS 2022.

Even so, the world - Kenya included - is entering a new post-infectious phase of the pandemic with a lot of unknowns much like Covid-19 outbreak itself.

A study titled Multiple early factors anticipate post-acute COVID-19 sequelae, published in January 2022 in the journal Cell, links long covid to four main factors: high levels of the virus RNA in the blood, pre-existing type 2 diabetes, high levels of Epstein-Barr virus DNA in the blood and the presence of 'autoantibodies' that attack the person's own body.