The Spectre of Long Covid

recovering from the acute infection does not mean that the patient is completely rid of Covid impact. As Long Covid, it leaves its signature in subtle ways

A person who has recovered from Covid-19 takes part in a rehabilitation programme. Pic: Getty

By Dr R Neerunjun Gopee

It was almost a given that sooner or later the Delta variant of Covid-19 would reach our shores too, as it indeed has. It will require a deeper analysis to establish with a degree of certainty how far this is related to the opening of our borders just over a month ago, and whether the sharp increase in the number of cases is linked thereto as well.

In the meantime, we have been facing a real wave or surge of cases. The tales of woe that are reported by patients and relatives, along with the tragic deaths that are taking place daily – all the more disturbing because of the young age of the victims – point to a health system that has been overwhelmed, a phenomenon which affected many countries as the pandemic unfurled as a tsunami at its very beginning.

Definitely we could have been better prepared. Is it that somewhere along the way we developed complacency or faced ennui and exhaustion? After all, it is humans who are manning this crisis, and long hours of overwork with the physical and mental stresses caused may be part of the explanation. But in no way does this justify a less than optimum preparedness in terms of the expected workload and the necessary resources ranging from hospital accommodation to treatment requirements that needed to have been planned for well ahead.

While we are now struggling to cope with the large number of cases that are being detected on a daily basis, there is at the same time an insidious invasion of the body systems other than the respiratory system, notably the lungs, that is taking place in Covid-infected patients. In fact, within months of the pandemic spreading, it was already seen to be affecting practically all organs, and also began to involve all ages – contrary to what a more ‘conventional’ virus does, that is target a specific organ or tissue in a more defined age group.

Another feature was the presence of some lingering symptoms, or reappearance of symptoms, in patients who had recovered from the initial acute infection. During one of his interventions on TV around that time, Prof Randeep Guleria of the All India Institute of Medical Sciences, New Delhi, had advised patients to go for check-ups of the lungs 3-4 months post-recovery even if they didn’t have symptoms, including doing an MRI scan that would show the residual damage in the organ and help clinicians to give advice accordingly.

The realization that Covid-19 is more than just about the lungs was confirmed in a paper published in the ‘Journal of Proteome Research’ in August 2020, which referred to abnormal findings in several chemicals in the body that were ‘consistent with recent reports that Covid-19 is a systemic disease affecting multiple organs and systems.’

Gradually scientists and clinicians have come up with the concept of Long Covid, which refers to the poor health condition that can persist in patients who have recovered from the early acute episodes of Covid-19. The symptoms are many and varied and all age groups including children are vulnerable.

In October 2021, WHO has come up with a definition of Long Covid as a ‘Post-Covid-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of Covid-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.’

‘Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others, which generally have an impact on everyday functioning. Symptoms may be new onset, following initial recovery from an acute Covid-19 episode, or persist from the initial illness. Symptoms may also fluctuate or relapse over time.’

Anxiety, depression, pain, and changes in hearing, smell, and taste were among the other symptoms that the definition included.

According to the WHO, ‘With a standardized definition, we hope to advance recognition of the condition. It will also help clinicians to identify patients more easily and provide them [with] the appropriate care. With this standardized definition, we will also be able to measure the burden of this illness better, giving us a better understanding of its prevalence globally. Finally, we hope it will aid and promote research on the topic. [Having] a single definition will allow us to synergize global research and advance a globally relevant understanding of the condition.’

Importantly, the WHO also noted that it expects this definition to evolve as more researchers accumulate more data on the condition. Moreover, the panel highlighted that a separate definition might be necessary to describe the condition in children.

This points to a need to better understand the long-term impacts of Covid-19 on the health of those who have been affected, and seek ways to predict the progression of the disease in both individuals and communities, as well as devise appropriate preventive measures and treatments.

Therefore, as much as we are rightly focusing on handling the acute cases that are currently our major concern, as soon as possible we must also start to give attention to the long-term impacts on individual patients and the national disease burden that this will entail too. Before it is too late and in order not to be caught unawares again, we must begin to get ready for diagnosing Long Covid locally. We must therefore look out for opportunities to collaborate with teams that are already addressing the issue by means of novel ways, using sophisticated platforms that may not be available here, such as those described in the paper alluded to, and that can carry out measurements of specific chemicals known as biomarkers in body fluids such as blood and urine. Besides detecting the active disease process, these tests may ‘provide early predictors of individual severity that could be of value in the management of hospitalized patients and the assessment of long-term recovery.’

From a broader Public Health perspective, this methodology could also provide inputs that will help predict risk factors for disease in the community, which in turn will help in the development of programmes for prevention. The overall benefit will be improvement in survival rates, especially in high-risk groups, reduction in mortality and improvement in the quality of life of people who have suffered from Covid infection.

In conclusion, it could be said that it is not over when it is over: that is, recovering from the acute infection does not mean that the patient is completely rid of Covid impact. As Long Covid, it leaves its signature in subtle ways in several organs, and can be tracked by innovative tests that can predict the further evolution of the disease in both the individual and at community level, at the same acting as tools to work out prevention and treatment programmes. All of these can help to mitigate the national disease and health burden.

* Published in print edition on 9 November 2021