The Longer Battle

Nearly two years after supposedly recovering from the disease, the effects of COVID-19 remain a heavy weight to bear for some survivors hit hard by the virus.

By JOAHNA LEI CASILAO and GISELLE OMBAY
June 8, 2022

It has been two years since she was announced recovered from COVID-19, but Bethel Guansing still carries the weight on her chest.

“Physically, if you look at me, I am OK on the outside. It’s as if I’m not feeling anything. But it’s here inside,” the 58-year-old housewife said.

Bethel, who runs a sari-sari store in Quezon City, first contracted the virus in June 2020, long before vaccines became available in the Philippines. She was admitted to the Lung Center of the Philippines on June 12, but her condition was so serious that she was immediately transferred to the intensive care unit.

The details Bethel remembers, she had to piece together from other people. “Someone told me that I had to be intubated. I lost consciousness for more than two weeks,” she said.

When she woke up, the nurse told Bethel she was experiencing hallucinations and that she had been sleeping for a long time.

But regaining consciousness did not mean an easy road to recovery. “My food was given to me through my nose. When my phlegm would be suctioned, it felt like my chest would explode. It was really hard,” she said.

The pain was enough for Bethel to wonder whether her time was up.

“There was a time when I wanted to give up. I told the Lord, ‘Please take me because I can’t do this anymore. You talked to me, I am OK now because my children have all graduated. I can’t do this anymore,’” she said.

But one evening — or was it morning? — Bethel had a vision where she saw herself in a pyre. Only, her body did not burn. To her, the message was clear.

“That’s why I continued to fight. Every time I would be intubated, I would cling on to the forearm of the nurse and I would help the treatment. I would do this. I would help because I knew I would not burn,” she said.

True to her dream, Bethel was transferred from the ICU after a grueling battle in early July. She tested negative for the virus on July 14. Two days later, she was discharged from the hospital.

Her return home, it turned out, was only the beginning of the longer battle.

It was with fear that made Bethel return to the Lung Center of the Philippines just four days after her discharge. Though she did not test positive for COVID-19 again, she experienced difficulty breathing anew.

From July to November 2020, after she supposedly recovered, Bethel continued to feel severe fatigue, heaviness in her chest and back, and difficulty breathing. There were even times when her hair began falling and the nails on her toes decaying.

But it was the weight on her chest that got to Bethel. “I am quite thin, so it felt really heavy, my body felt really heavy. Then I had depression. Sometimes I would cry,” she said.

Bethel has been diagnosed with pulmonary fibrosis, a possible consequence of COVID-19 pneumonia. This condition is associated with long COVID — the presence of symptoms long after recovery from infection.

Last month, the government finally confirmed that there were cases of long COVID in the country. But doctors have been observing cases of long COVID in patients with symptoms similar to those of Bethel.

“Sometimes, the acute infection can last up to four weeks. After the fourth week, that is the start of long COVID,” Dr. Maricar Limpin, the president of the Philippine College of Physicians, told GMA News Online.

Sub-acute cases of long COVID last for up to 12 weeks, but they have seen cases last much longer.

“And now we are seeing, actually even those more than six months, they continue. There are some patients who continue to have symptoms, [the] persistence of symptoms,” Limpin said.

These include shortness of breath, persistent coughing, a loss in the sense of smell and taste, and in some cases, depression — almost of which Bethel had experienced.

As she struggled to recall certain details during her battle with COVID-19, Bethel revealed that she was often unable to remember things or focus.

Brain fog, wherein a person becomes forgetful and unable to think properly, is also a symptom associated with long COVID.

Cases of long COVID are more often observed among individuals who, like Bethel, were in severe or critical condition. Since vaccines reduce the severity of COVID-19, Limpin said it also follows that the chances of vaccinated individuals experiencing long COVID also decrease.

Senior citizens and individuals with co-morbidities are also more at risk. While Bethel did not have pre-existing conditions — she “only had asthma” — her COVID-19 ordeal came months before the first vaccines became available.

By that token, Interior Secretary Eduardo Año, who has had heart problems in the past, was a walking time bomb for long COVID.

Año was among the first 2,000 COVID-19 patients in the country, contracting the virus in March shortly after a Metropolitan Manila Development Authority (MMDA) meeting with several key public officials.

“I was asymptomatic. I didn’t feel any symptoms. After 14 days of quarantine, I tested negative already and then that’s fine. I continued my work, so many activities, exposure. We were starting at that time trying to build up our healthcare facilities and do a lot of information campaign advocacy so we went around the country,” he said.

Months later, Año had to attend an August 10 meeting with President Rodrigo Duterte and the Inter-Agency Task Force (IATF) Against COVID-19 in Davao City. He tested negative for COVID-19 prior to the flight.

However, on his way back to Manila the day after, he developed a sore throat and started coughing. Año took another RT-PCR test and this time, it yielded a positive result.

That same day, he submitted himself to the hospital after an official from the Department of Health called to tell him he needed to be confined, as people who were infected with COVID-19 for the second time usually end up intubated.

Today, the former Army general and Armed Forces chief, who had seen a lifetime of action in the battlefield, admits the COVID-19 ordeal brought him to his knees.

“There were so many times when I was ready to give up. I had already talked to my family and my wife and said I think it’s already God’s will. Let’s already accept it,” he said.

He found himself inside a COVID-19 ward fighting for his life. His cough was dreadful, and his tonsils grew to the size of a golf ball. He had diarrhea and lost senses of smell and taste too. Nights were the the hardest, when symptoms attacked him most. His temperature also rose while he was asleep.

“You cannot sleep, you cannot rest because no matter what position you are in, you just cough and cough. It’s like you’re a dog that couldn’t stop barking. It was really very hard because the cough was dry. My body was tired too.”

Aside from the physical strain, there was also the mental health effect of being left alone in a COVID-19 ward. He likened it to being in purgatory with people looking like aliens, unidentifiable behind their personal protective equipment.

“You are there alone, no one is talking to you. Visitors are not allowed. It’s like one secluded isolated place with a big, locked door. When you go inside, there are only two possibilities — either you come out dead to get cremated or you survive the virus and then you come out alive.”

It was not until five days into his confinement when his fever subsided for the first time. He woke up the next day feeling better and even had the strength to take a bath after a long while in the hospital. The renewed energy, however, was only short-lived, because he was laboring to breathe later that day.

Thankfully for Año, his symptoms continued to improve. After 11 grueling days and endless whispered prayers, he was finally discharged from the hospital.

He continued his quarantine at home before resuming his work as the DILG chief. He tried to bring his life back to normal.

As a soldier, Año had engaged in strenuous physical activities such as mountain biking, golfing, and playing badminton, among others. He even compared his body to an athlete’s, being able to run five kilometers nonstop.

He tried to go back to his old active lifestyle, but he noticed something was off.

“While I was already okay, I felt like I was having trouble breathing. I got tired easily, I ran out of breath easily, then my heart rate would rise above 100 plus,” he said.

He knew something was wrong. A few months later, he finally scheduled a checkup, bothered by what the changes he felt in his breathing and in his heartbeat.

The checkup would last much longer than expected. His physician told him there was something really wrong with his heart — something bad, even possibly a mild heart attack. He had to be admitted then and there.

Dr. Ted Herbosa, an adviser of the National Task Force Against COVID-19, said one of the symptoms of long COVID includes the weakening of those who were physically active prior to infection, like athletes.

“They become weak, and the findings show that they had some form of inflammation in the heart and lungs. So, they had myocarditis and pneumonitis or inflammation causing this functional defect.”

Año already had an angioplasty in 2008, but his doctors found that he might have a heart attack and end up dying during the same procedure. His only option was a pair of bypass surgeries.

Hhe underwent his first heart bypass surgery on January 13, 2021, followed by a second one week later.

He had been on his way to recovery when he contracted a “superbug” called methicillin-resistant Staphylococcus aureus (MRSA), which led to his massive bleeding.

With fluid building up in his respiratory system, two tubes also had to be inserted into his lungs.

“Even swallowing a small fishbone already hurts, doesn’t it? What more if it’s in your lungs? The ends of those tubes were about the size of a car radiator. Imagine, I had two of those. All kinds of pain relievers or anesthesia were not allowed.”

The pain during the treatment was so bad that Año was at the point where he was “just waiting to die.”

According to health experts, as high as 50% of people hospitalized due to COVID-19 have experienced its long haul effects.

Herbosa said there is no treatment available yet for the weakness for cases of long COVID. “So your performance level, if you’re an athlete, it will definitely affect your performance level in whatever sport you are performing.”

Rehabilitation — physical and pulmonary — may help patients improve their body functions. For those with pulmonary fibrosis, there are also medicines that work by preventing the regeneration of fibroblast in the lungs.

Health Undersecretary Leopoldo Vega, the country's treatment czar, also suggest patients with long COVID may benefit from doing simple exercises such as walking, and getting proper sleep and nutrition. He also suggested doing mental exercises such as playing chess. Listening to classical music and meditation could also help their minds relax.

This is why her doctor advised Bethel Guansing to take daily walks at least 30 minutes each morning, a practice she continues to this day.

With pride evident in her voice, Bethel shared that the 30-minute walks have increased to over an hour.

“The doctor said this was good news. Sometimes I try to run. I remained fine. I didn’t really have difficulty breathing.” Not a beat later, Bethel corrected herself, “I had trouble breathing, but it wasn’t that bad.”

Her pulmonologist Dr. Jubert Benedict advised her to do breathing exercises to help with this struggle. “I just talked to her and asked her to focus on what she can do. Celebrate the small victories,” he told GMA News Online.

Meanwhile, Año is still undergoing therapy for his left arm, which became “frozen” after being inserted by an intravenous (IV) to his heart for months.

He recalled not being able to dress up on his own and even had to have his polo shirts customized with a zipper on the sides just so he could wear them.

He said he has also been doing stretching exercises and undergoing physical rehabilitation twice a week.

Like the soldier that he was, Año is back on his feet, doing activities like trail walking and golfing, but with more caution now considering his long battle with COVID-19. He has also returned to his post as the DILG secretary, serving out his remaining months in office before the term of President Rodrigo Duterte ends on June 30.

In January 2022, he contracted the virus anew amid the more transmissible Omicron variant surge. But unlike his first two infections, Año was in much safer hands in his third bout with COVID-19 as he was already fully vaccinated.

Limpin believes this is best way to avoid getting long COVID. “The one big way or the big and effective, preventive, management of long COVID will be to get vaccinated. Because the vaccine will prevent severe COVID,” she said.

Herbosa echoed this, adding that it is indeed vital to get the anti-COVID jabs, especially among children and adolescents so as to prevent the long COVID’s “lifetime effect.”

Both doctors already warn that long COVID may have a longterm impact not just on individuals, but on the country’s productivity and workforce. The Philippines’ has tallied nearly 3.7 million COVID-19 infections at the end of May.

“Among these post-COVID cases, many are 65 years old, but we also saw many who are still young and yet continue to have persistent symptoms,” Limpin said.

“IIf you have a workforce that has a chronic illness, that has chronic COVID or long COVID, what will happen is they will be in and out of the hospital. Number two, they cannot function as an individual of that same age,” Herbosa added.

Based on the NTF’s latest report, at least 64 million Filipinos are now fully vaccinated against COVID-19, while 11 million individuals have received booster shots or additional doses.

Bethel admitted there were times when she lost hope, because of her condition, which limited activities available to her.

“It’s like I experienced self-pity. I’m grateful that my family is here. They thought I was being dramatic, but my mood was really different. It’s like I was alive but dead,” she said.

With the help of her family, she is able to take one day at a time as she continues to consult her doctor. She has also completed her primary vaccine series and booster dose.

“I focused on life, on thanking the Lord, because he gave me my life back, that I am still alive. Once I left the hospital, I saw the sun, I saw the sky, I was blessed that I saw them again,” she said.

Her advice to other individuals coping with long COVID is to not lose hope.

“Keep fighting and trust in God,” she said.

For his part, Año said he has come to terms with the fact that COVID-19 has changed him forever. He believes the reason why he survived COVID-19 and its post-symptoms was to give hope to other people by sharing his experience.

“You will never be normal. You will never be back to normal, but you can cope,” he said.

Neither the DOH nor the Philippine General Hospital have studies yet on the matter.

In an advisory, the DOH said that compliance with minimum public health standards remains the best protection against long COVID. “The most effective way to avoid long COVID is to avoid getting COVID-19 in the first place. We know what works: continue practicing minimum public health standards and also get vaccinated as soon as possible and boosted once eligible.”

Meanwhile, the coronavirus is still mutating and experts have hinted of a possible new surge in COVID-19 cases. The battle continues.

With editing by Karen Galarpe and Virgil Lopez
Web production by Jessica Bartolome
Artwork by KW Multimedia