A deep dive into Long Covid

Dr. Srivatsa Lokeshwaran, Consultant - Interventional Pulmonology, Aster CMI Hospital

Since the start of the pandemic, patients recovering from acute COVID 19 infection have been increasingly reporting symptoms as a result of the fallout of multi-organ involvement by the SARS-CoV2 virus which persist well beyond the acute period and sometimes last for as long as 6 months. The effect of Long COVID adds to the burden on healthcare that is overwhelmed by the spate of waves of the pandemic due to the virus and its mutating variants. There have been a host of response in the international community to tackle Long COVID, with 40 odd clinics dedicated for long COVID opened up by the NHS and workshops conducted by the National institute of allergy and infectious disease to educate physicians on the symptoms and signs of the syndrome. As the ACE receptors, or the entry point of the virus is distributed far and wide on many organs in the body it doesn’t come as a surprise that the long lasting effects of the virus can present with a gamut of symptoms due to the various organs inflicted. The most common symptoms of Long COVID are breathlessness and fatigue. The other possible symptoms can be elaborated as.

• Respiratory system-breathlessness, cough.
• Cardiovascular system-chest tightness, chest pain and palpitations.
• Neurological symptoms-Brain fog (cognitive impairment), headache, sleep disturbances, delirium and pain in the peripheral nerves
• GI symptoms-loss of appetite with nausea and diarrhea.
• Musculoskeletal symptoms-joint pain and muscle pain.
• Skin rashes.
• Depression or anxiety.
• Generalized symptoms like fatigue, fever and pain.
• ENT symptoms like loss of taste or smell.

Such patients with characteristic signs and symptoms presenting to the physician would require a holistic assessment and a battery of tests to ascertain the underlying problem. It would include routine blood tests, checking the heart with ECG, echocardiogram, lung function test, 6-minute walk test, tests to determine autonomic dysfunction.

In view of the chronic nature of the problem the management approach should be directed at self-management or supportive self-management of symptoms. Potentially life threatening complications like pulmonary thrombo-embolism, stroke and acute cardiac events must be identified early treated promptly at specialist centers.

Treatment of Long COVID requires a multi-disciplinary approach including evaluation, symptomatic treatment, and treatment of underlying problems, physiotherapy, occupational therapy and psychological support.

Symptoms like cough can be treated symptomatically using anti-tussive agents and determining the underlying cause and targeting therapy. Myalgia is treated with analgesics and physiotherapy. We have also seen that the rehabilitative services plays a central role and are being increasingly utilized by patients with chronic myalgia and neuromuscular sequelae. Streamlining this care and channelizing patients into these services plays a vital role for faster recovery and optimum results.

In our experience, majority of people with mild-moderate symptoms and those who show improvement in symptoms can be followed up with online or telephonic consultation, with fewer face-to-face interactions. Those with severe symptoms and progressive worsening need frequent in-person review. Those developing acute worsening of symptoms or acute onset of new symptoms should be advised to report the emergency department immediately. Followup is usually tailor made to requirement of the patients and the seriousness of the undercurrent problem.

The prolonged nature of the illness and long lag of recovery and multimodal approach to treatment has significant bearing on the social and economic impact of the disease process. Hence we must harness the best practices and adopt specialized clinic giving access to the whole gamut of specialists to treat these patients and thereby speeding up recovery and not let any patient wane into a downward spiral again leading to repeated hospital admissions for acute conditions which can further impact future recovery.

With repeated mutations in the strain of the virus much remains to be understood on the pattern of Long COVID in various strains and how the challenges mount for the future.