When Recovery Does Not Fully Return:Long Covid, Depression, and the Hidden Community Care Gap

By Justin Gregory Maguire

BSc (Hons) Nutritional Science.

PG Dip Functional Blood Chemistry Analysis.

BTech Kinesiology and Applied Anatomy

Can long Covid cause depression?

Covid-19 is generally perceived as an infection that lasts for a period of a few days up to a few weeks. Yet for many people, recovery is not so simple. Long Covid has become an important health issue as symptoms can continue for many months after the initial infection. These symptoms may include exhaustion, breathlessness, brain fog, poor concentration, sleep disruption, and changes in mood. For some people, this ongoing state can begin to feel similar to depression, even though the original trigger is a viral illness rather than a primary mental health condition.

This matters because depression is one of the most significant health challenges worldwide. However, it is not a single, uniform illness. Depression can present differently from person to person, and it is often shaped by physical illness, social stress, economic hardship, and life circumstances (Herrman et al., 2022). This complexity makes it harder to define, diagnose, and treat consistently. The same problem now appears to be affecting long Covid care.

Getting the right care

A major concern raised in mental health research is the ‘treatment gap’. This refers to the large number of people who meet the criteria for depression yet never receive meaningful care. Across multiple countries, fewer than half of adults with depression have access to formal health services, and only around 10% receive care that can be considered truly effective (Thornicroft et al., 2017; Herrman et al., 2022). This is not only attributed to limited health services; it is also because symptoms are often misunderstood, dismissed, or poorly linked to the type of treatment that is required.

Long Covid seems to expose these same weaknesses in health systems. In South Africa, studies have shown that many people continue to experience symptoms for several months after infection. One large national cohort found that 66.7% of previously hospitalised adults still had persistent symptoms three months after discharge, with anxiety or depressive symptoms reported in roughly one-fifth of participants (Dryden et al., 2022). Another national cohort found that persistent symptoms remained present six months later in both hospitalised and non-hospitalised individuals, proving that long-term illness is not only limited to the severe acute cases (Jassat et al., 2023). In everyday language, this means that many people may ‘survive’ Covid yet not fully return to their previous level of physical, cognitive, or emotional functioning. A person may struggle to think clearly, feel constantly tired, or lose the sense of energy and motivation needed to work, socialise, or care for family. These inconveniences may seem minor but can adversely affect income, identity, independence, and mental well-being.

The importance of an accurate diagnosis

Comprehensive South African studies have shown that neuropsychiatric symptoms are common in long Covid. These symptoms can include depression, apathy, agitation, hallucinations or delusions, and insomnia – commonly found in patients with brain disease, injuries or dementia. In a Cape Town cohort, over half of participants experienced ongoing neuropsychiatric symptoms, while 44% were identified with objective cognitive impairment – which is a measurable diagnosis by a medical specialist (van Niekerk et al., 2025). Importantly, the biological markers measured early in illness did not consistently predict which patients would suffer long Covid. This creates a problem for frontline care: if there is no single test that clearly ‘proves’ long Covid, patients may be left in a grey zone where their suffering is real but difficult to precisely classify.

This diagnostic uncertainty is especially important in South Africa, where health systems are already under pressure. Long Covid symptoms can overlap with HIV, tuberculosis, anxiety, depression, and other chronic conditions (Pather, 2025). In busy clinics, where time and specialist support are limited, patients can easily fall through the cracks. Their symptoms may be treated as vague, non-specific, or secondary, rather than as part of a real and disabling post-viral condition.

Enhanced community awareness is required

Social realities make the problem worse. If someone is dealing with food insecurity, employment loss, transport costs, or limited access to healthcare, it becomes more difficult to get the correct care (Wickenden et al., 2023). In this context, long Covid is not only a medical issue. It also becomes a community issue, because optimum treatment for illness is mostly non-existent where there is poverty, disability, and fragmented public services.

Current South African policy recognises long Covid as a genuine condition and recommends symptom-led management within existing health services (Ministerial Advisory Committee on Covid-19, 2022). This is an important start, but recognition alone is not enough. Without clearer care pathways, better clinician awareness, and stronger links between medical, rehabilitation, and mental health support, many patients may continue to feel unseen.

Learnings from recent history

The encouraging part is that South Africa has dealt with complex chronic health challenges before. HIV care shows that outcomes can improve when support is decentralised into primary care, linked with community systems, and supported by trained non-specialist workers (Coetzee et al., 2004; Peltzer et al., 2012). Research on mental health has shown that practical psychosocial approaches such as psychoeducation, behavioural activation, and brief problem-solving support can be effective, especially in resource-constrained settings (World Health Organization, 2016; Chibanda et al., 2016).

The broader lesson is simple: people with long Covid-related, depression-like symptoms do not only need a label; they need joined-up care. That means care which sees fatigue, mood, cognition, and function as connected rather than separate. It also means building systems that do not require certainty before offering support.

The need for recognition of long Covid symptoms

Long Covid reminds us that recovery is not always visible, and that untreated distress is not necessarily caused by a lack of medicine. Sometimes it is caused by the gap between what people are living through and what health systems are prepared to recognise. Narrowing that gap may be one of the most important community tasks ahead to combat mental health and the link to long Covid.

References

Chibanda, D., Weiss, H.A., Verhey, R., Simms, V., Munjoma, R., Rusakaniko, S., Chingono, A., Munetsi, E., Bere, T., Manda, E. and Abas, M. (2016) Effect of a primary care–based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. Jama, 316(24), pp.2618-2626. Available at: doi:10.1001/jama.2016.19102  

Coetzee, D., Boulle, A., Hildebrand, K., Asselman, V., Van Cutsem, G. and Goemaere, E. (2004) Promoting adherence to antiretroviral therapy: the experience from a primary care setting in Khayelitsha, South Africa. AIDS, 18, pp S27–S31. Available at: https://journals.lww.com/aidsonline/abstract/2004/06003/promoting_adherence_to_antiretroviral_therapy__the.6.aspx

Dryden, M., Mudara, C., Vika, C., Blumberg, L., Mayet, N., Cohen, C., Tempia, S., Parker, A., Nel, J., Perumal, R., Groome, M.J., Conradie, F., Ndjeka, N., Sigfrid, L., Merson, L. and Jassat, W. (2022) Post-Covid-19 condition 3 months after hospitalisation with SARS-CoV-2 in South Africa: a prospective cohort study. The Lancet Global Health, 10(9), pp.e1247–e1256. Available at: https://doi.org/10.1016/S2214-109X%2822%2900286-8

Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T.A., Kessler, R.C., Kohrt, B.A., Maj, M. and McGorry, P. (2022) Time for united action on depression: a Lancet–World Psychiatric Association Commission. The Lancet, 399(10328), pp.957–1022. Available at: https://doi.org/10.1016/S0140-6736%2821%2902141-3

Jassat, W., Mudara, C., Vika, C., Welch, R., Arendse, T., Dryden, M., Blumberg, L., Mayet, N., Tempia, S., Parker, A. and Nel, J. (2023) A cohort study of post-Covid-19 condition across the Beta, Delta, and Omicron waves in South Africa: 6-month follow-up of hospitalized and nonhospitalized participants. International Journal of Infectious Diseases, 128, pp.102–111. Available at: https://doi.org/10.1016/j.ijid.2022.12.036

Ministerial Advisory Committee on Covid-19 (2022) Diagnosis, treatment and management of long Covid. Pretoria: National Department of Health, South Africa. Available at: https://www.health.gov.za/wp-content/uploads/2024/09/MAC-Advisory-Memo_Diagnosis-Treatment-and-Management-of-Long-COVID-27-May-2022.pdf

Pather, K. (2025) Addressing Long COVID Challenges in South Africa’s District Health Clinics: A Scoping Review of Diagnostic Barriers and Care Integration. International Journal of Infectious Diseases, 152, 107483. Available at: https://doi.org/10.1016/j.ijid.2024.107483

Peltzer, K., Ramlagan, S., Jones, D., Weiss, S.M., Fomundam, H. and Chanetsa, L. (2012) Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: results from a randomized trial. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 9(4), pp. 218–226. Available at: https://doi.org/10.1080/17290376.2012.745640

Thornicroft, G., Chatterji, S., Evans-Lacko, S., Gruber, M., Sampson, N., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L., Borges, G. and Bruffaerts, R. (2017) Undertreatment of people with major depressive disorder in 21 countries. The British Journal of Psychiatry, 210(2), pp.119–124. Available at: https://doi.org/10.1192/bjp.bp.116.188078

van Niekerk, I., Panieri, M., Müller, T., Mapahla, L., Dzanibe, S., Day, C., Stein, D.J. and Peter, J. (2025) Acute serum protein biomarker profile and prevalence of persistent (>6 months) neuropsychiatric symptoms in a cohort of SARS-CoV-2 PCR-positive patients in Cape Town, South Africa. Brain, Behavior, & Immunity – Health, 46, p.100990. Available at: https://doi.org/10.1016/j.bbih.2025.100990

Wickenden, M., Hart, T.G.B., Thompson, S.J., Davids, Y.D. and Ngungu, M. (2023) How did South Africans with disabilities experience COVID-19? Results of an online survey. African Journal of Disability, 12, p.1119. Available at: https://doi.org/10.4102/ajod.v12i0.1119

World Health Organization (2016) mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP) World Health Organization. Available at: https://www.who.int/publications/i/item/9789241549790