A long shadow – The Week

Vrinda Arora, 29, from Bengaluru loved to eat raw vegetables. “I would even eat raw onion and capsicum,” said Arora, a sales professional in an IT company. Life has not been the same for Arora after she recovered from Covid-19. She has had persistent symptoms, from headache and fatigue to loss of taste. “I can’t taste food like I used to,” said Arora who got Covid-19 in April 2021, “I used to love onions, capsicum, ginger and garlic but now they give me a foul smell and I have stopped having them . I prefer junk food now.”

Long Covid is absolutely real, said Dr Faheem Younus, chief of infectious diseases at the University of Maryland. “It happens with other viral infections as well. A subset of patients will have long-term side effects. That’s well known.”

However, there is no clarity on how long it takes to completely recover from Covid-19. “Even though we feel we’ve hundreds of studies on this subject, we still don’t have an unified definition of long Covid. We don’t have any specific lab tests. It’s all based on history, symptoms. And they vary from one study to another,” said Younus.

A study by researchers at the University of Michigan showed that more than 100 million Covid survivors worldwide have had long Covid. It could take a toll on vital organs like the brain, heart, lungs and kidney. Symptoms of long Covid could range from fatigue, aches and pains, to brain fog, and sleep problems that linger months after recovery.

Long Covid, however, is yet to be recognised as a legitimate disease. Does it mean it is all in the head? Dr Sushila Kataria, senior director, internal medicine, Medanta, Gurugram, begs to differ. “People definitely have long Covid or post-Covid problems. They have problems like lethargy, sleep disturbances, anxiety, palpitations, hearing loss, problems related to smell, concentration, muscle pain, tiredness, and mild breathlessness.”

Brain fog, in fact, is one of the most commonly reported persistent symptoms in patients after recovering from Covid-19. The person may have difficulty with everyday tasks because of impaired cognitive functioning. “Typical fog complaints people describe are memory loss, trouble finding words, problems with attention, and being overwhelmed by simple tasks,” said Dr Sagar Mundada, a consultant psychiatrist at Healthspring, Mumbai. “A lot of these patients have not had stroke or infection of the brain, no seizures or anything that was neurologically obvious during their infection.”

Dr H. Sudarshan Ballal, nephrologist and chairman of Manipal Hospitals, Bengaluru, tells his patients that Covid-19 is not a simple acute viral illness. It is important to get yourself tested for signs and symptoms of long Covid including kidney disease, he said. “As far as kidneys are concerned, during an acute infection of Covid, especially in the sicker patients, there may be acute kidney injuries due to multiple reasons like a direct impact on the cells of the kidney, inflammatory syndrome associated with Covid affecting the kidneys. , coagulation effects seen in Covid, secondary causes like sepsis medications and hypoxaemia associated with Covid,” said Ballal.

Usha Gulati’s road to recovery has been long. The 65-year-old suffered from Covid-19 in April 2021 and developed acute respiratory distress syndrome (ARDS). She had persistent symptoms even two months after getting infected and was admitted to Apollo Hospitals in Delhi. “Her oxygen requirement was very high and it wasn’t coming down. Most patients get better within three to four months but Gulati didn’t. Her family refused the transplant and the best thing we could do for her was to prevent her from getting any kind of secondary infections like a bacterial infection or tuberculosis respiratory,” said Dr Viny Kantroo, consultant, critical care and sleep sciences at Indraprastha Apollo Hospital.

Being in the hospital for six months, Gulati was homesick. Her husband, meanwhile, succumbed to Covid-19. Gulati was sent home. She required 10 to 15 litres of oxygen per minute. With regular physiotherapy, Gulati’s oxygen requirement started coming down. “It has been a year since she has been on oxygen. She is getting better,” said Kantroo.

I would discourage people from doing blanket investigations, said Kataria. “We don’t want people to be pushed into investigations. Unlike the Delta wave, in the Omicron wave, the patients who have residual effects are fewer. And these effects are not per se related to any biological abnormalities in the blood investigations. Routine screening tests like complete blood count (CBC), lactate dehydrogenase (LDH) and high-resolution computed tomography (HRCT) are not recommended.” Kataria prefers a follow up with the primary care physicians to be sought if the symptoms persist even a month after recovering from Covid-19.

Apollo Hospitals had launched its post-Covid clinics equipped with neurologists and immunologists in October 2020. Dr Sudarshan S., the consultant physician at Medall Healthcare, Chennai, felt primary care centers should also run ‘Covid Recovery Clinics’.

Dr Pritha Nayaar, a respiratory specialist at Asian Hospital, Faridabad, prescribes tests like ECG, echo and computed tomography (CT) pulmonary and angiography for people who develop chest pain, shortness of breath or blood-tinged sputum to rule out myocarditis, myocardial infarction and pulmonary problems. “People with persistent fever should check for fungal infection and those with persistent body ache should get their electrolytes, Vitamin-D and calcium levels checked,” said Nayaar.

Cognitive training is an established method to improve cognitive functions in individuals with neurological and psychiatric conditions, said Keshav Kumar, professor, department of clinical psychology, National Institute of Mental Health and Neurosciences, Bengaluru. “The cognitive retraining includes both in-person programs using paper and pencil format as well as the online program via cognitive apps,” he said.

NIMHANS’ neuropsychology unit has been developing comprehensive cognitive training programs for the clinical population for over three decades targeting specific brain circuitry and cognitive domains.

‘Rewire’, an Indian commercial app available on Google play store, can also be used to improve cognitive function and mental health outcomes in people with long Covid.

Arora does 40 minutes of yoga every day and goes for regular walks. It helps her manage long Covid symptoms to a certain extent. “I make sure I step out and take a walk once a day,” she said.

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