February 9, 2023

Evolving evidence suggest that after recovery from acute illness, patients may continue to experience symptoms. Terms used to refer to this condition are: post-acute sequelae of SARS-CoV-2 infection (PASC), long Covid, post-acute Covid-19, chronic Covid-19, or post-Covid syndrome.
During recovery from mild or severe illness, patients may experience symptoms that include the following:

  1. Fatigue or tiredness, weakness, and poor endurance. Fatigue is the most common symptom reported, and it can last for three months or longer especially among patients who required intensive care;
  2. Difficulty in breathing or dyspnea at rest or during physical exertion. Shortness of breath may persist or resolve in two to three months or longer;
  3. Cough, which may persist for two to three weeks after onset of symptoms, resolving in most patients by three months;
  4. Dizziness, syncope;
  5. Chest pain or chest tightness. Chest discomfort may resolve slowly, and may resolve in 12 to 22 percent of cases about two to three months after acute infection;
  6. Joint pain, headache, rhinitis (stuffy nose/colds symptoms) insomnia, myalgia or muscle pains, hair loss, sweating, and loose bowel movement; and
  7. Psychological or cognitive complaints that include new or worsened memory problems,inability to concentrate, anxiety or depression, and post-traumatic stress disorder.
    In a study among patients who were hospitalized, concentration and memory problems persisted for six weeks or more after discharge. Psychological problems, of which anxiety is most common, improve over time but may last for up to three months in some survivors;
  8. Worsened quality of life as reported by almost 50 percent of Covid-19 survivors; and
  9. Altered taste or smell. Most patients recover about one month after acute illness, but in some studies, these symptoms may persist longer.
    Studies suggest that symptoms may persist even among those who had mild disease.
    About 10 to 20 percent of discharged Covid-19 cases require re-hospitalization within 30 to 60 days and the risk factors for this are age 65 years old and older and comorbities like lung disease, heart failure, diabetes mellitus with complications, chronic kidney disease, and /or body mass index of 30-kilogram/m2 or higher.
    There is still no established guideline on the staging of recovery from Covid-19, but these categories, based on symptoms and not correlated with viral load or activity, are currently being suggested:
    “Acute Covid-19” – symptoms of Covid-19 up to four weeks from the onset of illness,
    “Ongoing symptomatic Covid-19” – symptoms of Covid-19 from four to 12 weeks after the onset of illness, and
    “Post-Covid-19” – symptoms develop during or after Covid-19 and continue for 12 or more weeks and these are not attributable to other illnesses.
    Patients who recovered from the acute illness are advised to seek immediate consult if they feel recurrent, persistent, or new signs and symptoms.

The Philippine College of Physicians, the umbrella organization of medical internists, has issued its official statement on Ivermectin.
It strongly opposes the dispensing of unregistered drugs like Ivermectin for indications that have not been scientifically established.
Based on current evidence, the drug does not significantly improve clinical outcomes or reduce death among adults with mild Covid-19. Its use has also been associated with side effects like nausea, vomiting, diarrhea, stomach pain, facial or limb swelling, dizziness, seizures, confusion, sudden drop in blood pressure, and liver injury or hepatitis.
It calls on the Department of Health, Food and Drugs Administration, and concerned agencies to act on the recent mass distribution of Ivermectin.