Long COVID In Gibraltar

How Long COVID is Affecting Gibraltarians

According to the World Health Organization, 10-20% of people who have had COVID are experiencing long COVID. This term is commonly used to refer to symptoms which persist beyond 12 weeks after a COVID infection with no other diagnosis accounting for them.

Symptoms can be physical, psychological or both – they vary from person to person and can fluctuate.  The most common symptom is fatigue, followed by breathlessness, chest pain and cough.  Less common symptoms include loss of smell or taste, joint pain, headache, dizziness, dry mouth, muscle pain, insomnia, hair loss, sweating and diarrhoea.  Some people may develop a characteristic “brain fog”, memory loss, anxiety or depression.

We spoke to Dr Isabella Bassill to find out how Long COVID is affecting people in Gibraltar and what you can do to overcome it.  Dr Bassill is a Consultant Physician who offers a long COVID service at the Specialist Medical Clinic.

Thank you for speaking to us about long COVID, Dr Bassill.  Can you start by explaining what long COVID actually is and how it is impacting people in Gibraltar?

Long COVID has two components.  Firstly, “ongoing symptomatic COVID” covering symptoms persisting 4-12 weeks after a COVID infection. Then there is “post-COVID syndrome” which are symptoms affecting the person which persist beyond 12 weeks with no other diagnosis to account for them.  When talking about long COVID, most people are referring to symptoms lasting more than 12 weeks.

My ongoing experience in Gibraltar is that long COVID involves more than just one thing.  Definitely, long COVID exists, but it is confused with many other conditions. There is a tendency to blame COVID for everything, sometimes by both doctors and patients.

When our life was dominated by COVID, new symptoms, especially breathlessness, chest pain and fatigue, were assumed to be caused by COVID, when often they proved to be a different medical condition that needed diagnosis and treatment. This has been made worse by the continuing difficulties in accessing face-to-face healthcare.

There are also mental health conditions such as depression and anxiety, along with the loss of physical fitness, which were made worse by lockdowns and inactivity.

In addition, there are various medical conditions precipitated directly or indirectly by COVID that now need to be treated as separate entities. COVID directly caused many heart attacks and inflammation of the heart but also “unmasked” patients with angina due to coronary disease that they didn’t know they had, but would have been developing for years.

Some patients, especially the seriously ill and ventilated, have developed chronic lung disease requiring ongoing monitoring and treatment.

Interestingly, there has been a big increase in new-onset asthma, likely due to the irritants in cleaning products.  The biggest increase in incidence is in cleaners and healthcare workers who are constantly sanitising due to COVID.

How long does long COVID typically last?

It is different for each person.  If you have not recovered from COVID after 3 months I would suggest a consultation with a doctor. The vast majority of patients I have seen improved over 6-12 months.  It is great to see some of the patients I first knew from the hospital with critical COVID come back feeling so much better.

Is there anything people can do to reduce the symptoms without medication?

Yes. I would suggest a programme of gradually increasing activity. This can be guided by a physiotherapist or self-guided. If you want to do it yourself, I recommend visiting the NHS website www.yourcovidrecovery.nhs.uk, as it contains plenty of accurate information about COVID and has a whole section on long COVID with information and practical advice on how start the road to recovery.

For those with an altered sense of smell, you may wish to check with an ENT doctor that there is no physical problem. Once you’ve ruled that out, the main treatment is “olfactory training” or smell training.  A great resource on how to do this can be found on the website of the charity AbScent.

I would also suggest talking to your employer about a gradual return to work as your symptoms stabilise or improve.  The right kind of work has great health benefits and we know that the longer someone is on sick leave the less likely they are to be able to return: those absent for 6-12 months have an 80% chance of being out of work for 5 years. Sometimes both the person and their employer want them to be 100% better before re-starting – but this is often counterproductive.

Employers who want to help their employees back into the workplace in the right way can consult an Occupational Health Specialist for a plan of action.

Are any treatments available?

The best treatment is prevention! People who suffered severe COVID are on average, more likely to have long COVID, anything to reduce the severity of the illness is therefore helpful. This includes vaccination and seeking medical assistance when necessary. For selected “extremely clinically vulnerable” people, there are treatments that can be started as an outpatient within a week of symptoms, to reduce the risk of going on to require hospital treatment or oxygen support.

Rehabilitation is the mainstay of long COVID treatment. There is no medication approved for long COVID as it encompasses so many different things. However, other conditions caused by, or confused with, long COVID do have medical therapies. Consult your GP, or a COVID specialist to work out the best course of action in your particular case.

I am currently working with long COVID patients in a number of ways, but it all starts from listening to them, taking them seriously and then working out the next steps to improving their health and quality of life. Each case is different, but if a person has persistent troubling symptoms they need to be seen by a doctor, experienced in the field, to determine the cause and whether they need specific tests or treatments. I help them to obtain the medical support they need and we work together to achieve the best possible outcome.

Hopefully we will see a decrease in cases moving forward, as we know that vaccination reduces the risk of long COVID. Also, the new variants seem to produce fewer cases. In one study of vaccinated people, 10.8% self-reported long COVID after Delta but only 4.5% after Omicron, so we should see a decline in people suffering from this tricky condition.

Last but not least, we know that COVID hasn’t gone away, how should people be protecting themselves now?

In one word – Vaccination.

The NHS have stopped recommending shielding. However, I would advise people to be sensible in taking precautions as they would do with flu or other viruses are in the community.  This includes handwashing, meeting outside when possible, facemasks in some circumstances and avoiding crowds or people known to be infected.

About our Expert

Isabella Bassill, MA (Oxon) MBChB FRCP, is a Consultant Physician at the Specialist Medical Clinic, who specialises in acute illness, breathlessness, chest pain, heart failure, COPD, dizziness, fainting, COVID, chronic disease management and complex patients with multiple medical conditions. She was a Consultant in Acute and General Internal Medicine for 5 years at Royal Derby Hospital before moving to Gibraltar, where she worked at St. Bernard’s for 18 months as a Consultant Physician.  During her time at St Bernard’s, she set up and ran the COVID follow up / long COVID clinic and helped develop the outpatient COVID antiviral and antibody pathway. She is now consulting through Specialist Medical Clinic and is also offering a long COVID service.