Over 6.5 million South Africans could be affected by long COVID

When Lindiwe Mhlongo, a South African mother of three, tested positive for COVID-19, she hoped for a speedy recovery. But a month after testing negative, she still wasn’t feeling well. "When I tried to sleep … I couldn't breathe,” she said. “When I had to do chores at home, I couldn't do everything and even if I did, I would do small tasks and then head back to bed.” Mhlongo is not alone. Research from South Africa shows that nearly half the individuals that were hospitalized with COVID-19 and about one in five of those that were not hospitalized have symptoms of long COVID six months after recovery. Researchers extrapolated these findings and estimated that over 6.5 million South Africans could have long COVID. “We barely understand how COVID has affected South Africans. There hasn't been enough research to look after people with persistent symptoms,” said Dr. Waasila Jassat, a public health specialist at South Africa’s National Institute for Communicable Diseases and the lead researcher for the study. Revealing results South Africa accounts for about 32% of all confirmed COVID-19 cases in Africa and the NICD is among the few organizations on the continent providing guidance on long COVID. The agency’s study followed up on 5,000 individuals with long COVID for one year. Through telephone surveys, at one month, three months, six months, and 12 months, participants were asked questions about their symptoms, background, and medical history. Researchers found that the prevalence of persistent symptoms declined with successive follow-up periods, from 82% at one month to 53% at three months and 47% at six months for hospitalized participants. A similar trend was observed from 51% to 40% in a Chinese cohort and from 68% to 60% in France. While a few studies suggested that COVID-19 vaccination reduced the risk of suffering from long COVID, this wasn’t the case in South Africa. The team concluded that there were no associations between self-reported vaccination status and persistent symptoms. The study also showed that individuals at a high risk of long COVID in South Africa include those who are older, female, had other medical conditions, and those that needed hospitalization. Interestingly, people that got COVID-19 during the earlier waves — Beta and Delta — were more likely to have long COVID compared with people who had COVID-19 during the Omicron waves. “That's probably related to the fact that Omicron caused less severe disease in South Africa,” Jassat said. ‘Left to fend for themselves’ Long COVID is difficult to diagnose and manage. It involves a diagnosis of exclusion as people usually present a wide range of vague symptoms. Treatment requires a multidisciplinary approach that may involve specialists, rehabilitation experts, mental health practitioners, and access to medical oxygen. In South Africa, where 84% of the population receive care through the public sector, Jassat said only two public hospitals, both in Cape Town, have long COVID clinics. “So all the other eight provinces don't really have established long COVID services,” she said. There is also a lack of information on the condition. Jassat said despite the country’s efforts — which included developing guidelines and training — the country’s public health sector still doesn't have a service point for long COVID and many health care workers are not sensitized to the problem. “People with long COVID are just left to fend for themselves,” she said. “They are running from pillar to post. People are not taking them seriously, even medical doctors, because of the nature of long COVID. They are desperate, they want help, and there's no way to get help.” Jassat said the private sector may be better equipped to help South Africans with long COVID. but it only caters for 16% of the population. A few private insurance companies also provide coverage for long COVID, which includes access to a specialist, a few tests and investigations, and oxygen rehabilitation. Finding solutions There are some continental efforts to address the problem. Dr. Ahmed Ogwell Ouma, acting director of the Africa Centre for Disease Control and Prevention said the agency is working on a capacity building initiative to equip health workers to diagnose and manage long COVID. The World Health Organization is focused on strengthening the primary health care level to respond, Dr. Thierno Baldé, regional COVID-19 incident manager at WHO’s Regional Office for Africa, added. “Part of it is integrating the clinical case management of COVID-19 cases including long COVID” and ensuring that detection and care are provided at the community level, he said. But Jassat warned that this could create a huge burden on overstretched primary health care providers and further increase problems with diagnosis. They are already involved in “just about everything” — malaria, HIV and tuberculosis care, mental health and childhood diseases and non-communicable diseases, she said. “I think it's an unfair burden without proper resources.” She said primary health care practitioners could attend to simple cases but countries need a well-structured referral system for easy escalation of patients that need specialized care. “People with shortness of breath for six months can't be seen at the primary care clinic. They need a multidisciplinary team to look after them,” she said.