THE PLIGHT OF THE COVID-19 LONG HAULERS

Long CoViD is not just with people taking time to recover from a stay in intensive care. Even people with relatively mild infections of the Corona virus can be left with lasting and severe health problems, writes RAJENDRA T NANAVARE.


For most people, CoViD-19 is a brief and mild disease. While some are left to struggle for months with symptoms like fatigue, pain and breathlessness. Such prolonged suffering due to the corona virus ailment is termed as ‘Long CoViD’.

There is no medical definition or matching symptoms among patients who have contracted CoViD-19. For example, two people with Long CoViD can have very different experiences. However, the most common feature is crippling fatigue.

Other symptoms include, breathlessness, nagging cough, joint pain, muscle aches, hearing and eyesight problems, headaches, loss of smell and taste as well as damage to the heart, lungs, kidneys and gut. Mental health problems have also been reported including depression, anxiety and struggling to think clearly.

Long CoViD causes debilitating effect on peoples’ lives, and stories of being left exhausted after even a short walk are now quite common. So far, the focus has been on saving lives during the pandemic, but there is now a growing recognition that people are facing long-term consequences of CoViD infection. Long CoViD is not just people taking time to recover from a stay in intensive care. Even people with relatively mild infections can be left with lasting and severe health problems.

Of all other myriad symptoms, extreme fatigue is a major debilatating health condition in case of Long CoViD sufferers even those who exihibit mild symptoms of CoViD-19 (Picture Courtesy: Getty Images).


EPIDEMIOLOGY: Pathophysiology

Even at this early stage, it might be important to determine what the potential pathophysiological mechanisms might be. So far, there is no convincing evidence of widespread infection of the brain by the virus. The virus has been detected in the CSF and the brain in very rare cases. However, there is evidence of widespread glial cell activation that may be related to metabolic dysfunction or massive immune activation in the periphery. Other possibilities are specific immune responses targeted against specific regions of the brain and autonomic nervous system. Depending on the predominant underlying pathophysiological mechanism at play, targeted treatment might be possible.

CLINICAL PRESENTATION:

Symptoms reported by people with Long CoViD include, extreme fatigue, long lasting cough, muscle weakness, low grade fever, inability to concentrate (brain fog), memory lapses, changes in mood, sometimes accompanied by depression and other mental health problems, sleep difficulties, headaches, joint pain, needle pains in arms and legs, diarrhoea and bouts of vomiting, loss of taste and smell, sore throat and difficulties to swallow, new onset of diabetes and hypertension, skin rash, shortness of breath, chest pains, palpitations, hair loss, teeth loss.

MANAGEMENT:

Unfortunately, it looks like the pandemic has got out of control. It is spreading rapidly across the globe, and even if we have an effective vaccine, we might never have enough dosages to administer to the eight billion inhabitants of this planet. And we also have a subset of the populace that is opposed to any kind of vaccination. So CoViD-19 is here for the long haul, and neurologists are going to play a critical role in the management of these long term sufferers. Several efforts are underway to prospectively follow these patients with persistent symptoms. Hopefully, we can get to the bottom of these manifestations soon and find solace for these patients in a timely manner.

Sufferers of Long Covid are often referred to as ‘Long-Haulers’. Health systems in some countries or jurisdictions have been mobilized to deal with these group of patients by creating specialized clinics and/or providing advice to physicians.

SUMMARY:

‘Long CoViD’, also called ‘Long-Haul CoViD’, ‘Chronic CoViD’, or ‘Chronic CoViD Syndrome’ describes long-term sequelae of coronavirus disease 2019 (CoViD-19) in which 10 to 20 percent of people who have been diagnosed with CoViD-19 report experiencing a range of symptoms lasting longer than a month, and 2.2 per cent (1 in 45 people) report having symptoms which lasts longer than 12 weeks.

Most of these patients were in excellent health prior to getting infected with SARS-CoV-2. They all had myriad symptoms during the acute phase; however, as the fever and respiratory symptoms improved, they were left with persistent systemic symptoms, some of which gradually improved, but not everyone followed the same course. While some were admitted to the hospital due to pulmonary symptoms, the majority remained isolated at home.

WAY FORWARD:

Many of these symptoms overlap with those of the patients suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The cause of ME/CFS remains unknown despite decades of research of this disease. Many of these patients similarly report a viral infection as a trigger, but since they come to our attention months and years after the symptom onset, it is impossible to know what may have triggered the symptoms. Clinicians and research teams working together may come up with a remedy for this illness in the near future.


RAJENDRA T NANAVARE is a Chest physician & Chairperson DRTB center, Bedaquilin at GTB hospital, Mumbai, Ex-Pharmcovigilance in Drug Safety Monitoring committee for Bedaquilin at I.C.M.R and Ex-Consultant for international union against tuberculosis and lung diseases. He is also postgraduate teacher for Chest & TB in College of Physicians and Surgeons, Mumbai. He can be reached at docrajn1203@gmail.com


Opinions expressed in this article are of the author’s and do not represent the policy of The Edition. The writers are solely responsible for any claim arising out of the contents of their articles.

Tags: #Covid19 #Coronavirus #LongCovid #LongHaul #Vaccine #ChronicFatigueSyndrome