The column is written by Dr. Chandrakant Lahariya (MBBS, MD), a Physician-Epidemiologist and a leading expert on COVID-19 disease and vaccines. In this fortnightly column, Dr. Lahariya picks up one topic and give you tailored solutions, catering to the health needs of your entire family — kids, adolescents, adults, and senior citizens, and all the other members of your family.
This week’s column talks about the post and Long COVID symptoms and suggests ways to combat them effectively.
What is post-COVID and long COVID?
For some people, coronavirus (COVID-19) can cause symptoms that last for weeks or for months after the initial episode of illness. If these symptoms last beyond four weeks, it is called ‘post-COVID’ and even beyond 12 weeks, it is termed as ‘Long COVID". These two conditions are very similar in clinical presentation and differentiated by duration since onset. At times, both are referred together as well. These are a wide range of new, returning, or ongoing health problems in individuals who had been tested positive for SARS CoV-2 and diagnosed to have COVID-19. Even asymptomatic cases can have post-COVID conditions. All the symptoms reported in COVID-19 can also be noted in post and long COVID-19. It is just the duration after infection which determines post or long COVID.
The most common symptoms include difficulty breathing or shortness of breath, extreme tiredness or fatigue, difficulty thinking or concentrating (sometimes referred to as “brain fog”), cough, anxiety, body aches and joint pains, continued loss of taste and smell and symptoms that get worse after physical or mental activities. However, a few researchers have listed up to 205 clinical conditions which have been reported by cases diagnosed as post or long COVID.
How common is long COVID or post-COVID?
The data on this is further emerging and there is no consensus. However, generally one in four patients who had COVID-19 develops post COVID symptoms. This rate is slightly lower at one in every 10 persons who were diagnosed with COVID-19 to have long COVID (or continue to have symptoms at and beyond 3 months).
There is a substantial body of research that suggests the long COVID issues are more likely to manifest in older age group, and could be twice as common among women.
How Post COVID is diagnosed or can one test positive for long COVID?
The condition is diagnosed based upon clinical analysis and observation. A key point is that if there is no other reason or new illness to explain the condition and, in general, in a person recovered from COVID-19, if the symptoms persist beyond four weeks, then the condition is diagnosed as post-COVID. If the symptoms persist beyond 12 weeks/3 months, it is termed as long COVID.
There are no separate diagnostic tests for long COVID, only clinical diagnosis is possible (because it is not caused by a pathogen but continuation of clinical symptoms). However, if someone is tested again for SARS CoV2 on RT PCR after a gap of 90 days, it is likely to be a fresh infection or re-infection (Though, getting infected again is rare but possible and that’s why even recovered individuals need to be vaccinated after 3 months (As per current Govt of India recommendation on COVID-19 vaccination) and keep following COVID Appropriate behaviours.)
What are the underlying causes that lead to long COVID?
The exact causes which lead to long COVID are still being explored. One of the explanations is that SARS CoV2 infection makes some people’s immune systems go into overdrive, attacking not just the virus but their own tissues. In that situation, the virus itself getting into and damaging our cells might explain some symptoms like brain fog and a loss of smell and taste, while damage to blood vessels in particular could lead to heart, lung and brain problems. Therefore, the tissue in whichever part of the body or organ is damaged; the symptoms are usually linked to that organ.
It has also been seen that female sex and long duration of acute COVID may predispose to developing long COVID. However, at times younger people also report long COVID. Doctors and researcher believe that though younger people are less commonly affected but they are more impacted and that’s why may report more than rest of the population groups. The research has indicated that probability of long COVID increases with increase in the age.
Does vaccination help people with long COVID?
The effect of vaccination in people who subsequently contract acute COVID and end up developing long COVID is not clear and more evidence is needed. However, what is becoming apparent is that the duration of long COVID may be cut short by getting vaccinated (though we need more evidence on this). A few studies have noted that even a single dose of vaccine may lead to an improvement in symptoms of long COVID in as many as half of the recipients. Vaccination is considered to work by resetting person’s immune response or helping the body attack any remaining fragments of the virus. In India, amongst the RT PCR confirmed COVID-19 cases, vaccination is recommended after a gap of 3 months from infections. As it is scientifically known that person after natural infection, followed by vaccination has far more antibodies than those who were not infected earlier and received one shot. Therefore, vaccination can also help prevent people contracting the emerging variant of the virus and developing long Covid as well.
What neurological problems do post and long COVID cause?
Post and Long COVID may show neurological manifestations, which includes anxiety and depression as well as insomnia; sleep which leaves you feeling tired; Late onset headaches; Loss of taste and smell and Cognitive impairments, including brain fog, which may manifest as difficulties with concentration, memory, receptive language and/or executive function.
What are the cardiovascular effects of long COVID?
Long COVID may show cardiovascular manifestations in form of short term symptoms such as chest pain and palpitations (rapid heart rate) as well as long term conditions of Stress cardiomyopathy; myocardial inflammation and Myocarditis. The patients with acute infection or those experiencing persistent cardiac symptoms should follow up with their doctor and should also continue the treatment for pre-existing illnesses or health issues.
Is long COVID contagious?
No. It is a clinical condition and it cannot be spread from affected person to a healthy person.
What steps should be taken to ensure good health post a COVID-19 infection?
In general, steps that would ensure good health irrespective of COVID-19 should be followed. These include eating healthy meals, and a regular sleep cycle. Breathing exercises including Yoga and Pranayam can also be useful. However, while exercising, it is important not to over-exert yourself, and take things slow.
Maintaining respiratory and hand hygiene and following social distancing and wearing masks are also important steps to ensure safety. The most important thing to do is to get vaccinated as soon as you become eligible.
Consulting a doctor in case any symptom persists beyond four weeks. People who recover from COVID or has a post or long COVID-19 should make themselves familiar with warning signs such as regular headache or an episode of fatigue. It is essential to focus on any noticeable signs and consult a health facility or provider. It is also important that treatment for ongoing illnesses is continued, after an initial consultation with a healthcare provider.
Dr Lahariya can be reached at his email firstname.lastname@example.org or Twitter Handle @DrLahariya