Covid-19: Did the WHO act in haste?

Arthralgia or pain in the joints is also a symptom of long Covid. Representation pic

On May 5 the World Health Organisation (WHO) declared that Covid-19 no longer constitutes a global public health emergency. However, health experts have expressed concerns about the urgency to make such an announcement, especially at a time when Covid cases are still on the rise in certain countries including India. They have also expressed concerns over long Covid ailments, which continue to impact those affected even two years later, as also reported in a Swedish study published in Lancet in its May and February editions.

Covid has not gone away

Dr Wiqar Shaikh, professor of medicine, Grant Medical College and Sir J.J. Group of Hospitals, says he is taken aback by the decision of the WHO. "Covid has not yet gone, and the recent surge of cases in China and in India provides ample evidence. In the past 7 days, the WHO has reported more than 4 lakh cases worldwide," Dr Shaikh said.

He quoted an article from journal Lancet of February 23, which talked about a study on 165 patients of Covid-19 at the University of Linkoping, Sweden. Patients were studied for continuing symptoms or repeated symptoms over a 2-year period. Approximately 21% of patients were readmitted to hospital for various causes. Cognitive symptoms, disorders of the sensory system, muscle disorders and fatigue were the most common symptoms persisting after 2 years. In fact, he said more than 200 symptoms have been identified in long Covid, impacting multiple organs of the body. Interestingly, the study did not find any difference in symptoms between patients who had recovered after being treated in ICUs and recovered non ICU patients.

Also Read: WHO downgrades Covid-19, says no longer an emergency

Dr Shaikh also quoted a similar study published in the journal Nature Reviews on January 13, 2023, which concluded that at least 10% of Covid patients suffer from "long Covid". The study estimated that 65 million individuals worldwide suffer from long Covid and these numbers are rising. Dr Shaikh recalled an article in mid-day dated October 4, 2021, in which he had quoted a study from the University of Oxford, which had studied 2.73 lakh patients and concluded that 37% of Covid sufferers suffer from long Covid. Dr Shaikh concluded that in the light of all these findings, it was premature for WHO to make the declaration.

‘Large variety of symptoms'

"The concept of ‘post-Covid-19 disease' was labelled by WHO expert committees. A large variety of symptoms, as many as 65, were reported, including mental fatigue, affective emotional symptoms, cognitive deficits, breathlessness, palpitations, etc. There are conflicting reports regarding risk factors for persistent symptoms of post-Covid infection, with some studies indicating that those with Covid severity and the female gender are at higher risk," said Dr Subhash Hira, professor of global health at University of Washington-Seattle and member of health committees of G20. "The cause of post-Covid is attributed to the virus hiding in body sanctuaries such as the inner eye, spine, testes etc. and it is frequently released and causes inflammatory reactions in multiple organs. The virus debris deposits also cause brain fog. India has the daunting task of handling millions with post-Covid," he added.

Latest study

Dr Hira said, "A Swedish study published in the Lancet in May 2023 showed follow up findings among 745 patients with a positive PCR for SARS-CoV-2 recruited between March and May, 2020, in Region Östergötland. Four months after acute Covid-19 and vaccines against it, over 40% experienced persisting symptoms indicating post-Covid-19 condition. The majority of patients ie 84% reported persisting problems affecting everyday life for up to 24 months. Cognitive, sensorimotor, and fatigue symptoms were the most common persisting symptoms at 24 months. No clear difference was evident between individuals treated in the intensive care unit (ICU) and non-ICU-treated individuals. Approximately half of these were on sick leave even at 24 months. Patients required long-term follow-up and therapeutic rehabilitation."

Generic terms

"The other terms for long Covid are Post-Acute Sequelae of SARS-CoV-2 infection (PASC) and Post-Covid-19 Conditions (PCC). It's a generic term for a wide range of health consequences that can be present four or more weeks after infection with SARS-CoV-2, the virus causing Covid-19. The prevalence may vary from 5%-25% in patients. The symptoms include breathlessness on effort, fatigue, myalgia (pain in muscles), insomnia, mood changes, cognitive decline, brain fog, cough, chest discomfort, arthralgia (pain in joints), erectile dysfunction, menstrual irregularities, etc. Citizens must consult their physician if they experience any of these symptoms," said Dr Ketan Vagholkar, professor of surgery at DY Patil Medical College.

Symptoms of long Covid

>> Photophobia (irritation to light), difficulty reading/blurred or double vision, difficulty watching fast moving objects; headache
>> Weakness in arms/legs, difficulty walking, driving car, performing personal chores like bath, dressing; altered body sensations
>> Difficulty remembering/finding word/concentratingmulti-tasking/expressing thoughts when speaking/mental slowness, increased sleep
>> Feeling anxious or depressed
>> Difficulty swallowing
>> Muffled sentences, difficulty understanding speech
>> Sleeplessness, irritability, phobias, nightmares

- Courtesy: Dr Subhash Hira