Doctor On Call (DOC): Dr Leong Hoe Nam on Long COVID – What Do We Know So Far? (Part 2)

Doctor On Call, or DOC for short, is a brand new series brought to you by Medical Channel Asia. This series aims to bring doctors and specialists from various fields to give you an introduction to common health and medical topics that you and the Asian population are interested in. In our 8th DOC, held on 9 March 2022 (Wednesday), from 8pm to 9pm (GMT+8), we have Dr Leong Hoe Nam, Senior Consultant Infectious Disease Specialist at Rophi Clinic, to talk to us about Long COVID – What Do We Know So Far?

For Part 1 of the forum, we have Dr Leong give us a presentation on the current research and knowledge about long COVID. In Part 2, Dr Leong goes through many questions posted by our enthusiastic audience, both collated from the registration process, and also posted LIVE. Read below to have your questions about long COVID answered by Dr Leong!

Question and Answer – Pre-collated segment

Q1: Can a fully vaccinated person (with booster shot) still acquire long COVID?

Dr Leong: Yes, it is still possible to get long COVID. However, vaccination reduces the risk of long COVID by half. While long COVID is not quantifiable, I suspect that it would be milder compared to someone who is not vaccinated.

Q2: How does long COVID affect children below 5 years old, who cannot get the vaccination?

Dr Leong: It is a problem, and unfortunately it can happen. While vaccines can be given, it is not certain that it will be efficacious. At this point of time, there is fairly little we can do. Sorry!

Question and Answer – LIVE

Q1: Are Lian Hua pills useful?

Dr Leong: Studies conducted with the Lian Hua pills report improvement of COVID symptoms. However, there is no evidence for survival benefits, for hospitalization or ICU admittance.

Q2: If one has been infected by H1N1 in the past and recovered, would there be a degree of immunity against COVID?

Dr Leong: No.  They are unrelated vaccines. There may have been an article suggesting that those who went for a flu vaccination ended up with mild COVID. However, those who go for their flu vaccinations tend to be more careful with their health – in turn, they are more likely to lead a healthier lifestyle and hence have a milder form of COVID.

Q3: Will long COVID ever go away?

Dr Leong: Yes! It can go away eventually. I have patients who snapped out of long COVID.

Q4: Can fully vaccinated and boosted (with Pfizer) people get long COVID?

Dr Leong: Yes, but the chances of getting long COVID is lower than without vaccination.

Q5: Is brain fog pathological?

Dr Leong: We don’t know. There are reports saying that COVID-19 can affect the brain, resulting in changes to the brain matter a few months later. However, where and why, we do not have the details at the moment.

Q6: Why are there differences between individuals when hit by COVID?

Dr Leong: There are several reasons.

  1. Strains: Some strains are worse than others. For example, Delta can result in more severe illness versus Omicron.
  2. Viral load: A greater viral load can result in more severe disease.
  3. Immunity: This includes things like general health, healthy Vitamin D levels, pre-existing co-morbidities etc.
  4. Individual’s Immunity: Different individual’s immune system can respond differently to infection, which results in different outcome.

Q7: Can asymptomatic COVID patient eventually suffer long COVID too?

Dr Leong: Yes, they may suffer from long COVID too. However, it is hard to document. It may not just be COVID, as any virus can potentially give one long COVID-like symptoms.

Q8: After feeling better from COVID, my long COVID symptoms suddenly get worse again when I catch a cold. Will this happen every time I catch a cold?

Dr Leong: It sounds like the immune system may be dysfunctional – when it sees a viral infection, it responds inappropriately to it. Yes, it may be bad again. I suggest doing a full-body screening to make sure all body systems are working normally; as well as checking Vitamin D and Thyroid function to ensure everything is normal as well. When all are in the normal range, the immune system may be in the right place to respond normally again.

Q9: Will using an inhaler alleviate symptoms of shortness of breath and chest tightness in COVID?

Dr Leong: The inhaler may help as the symptoms may be due to asthma, or asthma-like conditions. It may also have a placebo effect.

Q10: Does taking pain medication affect our immunity to COVID?

Dr Leong: You don’t take painkillers with vaccines as it may suppress your immunity to the vaccines. However, when you are experiencing COVID symptoms, you can certainly take painkillers to alleviate your symptoms. For example, anti-inflammatories can help you feel better, rest better and rest more, and better fight the infection.

Q11: When should I get my booster vaccine after testing COVID positive?

Dr Leong: The longer it is, the better it would be. The recommendations are to do it in 3 months. It is very uncommon for people to fall sick again in the first 3 months. I predict that every 6 months to 24 months, we can keep getting COVID-19. If you can afford to wait 6-9 months to get the vaccine, it would be ideal. A study suggested waiting 6-9 months before your booster shot, with great results. However, in order to lead a regular life, taking the booster shot at 3 months is good enough.

Q12: What can we do to help patients who are suffering from shortness of breath?

Dr Leong: Go and see a doctor or even a respiratory physician, to check if there is any heart or lung cause to the shortness of breath symptom. Otherwise, you can build the patient’s endurance and energy slowly.

Q13: I have been COVID negative for months, but still experiencing cough, breathlessness, and recurrence of asthma. What treatment can help?

Dr Leong: Look into the cough and breathlessness symptoms – a doctor will be able to diagnose if there is airway sensitivity or asthma. You may also check for gastroesophageal reflux, as reflux can possibly cause breathlessness symptoms. You may also be de-conditioned due to the prolonged rest at home, so you will need to train up again.

Q14: After 3 doses of vaccine, do I still have enough antibodies to protect myself?

Dr Leong: No. The vaccine developed in 2021 was designed against the original strain. Since then, the virus has mutated. In terms of B-cell matching (antibody production), it is not good enough and you will get infected with COVID-19. However, if you are young, you are less likely to suffer a severe form of COVID-19. I predict that you will fall sick, but you will have mild or asymptomatic disease, and life goes on.

Q15: Can a long COVID patient still be infectious to others?

Dr Leong: No. The general rule is, after 7 days, you are at low risk of transmitting to others, and at 10 days, you are at no risk. This applies to most people unless you have very poor immunity.

Q16: Does taking the COVID-19 booster shot during active chemotherapy affect the efficacy of the vaccine?

Dr Leong: Yes. During active chemotherapy, your immune system is down. Without your ‘soldiers’ to ‘train’, the efficacy of the virus is poorer compared to if you are not on chemotherapy.

Q17: Is a doctor’s diagnosis necessary for long COVID?

Dr Leong: Even diagnosing COVID is difficult. I suggest seeing a doctor to get help. If your long COVID is mild, you can cope with it yourself. However, it would be best for a doctor to confirm the diagnosis, and also be able to guide and support you along your journey.

Q18: Are there reports of COVID increasing the likelihood of heart issues i.e. sudden cardiac arrest?

Dr Leong: I would not say “increasing likelihood”, but I would say that the risk of heart issues with COVID-19 has always been there. The risk is there and it will remain there for quite a while more.

Q19: What is Dr Leong’s take on the decrease in vaccine efficacy for children below 12 years old?

Dr Leong: When they look at “vaccine efficacy”, they are looking to see if the child gets infected or not. However, vaccinating the children is not about whether the child gets infected, but whether their T-cells are trained adequately. mRNA vaccines are very good at training T-cell immunity. With greater T-cell immunity, there is a lower risk of getting myocarditis, long COVID and even diabetes mellitus in children. With vaccination, a child will be able to do better in terms of clinical outcomes.

Q20: How long do the benefits of COVID booster last?

Dr Leong: The COVID booster does two things: 1)  Boosts B-cell immunity and increase antibody levels, and 2) Train up T-cell immunity. Your B-cell levels will fall with time and rise with infection. At the end of the day, the T-cell immunity help result in milder illness, with 10 times lower risk of requiring ICU care.

Q21: Where can I seek help for long COVID?

Dr Leong: Go to National Centre for Infectious Diseases (NCID) – they have a clinic there that can help you (Singapore).

Q22: Contracted COVID 12 Feb, scheduled for myomectomy 3rd week of March. Is it safe?

Dr Leong: Usually a 6-7 week of rest between COVID infection and surgery is suggested. You may want to talk to your doctor about scheduling the surgery to another time.


What’s next in store?

  • Click here to see Dr Leong’s presentation in Part 1 if you have missed it!
  • If you have missed our previous DOC webinars, visit our Medical Channel Asia’s YouTube page, or you can also read the articles:
    • Doctor On Call (DOC): Dr Sean Leo – Common Sports Injuries Part 1, Part 2
    • Doctor On Call (DOC): Dr Lee Fang Jann – Men’s Health Part 1, Part 2
    • Doctor On Call (DOC): Dr Felix Li – Medical Aesthetics Part 1, Part 2
    • Doctor On Call (DOC): Dr Michael MacDonald – The Silent Killer Part 1, Part 2
    • Doctor On Call (DOC): Dr Jade Kua – DARE to Save a Heart Part 1, Part 2
    • Doctor On Call (DOC): Dr Radhika Lakshmanan – Facts and Myths of Breast Cancer Part 1, Part 2
    • Doctor On Call (DOC): Dr Julian Tan – Ischemic Heart Disease Part 1, Part 2

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