Chronic complications associated with COVID infection
Dr Vipul Gupta
The widespread perception is that if one gets COVID infection the possible outcomes include recovery in two to three weeks or hospital admission or death in severe cases. Contrary to this, for some people COVID 19 infections are not a discrete episode lasting a few weeks, but marks the start of a long-term illness with ongoing and often debilitating symptoms which is addressed as Long COVID.
This diagnosis challenges the clinical and governmental assumptions about COVID and brings more uncertainty into picture. Persisting pain and fatigue is one of the symptoms seen in Long COVID.
Studies have shown that the long symptoms may be because of many reasons. First, many patients were placed on ventilators they develop muscle weakness which needs extensive physiotherapy later on.
Some of the patients may also suffer from heart attack or stroke or kidney damage during the Covid infection because of which they may not become normal later on. But even beyond this serious in SS people doctors have found that some patients have persistent weakness or tiredness, shortness of breath, aches and pains, difficulty in concentrating, headaches, trouble sleeping, psychological disturbances including worry or anxiety, and loss of taste or smell. Persistence of these problems are termed as “long COVID”
Doctors have found that may be around 40% of the patients have persistent symptom (atleast one) post recovery from the acute infectious phase which may be complicating after two months of recovery. Even though the estimates range upto 14% of such patients having prolonged symptoms may actually be an underestimate.
There is uncertainty regarding the underlying mechanisms responsible for Long COVID. Some of the possible causes include a reduced or lack of immune response, relapse or reinfection of the virus, inflammatory and long-lasting changes to the immune system, post-traumatic stress and injury to multiple organs.
Similar was the case with a young doctor who was undergoing training in surgical field. However, Dr Nagendra (name changed) acquired COVID 19, but didn’t need any admission during his infectious period. Upon recovery he was left with some prolonged symptoms and by the time he got back to his work he had lost over 10 Kg weight within a span of 2 months. Other symptoms included breathlessness, fatigue, difficulty in concentrating, and with a feeling of being in a tough branch he then decided to change his field to a less demanding branch of medicine. He had what the doctors are now calling us “long covid”.
Even in countries like UK, with much smaller populations as compared to India, existing cases of long COVID problems account for over 10 lakh people. In a densely populated country like India, the number of people suffering from this condition will definitely be huge. It has been also observed that these patients are unable to make a come back to normal life with difficulties to continue their jobs ultimately losing it. Taking care of themselves and the family members with day-to-day activities also posts a major challenge for them. This not only causes financial and physical stress on the body but also takes a huge toll on mental health.
Interestingly, while men are highly vulnerable to get severe COVID infection, but women are probably more prone to get long COVID with equal susceptibility among the younger population.
There is a dire need to raise awareness among the masses especially among COVID patients about this problem. People with persistent symptoms should not ignore the problems and should consult their physicians to rule out any possibility of long COVID. If identified early, the condition can be helped by lifestyle changes such as increased fluid or salt intake, yoga and swimming. Patients feeling chronically fatigued are also advised to not to push themselves too much.
World over, dedicated long Covid clinics are being opened so that focus treatment can be done for such patients. Our health agencies, government as well as private sector is also going to face this huge burden of patients and should plan accordingly. Many trials have started world over to do research regarding the reason behind the symptoms as a list to find new treatments. Psychological support and rehabilitation will also help these patients to help them with their symptoms.
(The author is Director- Neurointervention, Artemis-Agrim Institute of Neurosciences, Artemis Hospital)
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