Spotlight
The long shadow of COVID-19 in Africa
Fanatic Studio/Science Photo Library
Published Online
September 30, 2022
https://doi.org/10.1016/
S2213-2600(22)00398-8
For more on the increased risk
of diabetes see Articles
Lancet Diabetes Endocrinol 2022;
10: 311–21
For more on increased risk of
venous thromboembolism see
Stroke 2022; 53: AWMP53
For more on long COVID in
South Africa see Articles
Lancet Glob Health 2022;
10: e1247–56
1016
Each week, pulmonologists, specialist physicians, nurses,
and respiratory technologists see 5–10 new patients in total
at the Groote Schuur Hospital Post-Covid-19 Lung Disease
Clinic in Cape Town, South Africa. Up to 30 follow-up
patients per week are seen by health workers who operate
within a hospital-wide network of rehabilitation, social,
dietary, and recreation services. The clinic was established
with the support of Professor Keertan Dheda (University of
Cape Town, Cape Town, South Africa) in July, 2020, soon
after the first COVID-19 wave in South Africa, to address
the need for post-acute care and long-term follow-up of
COVID-19 survivors.
“We recognised early in the pandemic that COVID-19
had the potential for long-term impacts on the physical,
emotional, mental, cognitive, and social status of
survivors. We needed to offer these diagnostically and
therapeutically destitute patients access to care, and
to build local capacity in understanding and managing
this complex clinical problem”, says the clinic’s founding
consultant Dr Rubeshan Perinal (Centre for the AIDS
Programme of Research, Durban, South Africa). The clinic
focuses on new or persistent respiratory complaints,
including cough, shortness of breath, and chest
discomfort. “These complaints usually occur within
diverse symptom clusters and overlap considerably with
other long COVID symptoms”, says Perinal. The most
common symptoms of long COVID are fatigue, cognitive
impairment (brain fog), anxiety, and pain symptoms
(muscle pain, joint pain, and headache).
Long COVID treatment is not straight forward. “This
highly specialised service, nested within a strong clinical
and research environment, offers comprehensive
diagnostic evaluations to identify the source of the long
COVID symptoms, the extent of residual organ damage
from acute infection, and opportunities for therapeutic
intervention”, Perinal explains. The therapeutic approach
is focused on supporting recovery through rehabilitation,
psychosocial support, optimal control of risk factors
and comorbidities, and linkage to research programmes
evaluating therapeutic interventions, he adds. “There
are presently no evidence-based treatments for long
COVID and so linkage to treatment research programmes
is an important part of supporting the discovery of
interventions, which might bring relief to the millions of
patients with long COVID worldwide.”
Self-care has emerged as an important aspect of the
journey for patients with long COVID, and interventions,
such as self-pacing, optimising nutrition, graded exercise,
mindfulness, and breathing exercises, might be helpful in
managing mild symptoms. However, self-management
should not replace the need for timely clinical care. Self-
prescribing practices and the reliance on unverified
information on social media platforms and online resources,
might come at high personal, financial, health, and social
cost if they are not guided by a professional, says Perinal.
“Most importantly, self-care should not be advocated as a
substitute to medical evaluation and care. We still know too
little about the genesis, evolution, and trajectory of long
COVID, and there is a desperate need for evidence-based
guidance for the identification, diagnosis, and treatment of
the diverse phenotypes of long COVID”, he further explains.
A major advance in the under­ s tanding of long
COVID, which has happened over the past 2·5 years, is
the recognition by researchers that while it might be
characterised by troublesome symptoms, it might also be
accompanied by an increased risk for new diseases (such
as diabetes) and life-threatening events (including venous
thromboembolism). Some patients with long COVID are
unable to return to their usual social and occupational roles
and experience a substantial reduction in their quality of
life, Perinal says. “In South Africa, we have shown that
66·7% of previously hospitalised patients develop long
COVID.”
“Unfortunately, very little attention is given to long
COVID in South Africa and across the rest of the continent,
but that is also the case globally”, Professor Resia Pretorius
(Stellenbosch University, Stellenbosch, South Africa) told
The Lancet Respiratory Medicine. “The state of long COVID is
not well documented on the continent yet”, says Dr Ahmed
Ogwell Ouma (Africa Centres of Disease Control [CDC],
Addis Ababa, Ethiopia). “We are working with the selected
countries who have good data from their health facilities
to capture the burden”, he added. “Unfortunately, many
people with long COVID do not return to health facilities
but instead try to manage it from home, which makes it
very difficult for us to have a clear picture of the incidence
of long COVID across the continent.”
Long COVID negatively impacts clinical and public health
systems as patients often need extended care, and “it
draws resources from other aspects of health care”, says
Ouma. He adds that the African CDC will work towards
better tracking of patients with long COVID across Africa
to ensure the required medical care is provided.
Perinal agrees that there is limited access to services
for long COVID in Africa and a paucity of capable, well-
resourced, multidisciplinary teams to deliver appropriate
care. “Long COVID is an inescapable public health concern,
and we simply cannot allow the post-pandemic world to be
characterised by wide-scale disability; we need to deepen
our efforts in uncovering the biological mechanisms behind
long COVID, which cause an acute viral infection to morph
into a chronic and potentially debilitating illness”, he says.
Munyaradzi Makoni
www.thelancet.com/respiratory Vol 10 November 2022