Mumbai: Must find means to tackle long COVID, says medical experts

Medical experts call union health minister’s warning against strenuous activity in light of severe COVID as just the tip of the iceberg, call on the govt to screen recovered patients and create robust data across the country

Union health minister Mansukh Mandaviya recently hinted at the long COVID impact and advised recovered citizens to refrain from strenuous activities. Health experts termed Mandaviya’s warning as the tip of the iceberg. In the USA and many European countries, disabilities due to long COVID are recognised by the Social Security Administration. However, India has not yet made such provisions. With potentially thousands of long COVID cases going unrecognised and with no data available, the situation appears grim. The BKC COVID Centre was the only jumbo centre in the country to screen discharged patients for long COVID. Over 13,000 patients were screened between September 2020 and March 2022 (see box).

Effects of long COVID

Almost 20-30 per cent people experience health problems long after having acute COVID-19. While most recover within a few weeks, those wild mild infection or unvaccinated people might have generalised multi-organ symptoms for a long time. Each time a person gets infected or reinfected, their chances of getting long-COVID increase.

“Common symptoms of long COVID syndrome include fatigue, fever, brain fogging (low concentration, poor cognitive actions, irrational thinking), and lung symptoms; neurological symptoms or mental health conditions, including difficulty in thinking or concentrating, headache, sleep problems, dizziness when standing, pins-and-needles feeling in arms and legs, loss of smell or taste, and depression or anxiety; joint or muscle pain, heart symptoms or conditions, including chest pain and fast or pounding heartbeats, digestive symptoms, including diarrhoea and stomach pain, and blood clots and blood vessel (vascular) issues. Most symptoms, such as a rash and changes in the menstrual cycle are difficult to differentiate from pre-existing medical conditions,” said Dr Subhash Hira, professor of global health at University of Washington and member of pandemic consultative committees of WHO.

Duration unclear

Dr Hira added, “Those with severe COVID-19 might experience organ damage affecting the heart, kidneys, skin and brain. Inflammation and problems with the immune system can also happen. It isn’t clear how long these effects might last. They could also develop new conditions like diabetes, or heart or nervous system issues. Over 22 per cent of young and middle-aged doctors in the US stopped their careers short due to the debilitating effects of long COVID. The same is being reported for other professional and manual workers. Unless people reveal their sufferings to disability boards, they might do more harm than good to communities.”

Research, line of treatment

According to Dr Hira, research has offered some insight but not enough to provide a solid understanding of long COVID’s progression. This knowledge is necessary to develop treatments. Testing to detect long COVID may comprise liver and renal function tests, immunologic markers (serum ferritin, D-dimer, CRP, IL-6), WBC and platelet counts, ESR, lipid profile, blood sugar, and LDH. “Treating symptoms and organs involved in long COVID has helped patients. Steroids have helped in lung symptoms. Metabolic disorders have been relieved with metformin,” Dr Hira said.

“The Union Health Minister rightly hinted at the tip of the iceberg when he spoke of the deaths during garba in association with COVID infection in the past. India is yet to decide on providing disability allowance for long COVID. In the US, around 80 per cent of adults with long COVID report limitations in performing daily activities,” added Dr Hira.

“While the US government has established 400 clinics to manage long COVID, India needs to explore ways to screen cases in urban and rural areas. Roping in NGOs and online telemedicine might be cost-effective,” said Dr Hira.  

Not one illness

According to Dr Ketan Vagholkar, Professor of Surgery, DY Patil Medical College, there is no single test that accurately determines if persisting symptoms are due to COVID. “Long COVID is not one illness. The diagnosis is based on health history, including the fact that the person had COVID-19. Living with long COVID can be hard, especially when there are no immediate answers or solutions. Estimates on the proportion of people having long COVID are variable. Since there is a lack of comprehensive authentic data, most of the countries are unable to include this syndrome in the disability list,” Dr Vagholkar said.

‘Need separate criteria’

Dr Rajesh Dhere, dean of BKC COVID Centre and nodal coordinator for all jumbo centres, said, “For long COVID cases, there is no harm in bringing in permanent/temporary disability. However, there should be a separate set of criteria formulated by competent authorities to deal with this. It is also advisable that a separate SOP be formulated for screening long COVID cases. Doctors who extensively worked in COVID care centres, can be roped in.”

30%
Proportion of people who may suffer long after acute COVID

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