Experts seek consensus on long Covid definition, bat for treatment protocol

One study found that 65 million patients, or 10% of the 651 million confirmed Covid-19 cases worldwide, have long-Covid. For hospitalised cases, the rate rose to 50-70%

Three years on, the medical fraternity is yet to build consensus on long Covid and how long it can last, with global studies suggesting a wide range of period from six months to a year. Nonetheless, long Covid is a reality that some doctors suggest is prevalent even now in a certain section of patients, with symptoms such as dry cough, digestive issues, headache, insomnia, difficulty in concentrating or even thinking clearly. Experts suggest it is important to understand long Covid to put in place a protocol for treatment of these patients.

“If you feel sick today and feel ill for more than a month, then is it long Covid or a post viral syndrome? Having a definition for long Covid is important. Work by different people across the world shows it is not one thing,” said Gagandeep Kang, noted virologist and professor at the department of gastrointestinal sciences at Christian Medical College, Vellore.

Doctors have observed that the general symptoms of long Covid typically include patients having high blood sugar levels after a few months of recovery from the disease, while some had persistent and nagging coughing, and increasing breathlessness too, despite having no or minimal lung involvement during their first episode of Covid-19 infection.

According to a recent study by researchers from the Patient-Led Research Collaborative and two others from La Jolla, California’s Scripps Research Translational Institute, even after three months, one of the three primary long Covid symptoms were present among the Covid affected patients. The study concluded that 65 million patients or 10 per cent of the 651 million confirmed Covid-19 cases worldwide have long-Covid. For hospitalised cases, the rate rose to 50-70 per cent.

Researchers from the University of East Anglia, UK, wanted to find out what factors may make people more or less susceptible to long Covid and looked at data from 41 studies (covering more than 860,000 individuals). They concluded that females, older age, increased BMI and smoking are associated with the risk of long Covid. Comorbidities such as asthma, type 2 diabetes, coronary heart disease, immunosuppression, anxiety and depression are also associated with increased risk. People who had been vaccinated had a 50 per cent lower chance of progressing to long Covid than unvaccinated participants.

“Long Covid cases are coming up even now in people who had severe diseases, suggesting it is lasting even more than a year. Symptoms are more in the elderly,” said Rommel Tickoo, director-internal medicine, Max Healthcare.

However, it isn't just the elderly but also the much younger lot who have struggled with the lingering effects of Covid infection. For instance, a 26-year old patient treated at Delhi’s Primus hospital continued to experience symptoms such as fatigue, headaches, and shortness of breath for months after contracting Covid. “She got investigated extensively for all other possible causes, but to no avail. She had to be on long-term treatment for her symptoms that are now being attributed to be from long Covid,” said Anurag Saxena, HOD- Internal Medicine, Primus Super Speciality Hospital.

It is more or less universally true for long Covid cases that the routine investigations are not throwing up major anomalies, even though the patients continue to suffer.

Doctors have also cited nerve damage as one of the common long Covid issues. Some very unusual side effects, including hair loss, memory loss, and even hallucinations have been reported in long Covid worldwide.

But diagnosing symptoms as such is complicated for medical practitioners. “If symptoms start after six weeks, then it is very difficult to ascertain whether this is due to an abnormal immune reaction to the Covid-19 disease,” said Rahul Pandit, Chair-Critical Care, Sir HN Reliance Foundation Hospital, Mumbai.

Several institutes are conducting individual studies on long Covid. Experts said while it is important to define long Covid, it is also crucial to develop effective treatments and management strategies to treat it.

“There is no specific treatment and we are simply treating the symptoms. We are also advising such patients to get the influenza vaccination as it can further aggravate their symptoms,” Tickoo added.