Long COVID-19 Pandemic: pain after the bite



Article By: Dr (Lt Gen) CS Narayanan

One cause of concern is long covid which afflicts a substantial proportion of the population which survives the acute infection.



The Covid-19 pandemic has touched the lives of so many people across the globe like no other event in the recent history of mankind. The spark that started at Wuhan, Hubei Province, China in late 2019 has become a raging fire that has brought vast nations, rich and poor, to their knees.

One defining feature of this scourge has been the lag to reach the peak in various countries. This led to a certain complacency in the initial response of these nations, who were lulled into believing that the problem was too distant to impact them. When healthcare systems in Italy and Spain collapsed in March 2020, the leadership in the United States of America was downplaying the likelihood of the pandemic reaching American shores. That, of course, was not to be. The US soon overtook all other countries in the world in the number of people who caught the infection and those who succumbed to severe Covid-19.

Another feature of the pandemic has been the tendency to ebb and flow in periodic waves. Just when Indians were wondering if they were somehow immune to the virus, having tided over the first wave relatively unscathed, a second wave engulfed them like a tsunami in Feb 2021. This tendency to let the guard down has been a recurring theme during this never-ending pandemic.

Governments in most Western countries are now confident enough of their healthcare measures and successful vaccination strategies to lift mandates to wear masks and to permit close social interaction. Economists are busy forecasting a ‘Post-pandemic boom’ with previously unheard-of rates of economic growth in these rich nations.

The celebration may be a trifle premature because the pandemic and its sequelae have not played out fully.

One cause of concern is long Covid which afflicts a substantial proportion of the population which survives the acute infection. Breathlessness, fatigue and inability to concentrate (‘brain fog’), which are the hallmark of this condition impairs the functioning of more than half of those affected by long Covid. Long Covid or Post-Covid syndrome (PCS), as it is formally called, is defined as symptoms affecting any part of the body for more than three months after a bout of Covid. Small physical tasks may leave a person breathless and exhausted. PCS is serious enough to limit even sedentary work and daily chores in about a fifth of those affected. The loss of smell sensation (anosmia) which is a typical feature of Covid-19 infection may transform into a condition called parosmia in survivors. People with parosmia report that everything smells unpleasant, rotten or disgusting. A piece of fruit may smell like chemicals, or even worse, like rotten flesh. Symptoms are more pronounced in the elderly and those with pre-existing medical disorders like asthma, hypertension and heart disease. It has been suggested that women are less likely to develop severe acute COVID but more likely to develop long COVID than men. This may be attributed to hormonal differences, chromosomal genetics, sex-dependent differences in immune system behaviour, and non-biological factors.

There have been around 160 million cases of confirmed Covid-19 across the globe. A preliminary survey by the UK Office of National Statistics estimated that long Covid affects 14% of persons who recover from the acute infection. While these figures are staggering, they are likely to be just the tip of the iceberg due to lack of access testing for the vast majority of the population. It is also likely to burgeon further in future with the recovery of acute cases in developing nations like India, where the pandemic is still raging with full fury.

Experts are just beginning to fathom the magnitude of impact of long Covid on the health and economy of nations.

While the condition is well-recognized, the exact reason for the syndrome is yet to be understood. Plausible causes are the persistence of the viral infection, a chronic auto-immune process, or residual damage to various organ systems in the body. Studies published in reputed scientific literature have shown that some people have traces of SARS-CoV2 proteins in their bodies for several months after they have recovered from acute Covid-19 infection. This persistent viral load after recovery from acute illness is akin to some well-known disorders like chronic viral hepatitis. Auto-immunity refers to collateral damage to organs by defence mechanisms mounted by the body to eliminate the virus. The intense inflammatory reaction which occurs during infection with SARS-CoV-2 virus can leave scarred tissue in many parts of the body in its wake. This can cause havoc long after elimination of the virus from the body. Fibrosis of the lung altered neuronal connections, and damage to blood vessels caused by this process may explain many of the symptoms of long Covid. It is quite likely that a combination of all these mechanisms may contribute to the symptomatology of an individual with long Covid.

Many of the symptoms of long Covid like fatigue and brain fog may be vague, but nevertheless debilitating. This is similar to another baffling condition called Chronic Fatigue Syndrome (CFS). Sufferers are likely to burden healthcare systems by moving from one speciality clinic to another in the quest of a cure.

In the absence of well-established guidelines on the management and rehabilitation of persons with long Covid, some young individuals in the peak of their career may be forced to drop out of the workforce altogether.

Adding to the magnitude of the problem is that many persons having these symptoms may never have been tested for SARS-CoV-2 infection or its antibodies belying a formal definition of their symptoms. It is also established that long Covid occurs not only in those with severe infection necessitating hospitalization, but also as a sequel to mild infections. Malingering and false claims for disability would compound the problem.

Currently managing patients with long Covid focusses on physical rehabilitation, breathing exercises, meditation and yoga. Support groups, counselling and flexibility in the work environment will give succour to many persons suffering from this condition.

Unravelling the precise mechanisms of the Post-Covid Syndrome by ongoing research will hopefully yield results in the form of targeted antiviral and immune-modulatory medications. The virus caught us unprepared and continues to take an enormous toll during the several waves of acute infection. We need to learn our lessons and be well prepared to tackle the insidious, but equally devastating consequences of long Covid.



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