One in 10 positive cases have ‘Long-Covid’

Over one in 10 individuals who tested positive for Covid-19 in Gibraltar have returned to the Primary Care Centre with prolonged symptoms after contracting the virus.
Fatigue, shortness of breath, headaches, chest pain or tightness, problems with memory and concentration such as brain fog, difficulty sleeping, heart palpitations, dizziness and pins and needles have been some of the more common symptoms.
A total of 4,283 individuals tested positive for Covid-19 in Gibraltar since the start of the pandemic, so it is estimated that over 400 people have taken longer to recover after six to 12 weeks of testing positive for the virus.
Among younger people, it might still affect some 10 to 15% of people, however in the over 70s, this number could go up to 20 to 25%.
The term that is being used to describe this is “long” Covid, and the Chronicle spoke to General Practitioner, Dr Roberta Meta, and Director of Public Health, Dr Sohail Bhatti, about what the Gibraltar Health Authority is doing in order to address this. 
“The phrase long Covid is not one which would be used in medical terminology because you would expect someone to have Covid for a while, and then they would recover,” Dr Meta said. 
“Medically speaking, there is post-acute Covid which refers to the first three weeks after testing positive, when you would expect many people would recover, and 12 weeks.” 
“And 12 weeks after contracting Covid is what we call the Post Covid Syndrome, and Long Covid is something that we have realised after a few months.” 
Due to increased demand, a Long Covid clinic has been set up within the GHA, that acts as secondary care for those referred to by their GPs.
While the GP can carry out basic tests and provide treatment if needed, but if any other tests or treatment is required then this can be provided for through the secondary-care Long Covid clinic.
Due to the low prevalence of Covid-19 cases in Gibraltar at the start of the pandemic, GPs were already coming across people who had ongoing symptoms.
But the spike in Covid-19 cases over the Christmas period has seen a jump in the number of patients requesting further help.
“The main problem for patients is that this is not something that we have treatment that we can help with straight away,” said Dr Meta.
“It is a bit more complicated than just administering antibiotics for a chest infection.”
“Most of the help provided is support, advice, follow-ups to see how things are, and we want to see if there is something else which is not linked to Covid but needs investigating.”
These further investigations are usually carried out to exclude any other issues, such as whether any fatigue is related to anaemia or whether it is Covid-related.
Dr Meta said that in some situations, there may not be any actual treatment but advised that patients should visit https://www.yourcovidrecovery.nhs.uk, a website launched by Public Health England that helps people with the after-effects of Covid.
“I appreciate that this is a long journey, and it fluctuates and varies where patients feel okay one day and feel much worse the next day,” she said, while urging anyone who feels like they are still affected to contact their GP.
“We are approaching this in a very open-minded manner, and this is what is what it needed to be.”
“Our practise is that we have a person in front of us, not just a disease, so we have to look at the bigger picture.”
“It doesn’t just affect the patient, but it also affects the people around them, so we need to acknowledge that in the process of recovery.”
Dr Bhatti added when there is a new disease doctors need to understand how and why people fall ill and come up with a way to treat them.

But there is also the need to understand the long-term consequences of a disease and distinguish between the people who have the chronic syndrome from severe disease that needed hospitalisation and those who recovered at home.
It is estimated a third of individuals who were hospitalised due to Covid-19 will return to the hospital, and there is a higher mortality in this group.
“It may be that we got them over the acute phase but there may be other sustained damage,” Dr Bhatti said.
“Remember those who go into hospital often have underlying diseases, not just age, such as obesity.”
“In essence we need to help and protect those individuals from harm, but we may not be able to do so because we don’t know enough about the disease.”
“We do know in laboratory settings that those individuals can have damage to their organs, such as their heart muscle, their liver, their brain, their lungs, kidneys, they can all be damaged and the one that is most fear-inducing is the lining to their blood vessels that could lead to clotting.”
Gibraltar had some 260 admissions into hospital for Covid-19, but it was quite “conservative” in that perspective, Dr Bhatti said.
As for the bigger group, those who contracted Covid-19 but recovered at home, Dr Bhatti said: “Some 10% of the population has had Covid, and those people seem to have nothing related to how mild their illness was, can have long-term consequences.”
“We again have to separate out something that we have known about for a long time, which is post-viral syndrome, which is that a lot of respiratory viruses lead to a chronic fatigue type of symptoms.”
Dr Bhatti said this can happen with illnesses such as the flu and common cold viruses.
But there is not enough information available on Long Covid to understand whether the virus stays in some cells and keeps coming back, such as what happens with Ebola, or whether it is in a “dormant phase”.
“There doesn’t seem to be any relationship at the moment that says that if you had a mild disease you would have mild symptoms,” Dr Bhatti said.
“In my case for example I had rapid heart rate and difficulty sleeping at the time, but it was not bothersome.”
“I know other people have very debilitating tiredness, lack of exercise.”
The GHA has set up a triage system, contacting those who tested positive for Covid-19.
Within eight weeks, half of the people have said they have said they do not have the same strength as before, meanwhile one in six have said they have long-term problems up to 12 weeks of increased breathlessness and tiredness.
“There are a lot of questions we don’t know,” he said.
“We are in the early stages to define the illness and once we have defined the illness, we can do some research on it.”
“Some of that can be basic pathology and biochemistry, all the way through to understanding the other consequences such as mental issues, physical issues and underlying issues.”
“At this stage we want as much information as we can gather, but we also know we have a lot of blind alleys that we will go down because we are observing much more closely.”
Covid and everything related to Covid is relatively new to the medical world, and in order to build a better picture of what is happening with the virus, Dr Meta is part of the Long Covid Study within the GHA. 
Individuals who tested positive for Covid-19 in Gibraltar are being invited to take part in the survey anonymously by email. 
The survey will enable the GHA to find out how many people have been infected in Gibraltar, with what symptoms and the duration of them, and to see whether any patterns emerge. There is also a survey that is designed for children.
The data is gathered locally and shared with the Long Covid survey that is being run by ISARIC, the International Severe Acute Respiratory and emerging Infection Consortium.
“It is very good that Gibraltar has the opportunity to take part and join in this international study because we are trying to help and also contribute towards the bigger picture,” Dr Meta said.
“This is really important because we have such a high rate of testing people that we can include people who had mild symptoms or no symptoms in the community, while lots of other research is only based on hospitalisations.”
“We have also been testing children which has not been happening elsewhere, so I think we can better understand the virus.”
In order to take part in the survey, contact longcovidstudy@gha.gi.

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