Long Covid: The two sides of the coin

The psychological impact of Covid-19 lingers months after patients first catch the virus, writes Dr Gillian Moore Groarke.

Understanding the differences between patients who are experiencing post intensive care syndrome, post viral fatigue, permanent organ damage and long-term Covid is vital for helping patients fully recover. File Picture.

Since March, I have been working online with patients who have had a positive diagnosis for Covid-19. Many patients are still sick months after catching the virus as a result of post-viral symptoms. These symptoms are not just physical symptomatology we are seeing, but more psychological in nature.

Patients both young and old are describing severe anxiety, pandemic insomnia, depression, OCD, fatigue and brain fog. While most patients recover within two weeks, those with so called 'long Covid' have symptoms that persist beyond a three-week period and up to 6 months after their positive diagnosis.

In truth, we are very much chartering unknown territory in predicting how long these patients will continue to show ongoing psychological impacts. 

The first call I got was from a mother who was distressed about her young son while he was in hospital. A healthy young man in his 20s, hard-working, full of life, a man who enjoyed sport and high levels of activity. Firstly, he developed severe anxiety and panic attacks. He was unable, until recently, to return to work and normal activity levels. He had many experiences of dealing with severe palpitations, chest pain and ongoing fatigue.

I have also dealt with many healthcare workers who continue to face strain from the psychological damage caused by long Covid. This is impacting greatly on our healthcare system in keeping essential staff in place. Our frontline workers cannot work from home and one lady with whom I have worked with has been in hospital on three different occasions with various issues following her initial diagnosis of Covid-19.

Understanding the differences between patients who are experiencing post intensive care syndrome, post viral fatigue, permanent organ damage and long-term Covid is vital for helping patients fully recover. File Picture.

So many people have become casualties of the pandemic and express a strong sense of abandonment. I predicted this in April when I wrote an article for the Irish Examiner ‘Professional help paramount for frontline staff once the crisis ends’.

What is notable is the unpredictable pattern of how patients present on a daily basis. From a psychological perspective, we see ongoing relapsing and remitting symptomatology. There is a need for all involved in the care of Covid patients to tread carefully and work towards a full understanding of this new illness with such a diversity of symptoms.

Many personal stories are beginning to emerge about the long term problems of Covid-19. The New Scientist journal reports that ‘estimates suggest that there could already be millions of people around the world living with long Covid’. 

Gaps in our knowledge

It appears that those with more than five symptoms during the first week of the illness are more likely to have longer term consequences. I have seen this in one patient who was immunosuppressed, and continues to have ongoing social anxiety with significant depression. This patient had no previous psychological or psychiatric history. 

In terms of treating the psychological effects of long Covid, cognitive behavioural therapy is proving extremely effective. Learning to listen to one’s body and using the techniques of relaxation, pacing and goal-setting are allowing patients to make slow but steady progress. Post viral fatigue is well documented, as are its far-reaching symptoms. There is a sense of your body ‘being out of control’, as one gentleman described to me. This, for him, created far reaching anxiety which five months later he is getting a grip on.

One patient - a young student who lost her sense of taste and smell - developed a pattern of late-night binging and gained significant weight over a period of 3 weeks. Much of the fall out comes from the period of quarantine and the subsequent isolation people are experiencing. Some have confided that among friends there is a ‘certain level of stigmatisation’ which is leading to avoidance of meeting up, and compounding feelings of isolation. 

Understanding the differences between patients who are experiencing post intensive care syndrome, post viral fatigue, permanent organ damage and long-term Covid is vital for helping patients fully recover.

The gaps that exist in all our knowledge about the long-term residual effects need to be urgently filled so that people are provided with a multi-disciplinary support that helps in all areas of their lives moving forward.

Patients who experienced chronic fatigue prior to Covid-19 are all too aware of the dilemma faced when their symptoms are dismissed as 'all in their head'. It is imperative that all disciplines of healthcare work together to review the psychological well-being of patients and examine the fluctuating range of symptoms. Patients' physical, cognitive and psychological conditions need to be assessed and, if appropriate, they should be referred for specialist and psychological treatment and support.

As early as May, the World Health Organisation (WHO) acknowledged the neurological and mental manifestations associated with Covid-19. They also highlighted that hospitalised patients could develop persistent psychiatric disorders, anxiety disorders and post-traumatic stress disorder. I have seen evidence of adjustment disorder which overlaps somewhat with PTSD. 

Several contemporary studies highlight this, including a Chinese-focused study which identified PTSD in patients, and another study focused on the Shenzhen Samii Medical Centre which highlighted self-reported depression.

Further studies highlight a reduced quality of life in patients and stress the importance of mental health interventions.

The differential psychological distances of populations around the world effected by Covid-19 has been highlighted by Zhang et al (2020) and some research (Lyons et al) goes so far as to suggest we should prepare for a tsunami of post viral depression.

There is a lot to be learned from the SARS survivors research, which examined stress and psychological distress among survivors one year after the outbreak, as well as the mental morbidities and chronic fatigue which was a factor for many years. Over and over again, the research highlights the importance of a holistic model of care involving psychological intervention when the medical model alone can not provide answers to all the presenting difficulties.

This is what, in essence, I mean by the two sides of the coin: the identification of both physical and psychological symptomatology and the need to separate out the physical aspects of treatment provided by the medical model and the psychological approach to treatment to eradicate and control the psychological effect and in some cases psychiatric disorders.

The readers need to be made aware that the option of online treatment is available by psychologists to assist them if they have a positive diagnosis or are in quarantine and self-isolating. If their psychological symptoms are persisting and they do not feel well enough to come into clinic the option of online therapeutic intervention is available to them to reach out and recover from the psychological trauma they are experiencing.

• Dr Gillian Moore Groarke is a consultant psychologist at Bons Secours Hospital Cork & Harley Court Medical Centre.