RESIDUAL PANDEMIC

There is a huge number of people who have defeated COVID-19, but continue to suffer its debilitating long-term effects RAVLEEN KAUR IN SURAT, GUJARAT

RAVLEEN KAUR IN SURAT, GUJARAT

PRIYA RANJAN SAHU IN BHUBANESWAR, ODISHA

SANSKRITA BHARADWAJ IN GUWAHATI, ASSAM

MEGHA PRAKASH IN DEHRADUN, UTTARAKHAND

G RAM MOHAN IN TIRUPATI, ANDHRA PRADESH

MOHD IMRAN KHAN IN PATNA, BIHAR

GAJANAN KHERGAMKER IN MUMBAI, MAHARASHTRA

KA SHAJI IN THIRUVANANTHAPURAM, KERALA

Back in 2009, Anthony S Fauci, immunologist and chief medical advisor to the US president, wrote in The New England Journal of Medicine: “We are living in a pandemic era that began around 1918 [the 1918-20 influenza pandemic].” The paper Fauci co-authored with two other influenza experts analysed all the pandemics—in 1957, 1968 and 2009—and seasonal epidemics caused by the influenza virus since then. It shows that the 1918 virus has persisted in humans for nearly a century and has been evolving, with its descendants and lineages inflicting huge economic and health costs on millions.

The world fears a repeat of the past. Will the novel coronavirus that causes COVID-19 also linger on?

Two years after the outbreak of the disease, the world has started grappling with a parallel pandemic. Millions who have recovered from COVID-19 say they still face a myriad health problems months, even years, after being infected by the virus. Doctors have listed nearly 300 such effects, which are quite wideranging: respiratory, neurological and gastroenterological. People complain of shortness of breath, muscle pain, fatigue, cough, headache, joint pain, chest pain, diarrhoea and an altered sense of smell and taste. Other persistent symptoms include “brain fog” that makes one’s ability to think sluggish and fuzzy, memory loss, disordered sleep, palpitation and sore throat. Rare cases of selfharm, suicides and seizures have also been reported. Most of the symptoms are observed after the infection has clinically ended.

While the world has tracked the pandemic in terms of people affected and recovered, the rise in cases of recovered patients with such a long list of ailments has largely been ignored. However, it has emerged as the starkest sign of the virus’ continuance in our body. Some call this new health crisis post-COVID syndrome while some have named it post-acute sequelae of SARS-COV-2 (pasc). Doctors also refer to those having persistent illness with one or more symptoms of the infection as “long haulers”. But the most common name for this condition the world over is “long COVID”. A report titled “A clinical case definition of the post-COVID-19 condition by a Delphi consensus”, released by the World Health Organization (who) on October 6, 2021, defines it thus: “Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-COV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.”

As of December 11, 2021, the world had 243 million people who recovered from COVID-19—meaning, three in every 100 people in the world have the viral infection. India has 3.4 million recovered people. In a study published on November 16, 2021 on the free online server for unpublished manuscripts medRxiv, researchers from the University of Michigan, US, estimate that some 100 million of COVID-19-recovered people have been enduring long COVID. The researchers reviewed 40 studies from some 17 countries on the lingering effects of COVID-19 to conclude this. They estimate that 40 per cent of the COVID-19 survivors suffer from the side effects, or have long COVID. The rate increases to 57 per cent for those who were hospitalized for COVID-19. The study also says 49 per cent of the recovered women havelong COVID while for men it is 37 per cent.

With more cases, the size of the recovered population also increases. This means the probability of more people suffering from long COVID also rises. Calculations show that currently we have more long COVID patients than those getting the infection itself.

The world has geared up for this crisis. In January 2021, who revised its guidelines for COVID-19 treatment to include a recommendation that all patients should have access to follow-up care in case of long COVID. In February 2020, the US National Institutes of Health declared a major four-year-long research initiative into “post-acute sequelae of COVID-19”, spending $1.15 billion. The UK’s National Institute for Health Research has also started four studies on long COVID.

INDIA’S RESPONSE

In the last week of July 2020, India’s Union Ministry of Health and Family Welfare asked its Joint Monitoring Group to frame guidelines on managing long-term complications arising from COVID-19. This group advises the ministry on responses to various health events. A study on recovered patients supported by the Union government’s Science and Engineering Research Board flagged the criticality of an organised follow-up of recovered patients. “It needs to figure out [sic] if the virus-mediated organ damage completely improves on recovery? In order to determine the actual consequences of the condition, it is essential to maintain follow-up studies on patients, and it will help to determine diseases at initial stages and allowing medical intervention in a timely manner. Moreover, this could provide enough comparative data among patients worldwide to determine the effects of COVID-19 on different populations,” says the study published in Science of The Total Environment on August 10, 2020.

In September 2021, the Centre released the National Comprehensive Guidelines for Management of Post-COVID Sequelae. This was the first official document to acknowledge long COVID and showed the government’s acceptance that the problem needed special attention. “Up to 20%-30% of patients hospitalized with severe COVID-19 have evidence of myocardial involvement manifested by elevated troponin levels, venous thromboembolism, heart failure and arrhythmias,” states the document. “Chest pain has been reported in ~20% of COVID-19 survivors at sixty-day follow-up. Palpitations have reported in ~10% of COVID-19 survivors at sixty-day follow-up. Ongoing chest pain and palpitations have been reported in 5% and 9% respectively at six-month follow-up post acute COVID-19. Stress cardiomyopathy is 4-5 times more common during the COVID-19 pandemic when compared to pre-pandemic periods (7.8% versus 1.5-1.8%). Myocardial inflammation detected on cardiac mri was found in as many as 60% of affected people more than 2 months after a diagnosis in one study,” it says.

In Surat district of Gujarat, Ayurvedic general practitioner Jaykar Vyas, who has been treating COVID-19 patients, is perplexed at the persistence of long COVID. On December 3, 2020, he was discharged from the hospital after a stay of 75 days for COVID-19. A year later, when Down To Earth (DTE) met him in December 2021, he was still on 24-hour oxygen support, could not eat on his own and needed assistance to sit or walk. This is after he had been through seven months of physiotherapy. “So severe was the nerve damage that I could not hold a spoon. Eating more than half a chapati made me vomit,” he says.

For Vyas, it was a second brush with a grave health emergency. He had earlier been treated for a year for tuberculosis. A borderline diabetic, when Vyas was admitted to the hospital on September 20, 2020, for COVID-19 his lung involvement (systemic inflammation and progressive scarring of the lungs) was recorded at 30 per cent, a dire condition. “Starting with 5 litres per minute, his oxygen support increased to 100 litres per minute on the 25 th day when his oxygen levels dipped to 65 per cent. That is when he was shifted to ICU. Steroids made his sugar level shoot up to 300mg/dL,” says Kardam, his son. “I attribute my recovery to my patients who prayed day and night for me,” says Vyas.