Long Covid How it continues to affect

Vishal Sharma

Sukhjeet Kaur (32), who was feeling extremely fatigued, requested leave from office. Her employer was reluctant to accede as she had utilised all her leave a few months earlier when she was admitted to the hospital for Covid-19 infection. The employer wondered if she had lost interest in her job as otherwise, Sukhjeet appeared to be well but had slowed down considerably.

What is long Covid

Covid-19 was primarily thought to be a cause of pneumonia, which could result in death due to respiratory failure. In the early days of the pandemic, Covid-19 was recognised as an illness that could impact virtually any organ system of the human body. However, it took some time for the medical community to accept the persisting and delaying symptoms that could occur months after the initial infection. The credit for recognising this variably named entity — Long Covid, Post-Covid, or Long-haul Covid — actually goes to the patient community. Those who suffered from debilitating manifestations after Covid-19 made the medical community take note of this increasing problem. What initially began as a Twitter trend and a topic for discussion on patient forums is now widely recognised as a distinctive clinical conundrum, with agencies such as the WHO and Centers for Disease Control and Prevention, US, providing case definitions. Long Covid is an umbrella term used to describe any (new or ongoing) symptom(s) that persists long after the Covid-19 infection, typically beyond three months.

Since this is a relatively new entity, there is a lack of knowledge about why these post-Covid symptoms occur. The persistence of the virus, autoimmune reactions to the infection, reactivation of other pathogens, inflammation-mediated changes, and alterations in gut microbiota have all been blamed as the cause. Due to this lack of clarity and in the absence of a specific diagnostic test, symptoms are often attributed to stress or psychological issues after Covid.

There is no single defining feature, but the common thread is the presence of Covid-19 infection in the past. While post-Covid symptoms may be more likely in those who developed severe Covid, nobody is immune. Individuals with mild Covid-19 infection, too, can develop these symptoms. Post-Covid medical issues may also be more common in those who have additional underlying diseases such as diabetes mellitus.

How many are impacted

Long Covid contributes to significant psychological morbidity, economic losses, and disability. Millions across the globe are affected — probably 10 per cent of all of those who got infected with Covid-19.

The symptoms

Patients with Long Covid-19 could have an extremely variable clinical presentation. Around 200 symptoms have been reported. Fatigue is a very common symptom, and can be extremely incapacitating. These individuals report an inability to exercise or even perform routine activities. Others describe a kind of cognitive dysfunction, commonly described as brain fog. The term is used to denote the slowing of mental functions, confusion, sluggish thinking or responses, inability to concentrate on routine tasks and loss of memory and words. Certain symptoms pertaining to the lungs, such as persistent shortness of breath and cough, have also been described as a part of Long Covid. Many patients report symptoms such as palpitations (pounding of the heart) and uneasiness. In fact, there have been reports of an increased risk of sudden death after Covid. Lack of sleep, chest pain, ongoing fever, abnormal sensations such as pins and pricks in fingers and toes, menstrual abnormalities, and joint pains have all been reported.

Gastrointestinal issues

We have come across patients who developed severe gastrointestinal symptoms such as extremely bad reflux disease. In some cases, it was so severe that it affected the ability to sleep while lying flat. Patients had to endure many sleepless nights or sleep in a reclining position, making changes in lifestyle and even avoiding dinner. Others have complained of severe diarrhoea seriously affecting daily functioning and requiring prolonged treatment. Some patients had a prolonged loss of smell and taste, even experiencing abnormal unpleasant taste or smell. The other reported symptoms are an extreme lack of appetite, feeling nauseous, abdominal pain and constipation.

Managing long Covid

With such unpredictable clinical presentations, it is natural that the diagnosis is difficult and takes time. Nobody really knows how long the symptoms could last, but these could continue for many months and even beyond a year. Most of the routine lab tests turn out to be normal, and the lack of explanation for these symptoms becomes distressing for patients. Many, therefore, end up with anxiety and depression.

Because so little is known about the underlying mechanisms, the therapy is primarily supportive. Doctors usually try to rule out other putative causes. There is no sure-shot cure for post-Covid issues and the best measure is to avoid catching the Covid infection. Some medicines could alleviate symptoms to an extent, but the biggest healer is time. A holistic care that addresses the symptoms (using drugs), physical well-being (rehabilitative therapy), and mental health (addressing psychiatric issues) may be required in managing Long Covid.

— The writer is Associate Professor, Department of Gastroenterology, PGIMER, Chandigarh