The COVID Cough

Written by: Luana Yoshikawa-Scanlan, MBA PRIME
Fetu was very scared of the COVID-19 virus. He heard that people who smoke, are overweight, have diabetes and heart disease suffered greatly from the illness. He knew he was not the healthiest person, even if he rarely went to the doctor when sick.  So, Fetu followed all the recommendations made by the Department of Health: washed his hands all the time, sanitized his hands when there was no water, wore a mask, and avoided gatherings.  When COVID started to spread in his village Fetu became very anxious.  He kept his wife and children at home.  They only left to work and to shop.  The day he tested positive for COVID, Fetu felt helpless and fearful.  Although the doctors gave him medicine and assured him that he would be okay, Fetu was scared. 
Fetu and his family were lucky. They all recovered from COVID within two weeks without having to be hospitalized.  But the effects of the virus lingered and impacted Fetu’s ability to work in the plantation like he used to.  He tired quickly, sometimes felt his focus drift off and his mind felt cloudy.  His wife often couldn’t smell or taste things.  His children were more resilient, but even they experienced fatigue and felt out of breath after normal physical activities.  The worst impact was a persistent cough that would start unexpectedly.
Researchers are now finding that coughing, fatigue, difficulty focusing, can last for months after testing negative.  These long-term effects are called post-COVID syndrome or long COVID.
An estimated one-third of COVID-19 survivors report experiencing a post-infection cough.  It is one of the most common symptoms caused by the viral congestion in the lungs and airways. Chest pressure or heaviness in the chest may also be experienced.  COVID infects the cells that line the mucous membranes in the lungs. These membranes produce phlegm that traps irritants in the airways, resulting in a scratchy feeling in the throat leading to a ‘wet’ cough. However, 50%-70% of COVID survivors report having a dry cough (American Lung Assoc, 7/14/21). 
In severe COVID-19 cases, the infected person may develop pneumonia which causes swelling and fluid build-up in the lungs. While most people recover from pneumonia without any lasting damage, pneumonia resulting from COVID-19 can be critical. Even after the disease has passed, lung injury may result in breathing difficulties experienced for months later, as Fetu did.  The chronic coughing and chest congestion put him at a higher risk for developing pneumonia in the future.
Researchers have identified three main factors that affect lung damage risk in COVID-19 infections (Woo-Jung, et al., 2021):
Disease severity — whether the person has a mild or a severe case of COVID.
Pre-existing health conditions – older people, those with weak immune systems, diabetics, people who are obese, people with heart disease and/or lung disease.
Treatment – the kind of care and timeliness of that care can minimize the impact of COVID in the future.  In 2021, the CDC recommended antiviral treatment to prevent severe illness, especially for those over 50 and those with pre-existing conditions.  Monoclonal antibodies were also approved to help the body identify the virus and respond quickly with antibodies. Treatment should start within days of the first symptoms to be effective.
According to the American Lung Association, recovering from lung damage takes time - scarring in the lungs may take three to twelve months to heal. While life has returned to normal, Fetu still feels a heaviness in his chest and deals with a chronic dry cough.  He drinks a lot of water nowadays, and watches what he eats.  COVID made him more aware of the value of his health – a positive side effect of his struggle to fully heal from the virus.
Woo-Jung Song, Christopher K M Hui, James H Hull, Surinder S Birring, Lorcan McGarvey, Stuart B Mazzone, Kian Fan Chung (2021). Confronting COVID-19-associated cough and the post-COVID syndrome: role of viral neurotropism, neuroinflammation, and neuroimmune responses. Lancet Respir Med., 9: 533–44.
Photo: Pacific Community Response. Dr. Paulo Vivili, SPC Public Health Director on COVID-19 retrieved:  ​https://www.spc.int/updates/blog/2022/09/covid-19-pacific-community-updates#Response