Part 1: The Long March Against Covid-19

When Malaysia declared its first MCO (movement control) early last year, it never occurred to me that this Covid problem would drag on for so long. My impression then was that within a few months everything would be over and we would be back to normal again. Unfortunately, it did not turn out that way.  It has been more than a year and the Covid problem remains unsolved, causing a lot of misery to many people.

I did not pay much attention to this epidemic and took life easy. We closed our centre and I stopped seeing patients. Up to this day our centre still remains closed. With the free time on hand I started to channel my energy to writing books – documenting our 25-years of experience helping cancer patients. The project kept me fully occupied. The results? In 2020, I wrote 4 books and had all of them translated into Bahasa Indonesia as well. But the Covid problem remained. After a short break, in early 2021, I started writing again and completed another 5 books! Now I have started writing last book of the series. When this is done there is no more writing for a long while.

But when is the Covid problem going to be over?  We can keep guessing but no one knows for sure. Before we discuss further, let’s learn a bit about this Covid – the virus that brought every country on its knee.

Coronavirus – SARS-CoV-2

The information below is obtained from websites of:

  1. Centres for Disease Control and Prevention, USA. (https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19.html).
  2. World Health Organization (https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions).
  3. Wikipedia (https://en.wikipedia.org/wiki/Symptoms_of_COVID-19)
  • COVID-19 is caused by infection with a new coronavirus called SARS-CoV-2. Since it is a new virus, there are still many things that we don’t know about this virus.
  • COVID-19 seems to spread more easily than flu and causes more problems.
  • We need to undergo testing to confirm a diagnosis of COVID-19.
  • Like cancer cells, this virus population is not dumb. As they multiply and spread, this virus constantly mutate and change to be become a vigorous and deadly variant.

Currently there are a few variants of this virus:

Alpha: This variant was initially detected in the United Kingdom.

Beta: This variant was initially detected in South Africa in December 2020.

Gamma: This variant was initially identified in travelers from Brazil, who were tested during routine screening at an airport in Japan in early January 2021.

Epsilon: There are two variants. They were first identified in California in February 2021.

Delta: This variant was initially identified in India in December 2020. According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases the Delta variant is the “greatest threat” in the world’s efforts to contain COVID-19.

Other emerging variants:

  • Zeta – earliest document in Brazil, April 2020.
  • Eta – multiple countries, Dec. 2020.
  • Theta – Philippines, Jan. 2021.
  • Iota, USA Nov. 2020.
  • Kappa – India, Oct. 2020.
  • Lambda – Peru, Dec. 2020.

How the virus spread.

Covid-19 can spread by the following ways:

  • Contact with droplets.
  • Airborne transmission.
  • Touching of contaminated surface.
  • Animal-to-human transmission.

In doing our daily activities we need to take care of our health and avoid being infected by the virus. Understand that Covid multiplies in the respiratory tract of the infected person. The saliva and respiratory secretions  are expelled  as droplets and particles of varying sizes when breathing, talking, singing, coughing, sneezing, etc.These expulsions contain the virus. So keep away from these droplets.

  • Respiratory droplet transmission can occur when a person is in close contact (within 2 metre / 6 feet)) with an infected person.
  • These droplets and particles expelled by the infected person can be breathed in or picked up by other healthy people nearby.
  • Respiratory droplets from infected individuals can also land on objects, thus contaminating the surfaces. Healthy people can be infected by touching these surfaces and then touching their eyes, nose or mouth before cleaning their hands.
  • COVID-19 primarily spread  from people who have symptoms. However, they can also spread the virus just before they develop symptoms, when they are in close proximity to others for prolonged periods of time.
  • Infected people who never develop symptoms (referred to as asymptomatic) can also pass the virus to others. It is still not clear to what extent this occurs and more research is needed in this area.
  • Covid-19 is also said to be airborne. The virus can spread from infected people over long distances by inhaling very fine respiratory droplets (aerosols) carried by the air. These aerosols are invisible to the naked eye and they can be carried farther and stay aloft longer, depending on humidity, temperature and airflow.
  • Infectious aerosols remain concentrated in the air longer in poorly ventilated, confined indoor spaces.
  • Indoor crowded spaces can potentially expose healthy people to an airborne infection. Avoid staying in inadequately ventilated spaces over a prolonged period of time with infected persons.
  • Indoor areas that aren’t crowded can also be hazardous e.g. in restaurant, singing / fitness class, etc.
  • Covid can spread also from people to animals in some situations. Pet cats and dogs can sometimes become infected after close contact with people with Covid-19.

Reinfection.

Reinfection means a person was infected (got sick) once, recovered, and then later became infected again Cases of reinfection with Covid have been reported, but remain rare​.​

Protect Yourself and Others.

Anyone infected with Covid can spread the virus even if he/she does NOT have symptoms.

To prevent transmission, CDC and WHO recommends the following measures:

Symptoms.

COVID-19 affect  different people in different ways. The virus cause respiratory illness ranging from mild disease to severe disease and death. Some virus-infected people never develop symptoms. Most infected people will develop mild to moderate illness and recover without hospitalization.

  • Most common symptoms are:
  • fever,
  • dry cough and
  • tiredness.
  • Less common symptoms are:
  • aches and pains,
  • sore throat,
  • diarrhoea,
  • conjunctivitis,
  • headache,
  • loss of taste or smell and
  • a rash on skin, or discolouration of fingers or toes
  • Serious symptoms are:
  • difficulty breathing or shortness of breath,
  •  chest pain or pressure,
  •  loss of speech or movement.

Patients with the following symptoms need urgent / immediate medical care:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

Of people who show symptoms,

  • 81% develop only mild to moderate symptoms (up to mild pneumonia),
  • 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging).
  • 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction).
  • At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease.
  • Other infected people will develop symptoms later, called “pre-symptomatic”, or have very mild symptoms and can also spread the virus.

Most symptomatic people experience symptoms within 2 to 7 days after exposure, and almost all will experience at least one symptom within 12 days.

It takes about 5 to 6 days (even up to 2 weeks in some cases) from infection with the virus to the manifestation of the symptoms.

Each country differ in the way it handles this epidemic. Generally once you are tested positive you have to be isolated and quarantined. Please follow the S.O.P. established by your health authorities.

What Happened After Being Struck by Covid-19

It never occurred to me that I needed to be bothered about Covid – after all I already have my hands full with cancer.  But reading the news everyday make one “sick” of the situation. People are losing their loved ones, losing their jobs and are depleted of their financial resources. There is no food to feed the family, etc. etc. Sad indeed. But that is politics and I would not want to go into that.

 What got me to “wake up” from this “couldn’t-careless-about-Covid” attitude are two episodes that happened a few weeks ago.

I had a call from my cousin in Kelantan. He and his mother (my 90+ year old auntie) were down with Covid. They were hospitalized and managed to survive the ordeal. I was told many others like them could not make it and died. I did not have a chance to talk to my auntie but was told that she is now “okay” post-covid hospitalization.   It was her son – my cousin – who has problem. After being discharged from the hospital, he was told his kidney was damaged. His medical report indicated:

  • Worsening renal function. Creatinine = 379. GFR = 14. He will need dialysis in the very near future.

(Note: Normal creatinine range =  61.9 to 114.9.  A GFR of 60 and above is considered normal, a GFR less than 60 may indicate kidney disease. A level of 15 or less is defined medically as kidney failure).

My cousin asked if I could help him by prescribing some herbs. As for now he is not ready for further medical treatment. I put him on our teas to improve his kidney function. He was happy with the initial results.

At the same time, I received emails from a friend in Pontianak, Kalimantan, Indonesia. He wrote:

  • 7 June 2021: Dear Dr. Chris, 

How are you there? Thank God, we’re okay here, but people around us are not okay. Friends and relatives, got COVID one by one. Sadly some of them couldn’t survive.

  • 17 June 2021:

Just for your information, I am infected by corona viruses. Today is my 4th day of having this illness. My condition looks stable, got fever (around 37.5 – 38.0), cold, cough, tiredness. I’m also losing my sense of smell. Hope things could be better tomorrow. 

  • 18 June 2021:

Really need to be careful, never ever release your mask wherever you are. My son released his mask when he went out for lunch and get infected although the restaurant was not crowded, almost empty. He then infected me. I’d received 2 doses of SINOVAC vaccine two months ago but still got infected. My condition today looks worse than yesterday. I pray that God take care of you and your family there. 

  • 21 June 2021:

I was admitted to hospital since a couple of days ago. I was very weak and not able even to talk. My oxygen saturation dropped to 91, so my friends urged me to go to the hospital. But thank God, my condition now is much better. Can talk and saturation already in normal range. I pray that you and Mdm. I am always in our God’s protection. 

  • 26 June 2021:

Thank you for your prayer. I was discharged from hospital a couple of days ago but my condition is still weak. Can do nothing, keep feeling tired. But my condition is improving now, much better than when I was at hospital. Lost around 5 kg within 4 days while at the hospital. 

From these emails, I learned that our health is so fragile. From being a fully vaccinated, healthy person my Indonesian friend became a sick and vulnerable person within days. This is what Covid can do to a person which I am not aware of.  So I stopped my book-writing for a while and started to read what I can get from the internet about Covid-19. There is so much information out there, and I am now beginning to learn the problems in greater depth.

Each day, we hear from the TV informing us about the number of new Covid cases and the number of deaths in this place and that place. Unfortunately, they don’t go beyond just counting numbers. We need knowledge, not just numbers.

At least from my little experience above, I now know that:

  • Even after being vaccinated you are still not 100% safe! Beware and take care. Don’t try to be a hero and believe that you are immune to the virus.
  • After being discharged from the hospital, don’t think that you are 100% cured! My cousin and aunty were lucky that they came out of the hospital alive. That’s a real blessing indeed, but their problems may not be solved yet. My cousin and my friend in Indonesia suffer from post-Covid-19 syndrome – medically they  name this condition as Long Covid! (long haul patient … on a long march?).

That being the case, what do they do now? Where do these Long Covid people go for help?

  • More importantly, it appears to me that this Covid problem is not going to go away anytime soon. It is also not going away easily. It is going to be a long march towards recovery. Or for some unfortunate people, they may not even recover. I have read that this epidemic will morph into endemic and we all have to learn to live with it for many more years to come.

Most people recover from the acute phase of the disease.

However, some people continue to experience a range of effects for months after recovery and damage to vital organs had been observed.

Long Covid Patients.

The Medical News Today has this very informative article What to know about long COVID. (https://www.medicalnewstoday.com/articles/long-covid).

  • People with mild cases of Covid usually recover within 1 to 2 weeks of contracting the virus. For severe cases the recovery can take 6 weeks or longer.
  • Long COVID refers to when people continue to experience symptoms of COVID-19 and do not fully recover for several weeks or months after the start of their symptoms.
  • Other terms for long COVID include post-COVID, post-acute COVID, long-tail COVID, and long-haul COVID. People with long COVID may refer to themselves as long haulers.

Prevalence of Long Covid.

  • Although it is still unclear how many people have experienced long Covid, data from the Covid Symptom Study suggested that 1 in 10 people with the illness experience symptoms for 3 weeks or longer. In UK the symptoms could last for a period of 12 weeks or longer.
  • This means that across the world, there may be more than 5 million cases of long COVID.
  • A study found that more than three-quarters of Covid patients in a hospital in Wuhan, China, still had at least one symptom, 6 months after their discharge from the hospital.
  • A study in Italy found that 87.4% of Covid patients reported experiencing at least one symptom 2 months after their discharge from the hospital.
  • A 2020 Swiss study also notes that as many as 1 in 3 people with milder cases Covid were still experiencing symptoms after 6 weeks.

Symptoms.

According to the US CDC:

  • Although most people with Covid-19 get better within weeks of illness, some people experience post-Covid conditions. Post-Covid conditions are a wide range of new, returning, or ongoing health problems people can experience more than four weeks after first being infected with the virus that causes Covid-19.
  • Even people who did not have symptoms when they were infected can have post-Covid conditions. These conditions can have different types and combinations of health problems for different lengths of time.

CDC and experts around the world are working to learn more about short- and long-term health effects associated with Covid-19, who gets them, and why.

People with long Covid report experiencing different combinations of the following symptoms:

  1. Tiredness or fatigue
  2. Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
  3. Headache
  4. Loss of smell or taste
  5. Dizziness on standing
  6. Fast-beating or pounding heart (also known as heart palpitations)
  7. Chest pain
  8. Difficulty breathing or shortness of breath
  9. Cough
  10. Joint or muscle pain
  11. Depression or anxiety
  12. Fever
  13. Symptoms that get worse after physical or mental activities

Multi-organ Effects of Covid-19.

Multi-organ effects can affect most, if not all, body systems including heart, lung, kidney, skin, and brain functions.

Multi-organ effects can also include conditions like multisystem inflammatory syndrome (MIS) and autoimmune conditions. MIS is a condition where different body parts can become swollen. Autoimmune conditions happen when your immune system attacks healthy cells in the body by mistake, causing painful swelling in the affected parts of the body.

It is unknown how long multi-organ system effects might last and whether the effects could lead to chronic health conditions.

People may also develop long-term complications that affect the organs. These complications are less common but may include:

  1. Inflammation of the heart muscle.
  2. Abnormal lung function.
  3. Severe kidney injury.
  4. A rash.
  5. Hair loss.
  6. Problems with smell and taste.
  7. Sleep issues.
  8. Memory and concentration difficulties.
  9. Anxiety.
  10. Mood changes.

Management.

Home remedies for managing long Covid may include the following:

  • Taking over-the-counter pain relievers, such as acetaminophen, to relieve painful symptoms or fever.
  • Resting and relaxing.

Taking care of general health is also important. This may involve:

  • Following a healthy diet.
  • Getting quality sleep.
  • Limiting alcohol intake.
  • Limiting caffeine intake.
  • Not smoking.

When And How To Seek Help.

A person needs medical help if they experience any of the following:

  • Breathlessness that worsens.
  • Unexplained chest pain.
  • A new state of confusion.
  • Weakness.
  • Changes in vision, hearing, or speech.

Recovery.

It is currently unclear how long recovery from long Covid may take. Research reports that people may experience symptoms 2 to 3 months after the initial infection, and some people may experience symptoms for longer than this.

An article by Tharanya Arumugam, Malaysians cautioned on Long Covid or Post-Covid-19 Syndrome(https://www.nst.com.my/news/nation/2021/06/697991/malaysians-cautioned-long-covid-or-post-covid-19-syndrome) reported the following:

Among the five symptoms often experienced by former Covid-19 patients were fatigue, difficulty breathing when doing activities (exertional dyspnea), difficulty sleeping at night (insomnia), cough and anxiety.

  • The Health Ministry today cautioned Malaysians on the Long Covid or Post-Covid-19 Syndrome, advising that precautions should be taken after a person recovers from the coronavirus to lower the risk of serious health problems.

According to a clinical study conducted by the Health Ministry involving 1,004 patients from categories 4 and 5 who received follow-up treatment on the infection,

  • 66 per cent of the patients suffered from the Long Covid syndrome.
  • Among the five symptoms often experienced by former Covid-19 patients were
  • Fatigue,
  • Difficulty breathing when doing activities (exertional dyspnea),
  • Difficulty sleeping at night (insomnia),
  • Cough and
  • Anxiety.
  • To date, the treatment offered to Long Covid patients is based on the symptoms exhibited by the patient (symptomatic relief) and the body functions involved. Referrals to relevant areas of expertise will be made to ensure patients receive optimal clinical treatment.
  • It is therefore very important to keep ourselves and our family members safe from the dangers of Covid-19 and register for the vaccine to reduce the risk of contracting the serious disease. This is because the effects can be prolonged and reduce a person’s quality of life as well as productivity.

Stories from People with Long Covid.

1. Lung Damage.

The Free Malaysia Today carried this report:

Amira, a 29-year-old administrative executive had Covid and was hospitalized for 33 days (including 9 days of sleeping in the ICU) in Sungai Buloh Hospital. After being discharged from the hospital, the doctor said 48% of Amira’s lungs are “dead”. It is now unable to function normally. Amira said: I also cannot move as vigorously as before. Even talking makes me tired, doing simple activities like drying clothes makes me tired. (https://www.freemalaysiatoday.com/category/bahasa/tempatan/2021/06/28/fungsi-paru-paru-tinggal-48-bekas-pesakit-covid-19-kongsi-pengalaman-dijangkiti/)

In the website Heart Matters (https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/long-covid) are more stories of people who suffered from Long Covid.

2. Martin had panic attack.

Martin spent 2 weeks in intensive care, where he was given antibiotics to treat the pneumonia and put on a CPAP machine [a machine to help you breathe,that is less invasive than a ventilator] to regulate his breathing and to help his lungs function. Fortunately, his condition improved and he was able to be moved to a designated Covid ward to continue his recovery. Covid impacted his mental health.

  • I found a couple of times I was getting quite emotional for no immediate reason. I used to walk down to a lake near where we live with my youngest son, and one day I had a panic attack because I thought: if something happens to me he doesn’t know where to go, what to do – it stopped me from doing certain things then. I found a couple of times I was getting quite emotional for no apparent reason.

3. Mark: Each day is a rollercoaster ride.

After 9 days of feeling unwell, Mark was admitted to a hospital and was given intravenous fluids, antibiotics and paracetamol to treat the Covid-19 infection and the pneumonia that had developed as a result.

After he got home, he felt exhausted. Although he had expected to feel a little better each day, he discovered that wasn’t the case. He said: “I just accepted that it wasn’t possible to predict how I was going to be from one day to the next.”

Then Mark developed new symptoms. “My heart was beating really fast and irregularly and I was sweating profusely. I felt more ill this time than I did before,” he says. 

Mark’s energy levels took around 6 months to get back to normal. He also suffered a painful slipped disc just two days after he originally fell ill with Covid-19, which is stopping him from getting more active.

Mark describes the psychological effects as one of the biggest aspects of his prolonged recovery. “Each day was like being on a rollercoaster in the dark,” he says. “I never knew what was going to happen the next day or how I’d feel. That was particularly difficult.

“In general the mornings were best for energy, so it was a case of making the most of the morning to do basic tasks, and to sleep when I needed it, especially in the afternoons.”

4. Suki’s Experience with Covid.

Suki Newman, 47, was always on the go, balancing a busy career as a finance director with looking after her two daughters, aged nine and ten. After returning home from a family skiing holiday, she developed a continuous cough, chest pain and had trouble breathing. She remembers, “Whenever I lay down, I felt like I was suffocating. I was crawling up the stairs on my hands and knees, to get to bed at 6 o’clock.”

Later she developed new symptoms. She was extremely tired, had bad headaches and difficulty thinking clearly. ” I was unable to manage complex information and I was forgetting words. I had problems doing simple tasks and basic logic problems. I would normally do these easily.”

For months, Suki went through cycles of feeling better, then getting worse again. As well as brain fog, debilitating headaches and fatigue, she developed many other symptoms including heart palpitations: “I could be sitting down watching the television or having a cuddle with my children and suddenly I’d feel my heart racing.”

Suki’s experience is not unique. According to Office for National Statistics estimates, 1.1 million people in the UK were reporting long Covid symptoms at the start of May 2021. These were defined as symptoms that had lasted more than four weeks. For 869,000 people, the symptoms had lasted more than 12 weeks, and for 376,000 of those, the symptoms had lasted beyond a year.

When Will It End?

Aaron Holley, associate professor of medicine at Uniformed Services University and program director of pulmonary and critical care medicine at Walter Reed National Military Medical Center said:

An article in The Economist asked this question which no one can give a correct answer: When will it end?

  • For a year and a half, Covid has gripped one country after another. Just when you think the virus is beaten, a new variant comes storming back, more infectious than the last.
  • Already, two things are clear:
  • That the last phase of this pandemic will be drawn-out and painful.
  • That Covid will leave behind a different world.