Covid-19 cases are rising again. India faces an impending threat of a fourth pandemic wave. Reminders are out to wear masks andmaintain respiratory and hand hygiene. Testing is already on the rise.
There is no reason to panicas of today, butone has to exercise caution and recall the lessons learnt from the second Covid wave. The Omicron and Delta variants dominated the third wave, but pulmonary complications and deaths were minimal. The latest wave may be no different.
However, even as the cases rise, we face a new concern daily in our clinics. We come across many cases of what is called ‘Long Covid’ (long-term consequences of Covid-19 infection) that mostly affects the heart, lungs, brain, nervous system and mental health (the latter two being most common).
Take the case of Parimal, 50. He had a completely uneventful recovery from Covid a few months back. He was treated at home after he developed the symptoms andfelt better after a week. Things were fine with him until recently when he started to feel that his thinking was hazy. He had no memory issues, but he began to find it difficult to multi-task, focus on his work and think in an organized fashion. He felt as if his mind was always “foggy”. So much so, that he couldnot drive or attend the office anymore.
Reema, 35, had a mild fever and an impaired sense of smell after she was detected with Covid. Weakness persisted for a month or so but was not impairing. Six months down the line, she started having fatigue. Taking a few steps or a flight of stairs made her pant. She couldn’t gym anymore and her heart always seemed to pound. Along with these concerns, she complained of an unbearable headache most of the timeand that started affecting her mood. A few weeks later, she feltdepressed and tearful throughout the day, unable to sleep and with irregular periods.
Ismail, 71, needed hospitalisation for Covid and recovered within two weeks. The shortness of breath lasted for a few weeks more and he needed oxygen infrequently. Since his recovery, he has started forgetting names, tasks, dates, etc. He often misplaces his clothes and spectacles and has problems calculating numbers. The family members note he is more irritable now and needs help with navigation. The memory issues only seem to deteriorate with time.
Such cases increasingly appear in our clinics these days. They are mostly a fallout of Covid infections of last year. Brain fog, weak memory, headache, depression and sleep problems are quite common and need urgent attention.
What are the common Long Covid symptoms?
General tiredness or fatigue that interferes with daily life, symptoms that get worse after physical or mental effort [also known as “post-exertional malaise”];
Neuropsychiatric (difficulty in thinking or concentrating -- sometimes referred to as “brain fog”), headache, sleep problems, dizziness when you stand up, pins-and-needles feelings, change in smell or taste, depression or anxiety;
Other symptoms include chest palpitations, diarrhoea, stomach pain, joint or muscle pain, rash, and menstrual irregularities.
Old age, unvaccinated individuals,the severity of infection, need for hospitalisation, use of steroids, the persistence of symptoms and pre-existing neuropsychiatric complaints are the risk factors associated with Long Covid. While some of the symptoms can persist for more than four weeks after the initial infection, in many cases they appear within six months of recovery. The effects on the brain and mind are most severe, ranging from depression, anxiety, and insomnia to neuropathy, headache and strokes (due to the propensity for increased blood clotting). This is because the SARS-CoV-2 virus has an affinity toward the nervous tissue and can stay dormant in the nerves for long.
What is challenging though is that at times such symptoms are non-specific and not detected by any diagnostic tests. This leads to an increased frequency of misdiagnosis and delay in seeking help.
Long Covid may not affect everyone the same way. In most patients, the symptoms slowly improve with time. However, in some others, they may last for months, and potentially years, after the Covid-19 illness. Sometimes they may result in disability and poor quality of life.
Long Covid symptoms lack public attention and current research focuses more on acute infection and lung complications.But as cases rise once again, such symptoms are also rising exponentially.
While these long-term effects on the brain, heart and mind may not lead to direct fatality, they tend to be chronic, difficult to detect and treat, leading to economic burden, frequent changes of physicians, hospitalisations, family distress and psychosocial disability. Further, the presence of stigma about the pandemic and misinformation over the last two years can lead to delayed diagnosis of Long Covid. The consequences can be worse in certain communities facing health inequalities and marginalisation.
The most effective way to prevent Long Covid is vaccination and respiratory hygiene (masks) and hand-washing. Early detection, prompt treatment and isolation during initial infection can save patients from long-term consequences as well. Awareness about the symptoms of Long Covid can promote early diagnosis and management that can help people avoid years of disability and distress.
Dr. Debanjan Banerjee
Consultant Psychiatrist, Apollo Multispeciality Hospitals, Kolkata
(dr.djan88@gmail.com)