It has been three years since the pandemic and as we still battle COVID-19, I have been witnessing Covid long haulers present themselves at my OPD with varying symptoms. Now this is something that needs to be addressed as a public health concern. And while there is no clinical finding yet to pinpoint what causes these conditions and research is on to find out the long-term damage caused by the virus, there is definitely a pattern emerging from the patients that I have been seeing for the last three years. Most experiencing long COVID, particularly women, have by and large had a severe manifestation of the disease, particularly after the Delta wave, or had co-morbidities. And all of it has to do with the immune dysregulation of the body, which means your body cannot control its immune response and can either underreact or overreact to foreign invaders. This explains their vulnerability to contracting other infections, suffering repeatedly and developing body conditions.
So what are the commonest symptoms of long Covid that I am seeing in my patients? Fatigue is a long-drawn side effect that many who had COVID first time round are still to get out of completely. Some of my patients had coughing bouts that lasted for almost two years as they were exposed to the slightest pollution or regular infections. They have been more susceptible to chest infections, palpitations, heart rate and breathlessness. The other severe manifestation has been in terms of anxiety, depression and panic attacks, with such patients saying they don’t feel like their original selves at all. Some of them continue to have insomnia, headaches, gastro-intestinal tract disturbances and loss of appetite.
The common aspect tying all of these conditions is that the virus had not only disturbed their immune system but weakened the organs it had impacted. And since the recovery of such affected organs hasn’t happened to the extent that they should have, they continue to be under stress.
IDENTIFYING PERSISTENT SYMPTOMS
Chest pain and palpitations: While elevated sugar levels have been a continuous marker in my patients, many of them haven’t quite got over palpitations, problems with heart rate or irregular beats. So far it seems that they may be caused by a problem in their autonomic nervous system, which controls heart rate, breathing patterns and blood pressure. This condition is called postural orthostatic tachycardia syndrome (POTS). Many of my patients complain of a very fast heart rate when they engage in vigorous physical activity and feel very fatigued afterwards. That’s because their heart rate, which could be normal during resting, races up suddenly to 140 to 180 during the activity. Chest pain is a common post-Covid symptom as viral infections cause muscle aches in your chest. But it could be related to an angina of the heart that has gotten aggravated or caused by inflammation of the tissue between your ribs and lungs (called pleurisy), or inflammation of the lining of your heart (pericarditis).
Fatigue: When even a routine chore makes you feel exhausted, or when you feel sapped out doing the same work you did in the past, it is a classic sign of long Covid. For this we usually advise pacing every activity to readjust the body to its old rhythms.
Vascular issues and organ damage: Some of my patients have developed deep vein thrombosis, pulmonary embolism and bleeding events because of micro clotting. Researchers have found a long-lasting reduction in vascular density, specifically affecting small capillaries, in patients with long COVID 18 months after infection. Multiple studies have revealed multi-organ damage, including the heart, lungs, liver, kidneys, pancreas and spleen. Neurological and cognitive symptoms have been seen in long COVID, but I have seen patients where depression has led to extreme irritability and anger simply because they do not understand their body anymore. Studies have found Alzheimer disease-like signalling in patients with long COVID, when peptides self-assemble into amyloid clumps which are toxic to neurons.
Reproductive system: Women have reported menstrual alterations and heavy bleeding. The virus seems to have affected ovary hormone production and endometrial response.
Respiratory symptoms: Like chest discomfort, shortness of breath and cough are the most common respiratory symptoms.
Gut health: The gut microbiota composition has been significantly altered with most Covid long haulers reporting reduced levels of the beneficial butyrate-producing bacteria. Most patients continue to suffer inflammatory bowel disease.
WHAT ABOUT TREATMENT?
At the moment, till research shows up something definitive, we treat long Covid patients symptomatically. Remember everyone’s experience is different, so it’s important to detail your symptoms to your doctor so that he can suggest how best they can be managed.
A lot of care is preventive and we try to take control of factors that we can reverse. For starters, I advise my patients to do a blood work every six months to keep track of markers that may need to be addressed from time to time. Those with heart abnormalities should do regular tests like ECG, chest X rays, monitor their heart rate and BP. Check your blood oxygen levels when you have breathing problems and take an exercise tolerance test to decide your fitness routine. I suggest a thyroid test because the gland was found to go haywire in its functioning in post-Covid patients. I also strongly recommend Vitamin B 12 deficiency, which results in a whole lot of the symptoms that I have mentioned and which needs to be addressed immediately. A majority of Indians are anyway deficient in Vitamin B12 but this is easily controlled with a good diet and supplements.
Otherwise, I advise the regular lifestyle correctives — good diet, sleep, exercise, keeping to a routine and provisioning for mental relaxation. Healing is a long process and that of long COVID is an exercise in patience.