What is long Covid syndrome?

The term long Covid was coined by patients who recovered from Covid-19. This condition may be continuous, or symptoms may recur intermittently. 

World Health Organization defines long Covid as “post-Covid-19 condition…” which they say “occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset of Covid-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis”

Are there other names for this condition?

Post-intensive care syndrome, post-viral fatigue syndrome, long haulers, post-Covid condition (used by researchers), long Covid (used by general population)

Some researchers and sufferers have likened this condition to chronic fatigue syndrome, (also known as myalgic encephalomyelitis) which can occur after other infections and also without obvious cause. 

What are the common symptoms?

The symptoms can persist from the initial infection or be of a new onset following the initial recovery. They have a tremendous impact on everyday functioning of an individual. 

The prevalence of these symptoms may vary from individual to individual, depending on various factors. A team collecting information from 32 research studies with 10951 people found that 41% of people had weakness, 25% reported breathlessness and 31% complained of fatigue. (Michelin M and group, BMJ Global Health, 2021) Some of them have difficulty to return to work or perform routine daily activities. 

How common is Long COVID 19 syndrome?

A research team after looking at 45 studies found that long Covid was persistent in three-fourths of people after the Covid infection. (Nasserie T, JAMA, 2021) These symptoms are more common in the older population. In India, data is being gathered with regard to the commonality of this syndrome.

Will I get this syndrome if I am vaccinated?

Vaccination reduces the chances of getting Covid-19 infection and, therefore, reduces the chances of long Covid. 

Why does this syndrome occur?

There may be multiple mechanisms which may contribute to these symptoms. However, the exact mechanism is yet to be identified.

The possible way in which syndrome occurs is unclear. It may be due to persistence of inflammatory response or persistence of virus in the body (rare), as a consequence of organ damage due to the virus or, due to prolonged hospitalisation. Harmful effects of medications used, deconditioning (reduced ability to exert due to illness preventing usual activity), psychological issues similar to post-traumatic stress disorder, or something else may also contribute.

Which group of people are at a higher risk of getting affected?

Women are more likely to develop long Covid compared to men is twice common (reason unknown). Advancing age and presence of multiple comorbidities (obesity, asthma, diabetes and hypertension) seems to contribute to an increased chance of developing long Covid as well. 

Presence of more than five symptoms in the acute stage (even if mild) may be associated with an increased risk of developing long Covid. (Ravindran AV 2021). 

Complications associated with this syndrome?

Respiratory, cardiovascular, gastric, renal, neurological, autoimmune complications have been described in Covid-19 as it is a multi-systemic disease. Complications associated with long Covid, are not well understood. Persistence of the initial presenting complaints have also been described. However, there continues to be an urgent need for research in this area. 

What are the management strategies for this condition?

Though there are clinical guidelines produced by many countries to help clinicians, the available treatment options are limited due to insufficient knowledge of the underlying pathogenesis (disease process) and long-term outcome of long Covid. A multi-disciplinary care team is needed to monitor the patients and identify complications. There is a growing need for the physical rehabilitation, ongoing mental health and social support for the individual. 

Based on the predominant residual symptoms, this syndrome could be further classified as

• Post-Covid cardio-respiratory syndrome
• Post-Covid fatigue syndrome
• Post-Covid neuro-psychiatric syndrome (Ravindran AV 2021)

This categorisation may help to identify the primary reason for the evolving symptoms. All symptoms may, however, need detailed evaluation to rule out any life threatening complications. 

Minor symptoms may be manged symptomatically, worsening of underlying functional status requires optimisation of the ongoing treatment depending on the possible pathophysiology. Regular follow up (teleconsultation or in person review) may be needed, this can be adapted based on the persons’ clinical condition and available resources. There is a need for evidence-based guidelines in this area as more information becomes available and knowledge base continues to evolve as more and more people recover from Covid-19. 

The role of Rehabilitation – can it help me?

Long Covid is associated with weakness, fatigue, breathlessness, concentration impairment, stress and sleep related problems. Rehabilitation is designed to optimize function and reduce disabilities and help with resuming normal activities of daily living. Pulmonary rehabilitation may help in reducing breathlessness and improving exercise tolerance. Exercise therapy improves muscle strength, psychological interventions and cognitive training may help in reducing stress.

Identifying people at risk in the initial phases and offering early mobilisation would also be helpful by limiting the muscle weakness. This would improve their ability to perform daily activities and quality of life. Mental health and social support groups would be helpful in reducing anxiety and stress related problems. Quarantine during the acute infectious period results in profound ‘social isolation’. Hence rehabilitation is only effective when it is comprehensive and includes physical, mental, social and vocational components. (Rehabilitation, World Health Organization 2021). 

When should I seek medical help?

Seek medical help if any of the following occur

• Shortness of breath with minimal activity (which does not improve even with relaxed positions)
• Chest pain, increased heartbeats or dizziness with activity
• Difficulty in speaking or comprehension
• New onset of weakness in face, arm or leg (especially on one side of body)
• Any thoughts of self-harm
• Any other symptom that you feel concerned about

Mr. Lenny Vasanthan T is a Lecturer in Physiotherapy at the Christian Medical College, Vellore, and Researcher at the Lancet Citizen’s Commission on Reimagining India’s Health System; Dr. Bhagteshwar Singh is a Clinical Research Fellow at the University of Liverpool; and Dr Priscilla Rupali is a Professor at the Christian Medical College, Vellore. Views are personal.

(This article is authored by Lenny Vasanthan T, Dr. Bhagteshwar Singh, Dr. Priscilla Rupali)