EXPLORING THE PSYCHOSOCIAL IMPACT OF LONG COVID ON PATIENTS AND HEALTHCARE

Wayfaring in an Uncharted Territory:

Amidst the rhythmic chaos in Nigeria’s vibrant and bustling city, Aba, the aftermath of the COVID-19 pandemic cast an ominous shadow on countless lives and disrupted the traditional sense of community. The customary warmth of embraces was replaced by the chills of social distance, creating an emotional void that echoed across the nation. The laughter of children playing in the streets dwindled, replaced by hushed whispers that seemed to hang in the air, laden with fear and uncertainty.

For me, it was the mounting anxiety over my parents contracting COVID-19 as more people in my community came down with it, the closest being our neighbour next door, a doctor who had drastically emaciated under the care of his pharmacist wife. ‘Why is he being home-treated?’ I remember asking. A reminder that no aspect of life was untouched by the pandemic's reach, vulnerability was most palpable among healthcare workers who battled not just COVID-19, but also the emotional toll it exerted. The very essence of their roles reshaped; their dedication often eclipsed by their defenselessness against the virus they fought to conquer.

The onslaught of isolation and bewilderment cut the deepest – the ache for the world that once was. Among others, even Christmas lost its innocence and merry to the many Covid-19 lockdowns. The streets that were once alive with activity now bore witness to a different kind of chaos marked by a surge in crime, from burglaries and break-ins to the rise of internet fraud and prostitution. The very landscape of my community was shifting, taking on a new cast of characters – beggars and mentally deranged vagrants who had succumbed to the economic fallout of COVID-19 restrictions and sought refuge by roadsides in numbers. At the time, I never quite understood the cause-and-effect theory of madness, detachment from reality, being in denial or the feeling of being outside one’s body like the world is no longer real.

It has been three years since the COVID-19 outbreak, but I still see it in my father’s eyes— melancholy and distress etched deep within by debts accrued from living through a pandemic in a system rigged against you. Call it the aftermath of COVID-19 or long COVID-19, it does not take away the brunt of what people have been through or the unsettling pang that things might not go back to the way they used to be.

Emphasizing on the context of Nigeria and Low-middle income countries (LMICs), this paper intends to fill the gap in literature on the overlap of events surrounding the psychological and social impact of long COVID-19 on patients and healthcare.

Not everyone traumatized by the pandemic since its outbreak in Wuhan, China, in December 2019, can be called a patient of Long COVID. The persistence of COVID-19 symptoms occurs in convalescent or cured patients who once tested COVID-19 positive. Long COVID is a new syndrome that has confounded medical practitioners and researchers for answers while devastating and plunging patients into social rollercoasters and whirlpools of psychological malaise. Also called Post-Acute Sequelae of SARS-CoV-2 infection (PASC), Long Covid is associated with causes ranging from ignorance to Covid-19 vaccination and poor patient awareness (Chizoba 2022), re-infection or relapse, immune response crisis, viremia in people with altered immunity, to hospital-associated infection, and clinical symptoms including fatigue, cough, breathlessness, psychosis like brain fog (poor concentration, confusion, slow cognition, fuzzy thoughts, forgetfulness) and Post-Traumatic Stress Disorder (PTSD) (Wu, Wang, and Liu, 2020).

PSYCHOSOCIAL IMPACT ON PATIENTS

        i.         PTSD (Is it all in our head?): Research and the likes of dogged psychologists like Sigmund Freud would quickly point out as evidence that physical events or damage affecting the brain can profoundly shape who we are. Examples range from the historical case study of Phineas Gage whose disposition was completely transformed by a head injury, to diseases like syphilis that disrupts the will of consciousness, Alzheimer's that robs rationality, and coffee or alcohol that inflame desires. The understanding that our emotions, memories, ambitions, and sense of identity are, in fact, orchestrated by a vast assembly of nerve cells and molecules underscores the intricate relationship between brain function and mental health. Peculiar long Covid-19 symptoms like Post Traumatic Stress Disorder (PTSD), cognitive impairment, and brain fog are potentially caused by disrupted neurochemical balance in the brain from the virus's interaction with neural receptors, inflammation, oxidative stress, or the lasting brain imprints of experiencing the pandemic’s gloom or witnessing loss (Tay et al, 2020).

      ii.          Insecurity: Long Covid-19 induced insecurity includes the emotional, social, financial, health, and academic insecurities that emanate from the closure of schools, shutdown of businesses, no movement orders, travel restrictions, closure of public spaces, and other COVID-19 containment measures.

Losing an entire year of intramural academic activities, learning experiences, hands-on internships and fellowships to COVID-19 has been an emotional meltdown of self-worth, values, and goals for academic students. The scenario for the over 40 million student population in Nigeria stifled by preexisting strikes in the academic sector has been the propagator of dropouts, juvenile delinquencies, and irrational behaviours like alcoholism and drug abuse in youths.

The loss of income, heightened financial difficulties, and strained livelihoods are other economic stressors. It has been survival of the fittest for families who have resorted to desperate measures to remain healthy to survive the pandemic.

    iii.         Grief: In her book, Notes on Grief, Chimamanda Adichie captures how grief over death can fracture self and person at once if not checked. Long COVID is an extension of the unbearable weight of grief and the mental toll in the loss of families, friends, spouses, healthcare workers, leaders and societal figures to the pandemic.

     iv.          Life behind screens (evolutionary or backward?): Phone calls, Google Meet, zoom meetings, texts, and increased screen time have become the new normal of interaction as the world craves ways to control the spread of the COVID-19 pandemic. While virtual technology has been effective in making the world a global village, completely replacing the humanity and physicality in social events like conferences, graduation ceremonies, worship services, and cultural festivals was never the goal until COVID.

PSYCHOSOCIAL IMPACT ON HEALTHCARE

      i.         Vulnerability: The forefront group in combating this virus bears the most emotional complications. Under the pressure of a rapidly evolving COVID-19 virus and the spiking mortality rate, in addition to the lack of personal protective equipment and effective treatments, healthcare workers become victims themselves to COVID-19 infection (Kherandmand 2021).

     ii.         Maladaptive behaviours: Insomnia, distress, OCD, avoidance, withdrawal, passive aggression, and suicidal tendencies rife among healthcare providers and emanating from subjugating long working hours or patient load have been aggravated by the burden of long COVID-19.

   iii.         A virulent COVID-19 versus an inadequate system: Dealing with patient volume and clinical presentations that defy established diagnostic frameworks with little or no specialized training in Long COVID or approved therapeutic or preventive treatments demoralizes healthcare providers, predisposing them to fast burnout and medical errors. The scenario is worse for LMICs in Africa with low life expectancy stemming from the scarcity of medical personnel and healthcare facilities like respirators, Intensive Care Units (ICUs), and specialized rehabilitation centres essential for effective treatment of long Covid-19 cases (Lucero-Prisno, 2021

OVERCOMING THE PSYCHOSOCIAL IMPACT OF LONG COVID

      i.         Prevention over cure: Individual and collective responsibility in preventive social vaccines like social distancing, thorough handwashing, and mask-wearing is crucial. Organizing awareness campaigns and rural outreaches would sensitize people on the symptoms and management procedure of long COVID-19 (Chizoba 2022).

     ii.          Insight into herd immunity (Vaccination): Effectively nipping the virulence of the COVID-19 pandemic in the bud hinders long COVID-19 syndrome or the culmination of psychosocial impacts. This can be achieved by promoting COVID-19 vaccine acceptance and deploying massive vaccine coverage against the pandemic (WHO, 2021).

   iii.         Strong Support System: In the know that COVID-indued-insecurities foster crime in youths, stakeholders-- families, communities, and educational institutions—should make provisions for support systems, positive environments, and constructive outlets like counselling and mental support services to ensure emotional and psychological well-being.

Governments should resourcefully compensate the masses for COVID-19 lockdowns and provide comprehensive safety measures for healthcare workers like accessible COVID-19 testing and vaccination, adequate personal protective equipment, and training on long COVID specialization and management.

   iv.          Development agenda and Collaboration: Long COVID research is essential for understanding the condition and developing evidence-based guidelines for standardized treatment approaches. This is achieved through healthcare investments and international collaborations, creating room for medical infrastructure in LMICs and innovations for better pandemic preparedness/response.

CONCLUSION

Long Covid’s psychosocial impact is a shared challenge demanding comprehensive efforts. We can mitigate the psychosocial toll on patients and healthcare providers by involving communities, governments, and healthcare systems. Accessible mental health services and telehealth platforms for counselling are imperative to reduce the psychological burden of Long Covid-19 on patients and healthcare providers. The amalgamation of awareness, support, and collaboration paves the way for a more resilient society in the face of Long Covid's far-reaching effects.

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