For Megha, it's a persistent lack of energy. Joint and muscle pains make Shekhar (51) feel 20 years older. Govind finds himself trapped within loops of anxiety spirals he hadn't known before 2020.
Gnawing headaches like a bad migraine, dizziness and palpitations, and an inability to recall things are some of the other, and among the most common, complaints that young and middle-aged Indians with no history of these ailments have been going to doctors with.
There's just one plausible answer. These are some of the known symptoms of long Covid which, according to recent studies and a growing body of evidence, appears to be much more common than believed earlier. These are also the symptoms easily ignored by unsuspecting patients. After all, the Covid-19 infection resolved itself months - or by now, years - ago.
For many "long-haulers", the after-effects of Covid have been debilitating, though they emerged from the infection relatively unscathed from the time the novel coronavirus was actively colonising cells in their bodies.
Megha Singla (41), a travel agent in Gurgaon, is one of them. She was diagnosed with Covid-19 in October 2020 and her illness was mild, with symptoms that subsided within a week. But she has been forced into a restrictive "new normal" since. "I used to do yoga every day. Now, I can hardly do breathing exercises for a minute. I got better in seven days after Covid but never regained my strength. I have difficulty sleeping and struggle to remember things sometimes. It's as if a part of my memory has been erased," Singla, who is fully vaccinated, told TOI.
Vipin Kumar, 29, was infected in May 2020. He had the "moderate" version of the illness - fever, cough, fatigue, and loss of smell and taste. His recovery didn't take long but he hasn't felt like himself in the last two years. "I feel exhausted quickly. I've also been suffering from stomach ailments. I can't remember things... I don't understand why I have long Covid because I had no comorbidities," the accountant based out of Gurgaon said. Kumar recently got his booster shot.
Kumar isn't alone in being flummoxed about long Covid. Scientists world over are studying it, still piecing together its myriad symptoms and the Sars-CoV-2 virus's exceptional capacity to cause long-term effects.
Slowly and surely, the picture is emerging.
A study published in the journal, The Lancet Respiratory Medicine, in May found about half the patients admitted to hospital for Covid-19 treatment continued to experience at least one symptom two years after the infection. The research, done by the China-Japan Friendship Hospital in Beijing, is the longest study for long Covid thus far.
The scientists, who followed up with patients admitted to a Wuhan hospital in early 2020, noted that physical and mental health improved over time, but quality of life of Covid-19 patients was lower than those spared by SARS-CoV-2. "Our findings indicate that for a certain proportion of hospitalised Covid-19 survivors, while they may have cleared the initial infection, more than two years is needed to recover fully... There is a clear need to provide continued support to a significant proportion of people who've had Covid-19," said professor Bin Cao of the China-Japan Friendship Hospital, and the lead author of the study.
Other research too has pointed to the prevalence of long Covid. According to another study by the US Centres for Disease Control (US-CDC), one in five Covid-19 survivors - adults below 65 - experienced at least one symptom of long Covid. For those above 65, the incidence was higher, at one in four.
Govind Rawat (41) used to work as a front desk manager at a hotel in Dehradun. He got Covid in September 2020 and has since been, as he puts it, "under the influence of the virus". "I still have insomnia. I get anxiety attacks. And I don't go out with friends. I feel some part of me was taken away by the virus," he said.
Shekhar Kumar (51) is similarly afflicted. He was infected during the second wave last year. "I have chronic fatigue. I used to go jogging daily, but now walking up the stairs in my house is a task. I have difficulty reading and I keep hearing a buzzing sound. It feels like I have aged directly to my 70s," he told TOI.
Doctors treating patients for post-Covid syndrome, as it is officially known, say anecdotal evidence backs scientific proof. "Even after two years, many people are experiencing post-Covid symptoms such as coughing, fatigue, hypertension and breathing issues. Going forward, it will perhaps be one of the most common pre-existing conditions. We don't normally ask patients about their Covid-19 history, but we might have to make asking about post-Covid symptoms a procedure while treating other ailments," said Dr Sushila Kataria, senior director of internal medicine at Gurgaon's Medanta hospital.
Dr Narendra Mishra, an immunologist and former dean of AIIMS Delhi, said genetic factors may explain how each person reacts differently to the infection. Another reason may be that people have undiagnosed comorbid conditions that could be defining the body's immune response to the virus, he said. "But it is important that we conduct a study on long Covid," he said.
Such a study is under way at the Omandurar Government Medical College in Tamil Nadu. "A total of 1,342 patients are currently participating in the long Covid study. We followed these patients six months after their recovery from Covid infection. We found that 46% of them had long Covid symptoms," said Dr Arul Murugan, head of the college's community medicine department. "The major persistent symptoms are general weakness followed by neuropsychiatric disorders, concentration or memory deficit and dyspnea. Hair loss was the least persistent symptom," he added
Comorbidity, said Dr Murugan, was a significant factor. "We found hypertension was the leading co-morbid condition, followed by diabetics in these cases. Cancer was the least co-morbid condition. These long Covid patients had mild to moderate Covid symptoms. Most are suffering from multiple comorbidities (at least three)," he said.
In Haryana, a long Covid study on 2,000 patients from Gurgaon, Rohtak and Jhajjar is on at PGI-Rohtak.
With a wide array of non-uniform symptoms, doctors said they are tweaking treatment for long Covid based on a patient's ailments. Case-to-case medication aside, they are asking people to practise healthier lifestyles - adequate hydration, high-protein diets, regular sleep cycle and psychological support.
Treatment for long Covid is also becoming more institutionalised. Both government and private hospitals in India have opened post-Covid OPDs, where a patient's condition is divided into two categories - the diseases linked to Covid-19 and the consequences of Covid-19 treatment.
Dr Janet Diaz of the World Health Organization (WHO) too spoke about focused treatments in an interview with TOI this May. "We don't have any drugs for the treatment of post-Covid-19 conditions. But we do have interventions such as rehab interventions or self-management techniques to help improve quality of life," she had said.

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