The long and short of long Covid

The effect of long Covid adds to the burden on healthcare that is overwhelmed by the spate of waves of the pandemic due to the virus and its mutating variants, writes Dr Srivatsa Lokeshwaran

Since the start of the pandemic, patients recovering from acute Covid-19 infection have been increasingly reporting symptoms as a result of the fallout of multi-organ involvement by the SARS-CoV2 virus which persists well beyond the acute period and sometimes lasts for as long as six months. The effect of long Covid adds to the burden on healthcare that is overwhelmed by the spate of waves of the pandemic due to the virus and its mutating variants. There have been a host of responses in the international community to tackle long Covid, with 40 odd clinics dedicated for long Covid opened up by the NHS and workshops conducted by the National Institute of Allergy and Infectious Disease to educate physicians on the symptoms and signs of the syndrome. As the ACE receptors or the entry point of the virus is distributed far and wide on many organs in the body it doesn’t come as a surprise that the long-lasting effects of the virus can present with a gamut of symptoms due to the various organs inflicted. The most common symptoms of long Covid are breathlessness and fatigue. The other possible symptoms can be elaborated as.

Respiratory system: Breathlessness, cough.

Cardiovascular system: Chest tightness, chest pain and palpitations.

Neurological symptoms: Brain fog (cognitive impairment), headache, sleep disturbances, delirium and pain in the peripheral nerves.

GI symptoms: Loss of appetite with nausea and diarrhoea.

Musculoskeletal symptoms: Joint pain and muscle pain.

Skin rashes.

Depression or anxiety.

Generalised symptoms like fatigue, fever and pain.

ENT symptoms like loss of taste or smell.

Such patients with characteristic signs and symptoms presenting to the physician would require a holistic assessment and a battery of tests to ascertain the underlying problem. It would include routine blood tests, checking the heart with ECG, echocardiogram, lung function test, 6-minute walk test, tests to determine autonomic dysfunction. In view of the chronic nature of the problem, the management approach should be directed at self-management or supportive self-management of symptoms. Potentially life-threatening complications like pulmonary thromboembolism, stroke and acute cardiac events must be identified early and treated promptly at specialist centres. Treatment of long Covid requires a multi-disciplinary approach including evaluation, symptomatic treatment, and treatment of underlying problems, physiotherapy, occupational therapy and psychological support. Symptoms like a cough can be treated symptomatically using anti-tussive agents determining the underlying cause and targeting therapy. Myalgia is treated with analgesics and physiotherapy. We have also seen that rehabilitative services play a central role and are being increasingly utilised by patients with chronic myalgia and neuromuscular sequelae. Streamlining this care and channelising patients into these services plays a vital role in faster recovery and optimum results.
(The author is an interventional pulmonologist.)