It's been a long, excruciating wait for millions living with long Covid

New Delhi, Sep 17 (IANS) Long Covid -- a condition first recognised in early 2020 at the peak of the deadly pandemic -- has left millions of sufferers looking for answers more than three years later as there has been no significant progress in understanding its causes, prevention or treatment.

While the world is determined to move on from the acute phase, over 65 million people are estimated to struggle with long Covid -- a debilitating post-infection multisystem condition with common symptoms of fatigue, shortness of breath, and cognitive dysfunction, impairing their ability to perform daily activities for several months or years.

According to a recent Lancet report, the consequence is widespread global harm to people's health, wellbeing and livelihoods as an estimated one in 10 people who develop long Covid stop working, resulting in extensive economic losses.

A study by the Indian Council of Medical Research (ICMR) published recently found that 17.1 per cent of the participants experienced post-Covid conditions such as lethargy and breathlessness, and cognitive abnormalities like brain fog and difficulty in concentrating.

The study also said that people were nearly three times more likely to die if they experienced these post-Covid-19 conditions.

The ICMR study defined “post Covid-19 conditions” as persistent or new onset of fatigue, breathlessness, or cognitive abnormalities.

According to Dr Tribhuvan Gulati, lead consultant, diabetes, obesity and internal medicine at the CK Birla Hospital, Delhi, while the Covid infection typically resolves within a matter of days to a week, a subset of patients encounters a prolonged period of symptoms, which can persist for weeks, months, or even years.

“It's important to note that long Covid can manifest in individuals who have experienced various forms of infection, ranging from mild to moderate, severe, or even variants like Omicron or the Delta wave,” Dr Gulati told IANS.  

The main symptoms of long Covid encompass a range of manifestations. Among the general symptoms, fatigue stands out as a prominent feature. Additionally, individuals with long Covid may experience abnormal body movements, fever accompanied by chills, insomnia, increased daytime sleepiness, restless leg syndrome, and generalized weakness.

In some cases, redness of the eyes has been observed. In the case of brain, brain fog, headaches, dizziness, mood swings, and disorders related to anxiety and depression were reported and some individuals may also have tingling sensations throughout their body and cognitive impairments such as dementia.

Researchers have now found that blood clots after a Covid infection may be due to ongoing cognitive problems, commonly referred to as 'brain fog'.

Researchers from the University of Oxford, UK said that high levels of two proteins at the time of Covid-19 have been found in patients who later experienced cognitive problems, including ‘brain fog'.

The study gave a major clue as to one cause of their symptoms: blood clots.

Dr. Preeti M Pillai, senior consultant, infectious diseases, Sir HN Reliance Foundation Hospital in Mumbai, told IANS that as of now, there is no recommended treatment or proven cure for Long Covid.

“Treatment strategies involve symptom alleviating measures. Since the basis of this ailment is immune dysregulation, vaccination may be a useful intervention. Lot of experimental treatments are being studied which include injectable immunoglobulins, monoclonal antibodies to autoantibody receptors, antiviral paxlovid, low dose naltrexone, antihistamines, coenzyme Q supplementation etc,” she informed.

Apheresis, anticoagulation therapy are targeted therapy for clots while beta blockers for postural hypotension may be given.

“Also, conditions that aggravate symptoms should be avoided, like in patients who report post exertional worsening muscle pain and fatigue exercise is contraindicated and should be discouraged,” Dr Pillai advised.

Long Covid can affect anyone who was infected irrespective of the severity of the illness.

There are some risk factors which make individuals more prone -- female sex, patients with underlying connective tissue diseases, patients with psychiatric illness, individuals with recurrent Covid infections and unvaccinated individuals.

“Also, people with hypersensitivity or allergic tendencies also have higher risk. Some affections like respiratory ailments are more pronounced in patients with severe disease and prolonged ICU stay,” Dr Pillai told IANS.

Among other symptoms, patients have reported sensations of ringing or tinnitus in ears. Loss of smell, taste, and appetite may persist over an extended period in certain cases. Respiratory symptoms may persist as well, including a persistent cough and breathlessness. Generalized symptoms encompass muscle aches, joint pains, chest discomfort, and irregular heart rates.

“The most effective strategy to prevent long Covid is to prevent and avoid Covid-19 altogether, as it is essentially an extension of the symptoms from the initial infection. This can be achieved through vaccination, practicing good hygiene, wearing masks, and maintaining physical distancing,” said Dr Gulati.

Dr Manoj Goel, director, pulmonology at Fortis Memorial Research Institute, claimed that most of the long Covid patients have recovered.

“Very few of them are complaining of minor complaints like easy fatigability, lack of sleep, lethargy, weakness and poor concentration. Yoga, meditation, breathing exercises like prayanam, plenty of fluids and a diet high in protein can help recover these patients,” he added.

The Lancet report, however, lamented that while the acute months of the pandemic motivated an unprecedented response from governments, international organisations, pharmaceutical companies, and civil society, “long Covid has not received anywhere near the same level of attention or resources”.

“The result has been widespread harm to health, societies, and economies. Three years in, more is needed to recognise, treat, and support patients with long Covid,” it noted.