Long Covid: Range of symptoms, medical burden

Long Covid symptoms occur more frequently in women, middle-aged, and in those with more symptoms initially, according to a World Health Organization (WHO) definition.

On December 3, Sangeeta Gharat went back to work seven months after she contracted Covid-19. A 51-year-old assistant administrative officer with the Life Insurance Corporation (LIC), Gharat took her 24-year-old daughter, Priya, with her on the first day.

Here’s what’s confounding the medical experts: Long Covid does not depend on the severity of the infection.(Reuters)

The mother and daughter spent the first few hours conducting a trial of sorts: Priya stood by, ready to help, as her mother pushed open the main door of her first-floor office in Mumbai’s Nariman Point. It took Gharat all the strength she could muster. Priya watched as her mother struggled to grip the handles of her swivel chair. Gharat couldn’t push the pile of files — gathered on her desk over the months she was away — and moved each one out of her way. When she opened the drawer, Gharat let out a painful sigh. “I feel like I have to re-learn basic movements. I am no longer sure of my strength,” Gharat said.

A resident of Airoli, Gharat contracted Covid-19 in April as the pandemic’s second wave raged across the country and hospitals struggled to accommodate patients and ensure adequate oxygen supply. Before the infection, Gharat lived a healthy life and she had no comorbidities. Her infection was a severe one: she spent 74 days in hospital, including nearly 50 days in the intensive care unit (ICU). During her hospital stay, Gharat also contracted a fungal infection leading to septicaemia — a secondary infection often seen in severe patients hospitalised for a longer time, or those who have extremely low immunity.

Six months after her discharge from the hospital, Gharat is still not healthy.

A range of symptoms

Gharat is a patient of Long Covid, where symptoms linger for weeks or months after the person is Covid negative.

Around the world, scientists and medical professionals are trying to pin this down. Starting last year, experts began to use the term to refer to patients who, having recovered from the primary infection, continued to struggle with its after-effects. These were linked to the virus’s ability to impact all organs and body systems.

A November 2020 study published in the British Medical Journal that followed up on 201 patients in the United Kingdom stated that “Almost 70% had impairments in one or more organs four months after their initial symptoms of SARS-CoV-2 infection”.

Long Covid symptoms occur more frequently in women, middle-aged, and in those with more symptoms initially, according to a World Health Organization (WHO) definition.

Here’s what’s confounding the medical experts: Long Covid does not depend on the severity of the infection. It doesn’t manifest uniformly across different people. Little is known about how it varies from other post-viral symptoms, or what parameters should medics use to ascertain it. A Lancet editorial published in August called Long Covid “a modern medical challenge of the first order.”

“The effect on society, from the increased health-care burden and economic and productivity losses, is substantial,” it stated.

International studies show a high prevalence of post-acute symptoms. For instance, a UK study published in Plos Medicine journal in September looked at electronic health records of 273,618 Covid survivors and found that nearly 57% had one or more Long Covid features recorded during a six-month period.

Another research published in The Lancet in July looked at a cohort of 3,762 patients from 56 countries and found that the time to recovery exceeded 35 weeks in almost 91% of the patients. Almost 45% of the patients required a reduced work schedule compared to pre-illness, the study noted.

As the virus continues to mutate, cause re-infections and breakthrough infections across the world, there is a growing concern about the medical burden of Long Covid. Survivors and experts have formed advocacy groups to understand the condition in greater depth, many have taken to chronicling their struggle on social media platforms.

There is a lack of data on long Covid from India. A tele-interview-based study carried out by Max Super Speciality Hospital among 1000 acute patients in July showed that 40% had Long Covid symptoms — 31.8% had symptoms beyond three months after their discharge from the hospital.

There have been varying estimates of the burden of Long Covid from different parts of the world, but once again, data from India, which has recorded over 34.7 million Covid cases, is largely absent. This doesn’t mean that the doctors on ground aren’t confronting it.

“Covid-19 not just impacts the lungs but it also attacks other organs in the body, one after another,” said physician Dr Jalil Parker, who treated Gharat at the Bandra’s Lilavati Hospital. In addition to the damage caused by the virus, patients are pumped in with a range of antibiotics, steroids, antiviral medications that put pressure on the kidneys. “Kidney injury among such patients is therefore very common,” said Parker.

Parker said that he has seen patients like Gharat with severe Covid grapple with the long-term impact, as well as patients who had mild to moderate Covid, battle fatigue, brain fog, hair loss, anxiety and other symptoms that affect their everyday functions.

Some doctors describe Covid’s ability to impact a patient from head to toe — many suffer from what is known as Covid toes, with painful rashes and blisters on them.

“At times I feel long-term impact of Covid in a few patients are worse than a cardiac bypass, as the virus has a tendency to affect every organ and function of the body,” said Parker.

“When we look at major illnesses in general, the inflammatory parameters in the body tend to be high,” said Dr Anita Mathew, an infectious disease specialist from Fortis Hospital in Mulund. “In Covid, the inflammation is often seen throughout the body and not just within the lungs which the virus affects first. Therefore, the C-reactive protein (CRP) levels are fairly high in many patients,” she said.

Mathew has observed such inflammation even in mild Covid patients who turn out to be long haulers.

A post-Covid house

“This is something different. It’s extremely debilitating,” Gharat said. She offers instances of what’s going on with her: she struggles to grip a cushion and the tips of a bed sheet. She enters the kitchen to give a stir to something cooking on the stove only to realise that she can’t hold on the spatula.

Her house is testimony to her post-Covid struggle. Two jumbo oxygen cylinders stand in a corner next to a walker. In another room, a stack of medicines offers a daily reminder of how at the height of her illness, Gharat required two litres of oxygen every minute for nearly three months even after she was discharged. When she started undergoing physiotherapy on her doctor’s advise, her oxygen requirement increased to three litres per minute, for at least 20 hours a day.

She was weaned off oxygen therapy in October, but the medication multivitamins, minerals and supplements continues. New ones were added. Gharat was diagnosed with renal hypertension, or high blood pressure caused by kidney disease, soon after her discharge.

Unknown medical burden

Infectious disease expert Dr Tanu Singhal, who treats patients at Kokilaben Dhirubhai Ambani Hospital, Andheri, said that tiredness and fatigue are the most common complaints among Long Covid patients.

However, not many patients seek help for long Covid. “The problem is not non-existent, but its real burden is unclear,” Singhal said.

Dr Om Srivastava, an infectious disease expert and member of Maharashtra’s Covid-19 task force said that long Covid can sometimes be trivialised, but it can make fully functional people redundant. “I have seen patients grappling with facial palsy, unable to swallow food properly, muscle disorders and even involvement of the spine and brain,” he said.

Twenty months into the pandemic, it is still hard to define what Covid does to the body, what is the kind of residual damage it leaves behind, said Dr Srivastava. “We will know its true impact only years from now,” he said.

Priya Gharat, however, notices the impact of her mother’s condition every day. “She is doing her activities, but not as quickly as she once did,” she said. “Like, getting out of the cab while holding her purse and tiffin bag in one hand is not possible for her. Opening heavy drawers in the office is also difficult,” she said.

“Opening the door of the office and the washroom felt as though I was moving a heavy object,” Gharat recalled of her first day back at work earlier this month.

Seeing her mother’s experience on her first day, Priya decided to accompany her every day. “I will continue to do so for the remaining month,” she said.