“I’m tired all the time.”
“I can’t remember names.”
“I can’t concentrate.”
“I can’t sleep or I sleep all the time.”
Common concerns these days. Approximately 59 crore people across the world got Covid some time or the other since the turn of the decade; some died, but most survived. But the questions have multiplied into new worries. Each time someone has a persistent body ache, fatigue, or cough and cold, chances are the person has long Covid.
Also known as a post-Covid-19 syndrome, long Covid emerged as a colloquial term in May 2020 when a certain American woman named Elisa Perego created the hashtag on Twitter. Almost 15 months later, the WHO issued its clinical definition.
It says, “Post-Covid-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis.”
Over time more than 50 symptoms have come to be associated with long Covid. Among the most common are fatigue, prolonged cold and cough, headaches, brain fog and hair fall. While the symptoms in isolation aren’t life-altering, it is their inexplicable nature and the inability of the patient to associate it with an underlying ailment that baffles the mind, and in turn the body -- and doctors too.
Rebecca Toms, a 32-year-old management consultant in Bengaluru, recovered from the virus in April. She is alarmed that her body and mind haven’t felt like her own ever since. Four months after her recovery, she struggles to speak for long periods of time without panting. There is more. “I’ve never forgotten birthdays, but now I do. My concentration levels have dipped, and it is harder to recollect information. Bruises take longer to heal,” she rues.
The story is not very different for Nidhi Taparia, who lives in Mumbai. The 40-year-old marketing professional caught the virus twice -- first in April 2021, and then in January 2022. While her symptoms, in both instances, were mild, she continues to lose hair; so much so that she has resorted in desperation to a remedy posted on Instagram -- watercress laddoos. She says they have helped.
“The virus though has aged me more in the last one year. My body no longer has the same energy. Earlier, I could work for 14 hours at a stretch, but now it’s just not possible. My headaches, cough and cold have become frequent, which means my immunity has been compromised,” Taparia regrets, adding, “I get brain fog. Sometimes, I look at someone and can’t recall their name.”
Hair loss is a major symptom of long Covid. Writer Devapriya Roy tried ‘magneto therapy’ as recommended by a friend; it involves using electromagnetic radiation to battle the problem. The jury is still out on its effect. Many sufferers of the condition are gradually coming to terms with the prospect of living with the symptoms for the rest of their lives.
Doctors, however, warn that such an attitude has a potential downside. The common nature of most symptoms makes it difficult to identify their causes without proper medical exploration. Many people are likely to dismiss their symptoms as a consequence of long Covid, while an underlying health condition could be the reason. Then how can one reach the right conclusion?
Dr Ajay Gupta, Head of Department, Internal Medicine at Max Hospitals, Vaishali, explains that the diagnosis of long Covid is determined by ‘diagnosis of exclusion’. He elaborates, “Anything except pregnancy could be caused by Covid -- hair loss, eye problem, headache, continuous nasal discharge, mouth ulcers, chest pain, breathlessness, lethargy, pain in abdomen, diarrhoea, body ache, brittle nails. These are all symptoms of long Covid, and could extend from six weeks to even six months. But if you get chest pains, it is better to get it checked instead of just attributing it to long Covid, because it may indicate a heart problem, acidity or a lung infection,” he says.
Dr Nikhil Modi, Senior Consultant, Respiratory Diseases, Apollo Hospitals, concurs. “Every long Covid symptom may not always be a consequence of Covid-19. Such a conclusion needs proper medical evaluation,” he warns.
On the other end of the spectrum of long Covid patient behaviour is paranoia or stress that has set in with the persistence of the symptoms. Sometimes the peculiarity of the symptoms can be frustrating enough to cause stress. A major Covid-19 symptom was the loss of taste and smell. While the sensations returned to most people, many others continue to deal with the loss, even in a selective manner.
Dr Modi says many of his long Covid patients have complained about their altered sense of smell. “They have regained their olfactory sense, but now perceive a certain good smell as a bad smell.”
Roy, who, like Taparia, had two bouts of Covid, remembers losing her ability to smell during Covid. She did regain it, except the scent of a specific perfume. “It now smells like chemical water,” she admits.
Dr Modi warns that persistent long Covid symptoms naturally leads to stress, which, in turn, may result in further physical ailments. He says, “Anxiety can lead to persistent headaches, lack of sleep, your body may show signs of gastritis, and your appetite may change. Post-Covid stress and anxiety itself could be the culprit behind many problems in the body. So, psychological aspects of the patient should always be studied.”
Given that the symptoms of long Covid are so varied, doctors say there is no one treatment to cure the syndrome. Dr Gupta says healthy lifestyle practices, including yoga, breathing exercises and physiotherapy help mitigate, if not eliminate, various symptoms like cough and cold, body ache and breathlessness. More serious symptoms have to be treated on a case-by-case basis, Dr Modi adds.
Delhi-based acupuncturist Dr Adil Khan, who treated about two patients a month for ‘health anxiety’ before the pandemic, now receives 30-50 patients every month. Those suffering from this condition often perceive symptoms like headaches, breathlessness and nervous twitches, as signs of grave and serious illnesses.
Talking about one of his long-Covid patients, who had developed health anxiety after suffering from mild Covid, he says, “The anxiety was a symptom of long Covid, where his subconscious mind took over his conscious mind, making him believe he had no control over his health.He ended up having a panic attack and getting hospitalised.”
According to a global study this year, about four crore people have experienced long Covid symptoms since 2020. Another study found that 65 percent of Indians have one or more people in their close circle with long Covid symptoms. The pandemic may ebb and flow, but the residual pandemic seems here to stay.
What is long Covid?
According to the WHO’s clinical case definition, “Post-Covid-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis.”
Who can develop long Covid?
While any Covid-infected individual can develop long Covid, studies have shown that 80 percent of the patients who were hospitalised during the illness are likely to have long Covid. A study by Centers for Disease Control and Prevention (CDC) said people over 40, women and those with underlying health conditions were most likely to develop the syndrome.
Is long Covid contagious?
Long Covid is not contagious. Each patient has unique symptoms, resulting out of their body’s response to the viral infection.
Does getting vaccinated reduce the risk of developing long Covid?
A 2021 study suggested that vaccines do reduce the risk of long Covid, but only by 15 per cent.
Can long Covid be treated?
While there is no one treatment to cure the syndrome, doctors recommend following healthy lifestyle practices, including yoga, breathing exercises and physiotherapy. More serious symptoms have to be treated on a case-by-case basis.
Source: Online journal Scientific Reports, (Published in August 2021)
with inputs from Noor Anand Chawla