KUALA LUMPUR (Dec 21): When former journalist Ali Imran Mohd Noordin got COVID-19 in July this year, it was a bad one. He had trouble breathing. He had to be hospitalised for four days. Doctors put him on Paxlovid.

This was his second time dealing with the coronavirus, the first time being in August last year prior to vaccination. The father-of-five described the first time as “mild” and a “wake-up call” to take care of his health as he did not escape unscathed.

“I went for a full medical check-up in January this year. That was when I found something in my lungs... I couldn’t do the lung test properly,” he told Bernama via Zoom.

Then with the second bout, the doctors found a scar on his lung. He had to be admitted and prescribed Paxlovid, the anti-COVID-19 medication from Pfizer. Although he recovered, his pre-pandemic self continues to be out of reach. He said to this day, he is unable to do anything strenuous without taking a break.

For the 40-year-old, it is the stuff of nightmares. His father also had a lung problem but he was 65 years old when he first had to deal with poor lung function.

It is as if COVID-19 had aged Ali Imran’s organs, accelerating the development of health issues. The kicker is, he is not alone.

Three years after COVID-19 came about, millions of former patients in many countries say they are still feeling the effects of the infection, such as difficulty breathing, brain fog and intense fatigue. These lingering symptoms and others – called Long Covid, long-haul Covid, post-Covid or post-acute Covid syndrome – are affecting their ability to work, risking their financial independence.

Worse, Long Covid’s impact on the economy and healthcare system stands to worsen over time if countries, including Malaysia, do not take the necessary policy actions to prepare for a future where part of the workforce will likely be sicker at a younger age.

Post-Covid-19 issues

Ali Imran resigned from his journalism job a few months ago to concentrate on his health and when he could not come to an agreement with his company over work flexibility. Because of COVID-19 and ensuing health issues, he also had to quit his Master’s degree programme.

“I feel sad (I caught it) because nobody wants to get COVID. But when I got COVID, I found out later that it affected me longer than I thought it could have. I left (my old company) because I wanted to do something with my health but then I got it again,” he said. He now works as a freelance writer.

There is a term for the scores of people like Ali Imran who decide to leave the workforce due to health reasons and it is called ‘The Great Resignation’.

An August 2022 Brookings Institution report estimated that up to four million people worldwide are no longer able to work due to post-COVID-19 health issues while another report by the US Department of Health and Human Services estimated as many as 23 million people have Long Covid.

While there are no exact statistics dealing with this phenomenon, the Department of Statistics Malaysia recorded the number of inactive unemployed – which includes those who would have looked for work if they had not been ill – increasing by 2,300 to 110,700 in October 2022 from 108,400 in September 2022. Other people in this category include those who did not look for work because they believed no work was available or that they were not qualified for it, as well as those who are waiting for the result of job applications.

COVID-19’s impact is not just restricted to the inability to work, it is also tied in to people’s inability to work well.

Bernama came across several cases that fit this bill. One of them is a 53-year-old oil and gas company executive who has not been able to return to work fully due to Long Covid symptoms. Another case involves a medical professional with a family history of heart disease who has had to undergo angioplasty at the age of 34 and be on heart medication for life. Prior to his COVID-19 infection, he was a runner and hiker.

Like Ali Imran, his family medical history is manifesting sooner than expected.

Epidemiologist Datuk Dr Awang Bulgiba Awang Mahmud is not surprised to hear of these cases, saying COVID-19 is one of a few infectious diseases whose effects last long after infection, which may also shorten life expectancy.

“The damage caused by the SARS-CoV2 virus does not end with the eradication of the virus from the body. In fact, it seems to set off a chain of events long after apparent recovery from the acute infection,” he said via email.

He said studies have shown that former COVID-19 patients are now more likely to develop and possibly die from non-communicable diseases (NCDs), including cardiovascular disorders and diabetes, compared to those who have never been infected.

A recent British Medical Journal study tracked 54,000 people in the United Kingdom for four-and-a-half months and found that those whose COVID-19 infection was mild were still 10 times more likely to die of any cause during the four months.

A US Veteran Affairs study, which came out in February 2022 and involved 150,000 subjects, found stroke risk increased by 52 percent within a year after infection while the risk of heart failure increased by 72 percent. The risk may also be present in children.

“Even children are not spared and there is already evidence of increased incidence of rare disorders among children and adolescents post-infection,” Dr Awang Bulgiba added.

The need for data

In order to prepare for the incoming burden on the Malaysian healthcare system, economy and household wealth, data is needed – the more detailed the better. Calculating the cost of Long Covid to the economy would require data such as the number of such cases, the severity of the affliction, the number of work days lost due to illness, loss of quality of life and the medical cost of treating the illness, according to Harvard economist David Culter.

Unfortunately, health and economic experts say there is not enough data in Malaysia for now, partly due to difficulty in diagnosing whether the symptoms are part of Long Covid or something else.

Furthermore, the number of COVID-19 cases recorded is likely an undercount, according to an analysis by the COVID-19 Epidemiological Analysis and Strategies (CEASe) research group. Tracking of infections has dwindled even as more people are getting infected or reinfected.

Dr Awang Bulgiba, who is part of the CEASe group, told Bernama the likely figure is at least three times the officially reported figures.

“This means that we are probably under-estimating the number of people suffering from Long Covid too,” he said, adding that there needs to be more investment in research into Long Covid to determine how long these effects last and whether there are ways to prevent them from becoming permanent.

Currently, there are several studies tracking the health status of former COVID-19 patients and healthcare workers at Universiti Malaya Medical Centre (UMMC), run by health economist Prof Maznah Dahlui.

She told Bernama the studies are checking if the subjects have developed Long-Covid symptoms and are experiencing loss of earnings and quality of life.

“We’re also looking at (the issue of people returning) to work. We want to see how many of them with a history of admission for COVID-19 had returned to work and if not, why. Whether or not it is because the company is closed or because they’re not able to cope with the previous tasks. Sometimes it’s just that they are no longer working because they were (fired) or they could still be working but in a different type of job,” she said. 

Dr Maznah said so far, researchers have found a majority of previously healthy people have not developed Long Covid symptoms. She added Long Covid was more common among those who had to be hospitalised and the elderly.

Nevertheless, she acknowledged COVID-19 infection may cause some new symptoms or exacerbate health conditions after recovery, saying Malaysia was not prepared for the post-pandemic burden on the healthcare system.

“We are having this double disease burden. We are still struggling with communicable diseases like tuberculosis, dengue, malaria and yet we are (getting) more NCDs like diabetes, mostly lifestyle diseases related to obesity,” she said.

She added the government needs to increase the healthcare budget from the current two percent of the Gross Domestic Product (GDP) and invest more in preventative healthcare.

Prior to the 15th general election, all the major coalitions – Pakatan Harapan, Barisan Nasional and Perikatan Nasional – vowed to increase the public healthcare budget to five percent of the GDP. 

Dr Maznah, who is also a public health specialist at UMMC, said Malaysia’s healthcare services and delivery system are generally good but financial coverage of healthcare, that is, medication is still lacking.

“Right now, even if you don't have money you can get access to healthcare services – just pay RM1 – but you need to pay out of pocket for some drugs, especially cancer drugs, and people can get poor by paying for it. It’s a catastrophic healthcare expenditure,” she said.

As medical costs will continue to balloon, she said Malaysia should implement a national health insurance or social health insurance scheme to complement healthcare by paying for medication and others.

In the meantime, Dr Awang Bulgiba said the best solution is to prevent getting infected or re-infected by the COVID-19 virus by continuing to mask up, especially indoors. He also called on the health authorities to think of a permanent structure for COVID-19 vaccination to provide boosters and new vaccines when necessary.

“Right now, the thinking is still ad hoc but the planning for such vaccination should already be made,” he said.

On the labour side, many employees with health problems post-COVID-19 will no longer need to choose between their health and work when the Employment Act amendments allowing flexible working arrangements come into effect soon. However, the employees will have to apply to their employer for a flexible working arrangement.

As for Ali Imran, he is tired of the medical community dismissing his symptoms. He hopes the medical community will learn more about Long Covid and consider COVID-19 as a contributing factor when assessing health issues.

“Usually, they will do a lot of screening and then they say, ‘Oh, this is not because of COVID-19, this is something else.’ Nobody is even sure of the real impact of COVID-19 so don’t act like you know everything,” he said.

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