From breathlessness to 'brain fog', Indian doctors are now up against effects of "long COVID"

To say that we live in strange times would be the understatement of the year. We have started the last quarter of 2020, trying to survive a disease with the label COVID-19, which reminds us that it’s been a year now that we are living in this altered reality. During the year, more than 40 million people have been infected worldwide, and over a million have died. COVID-19 is truly an enigma — every time we feel like the medical community is getting a handle on it, it has the ability to throw a curveball, and set us behind. What is unique to this infection, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV) 2, is the range of its effects- from being asymptomatic to causing death. For the vast majority who survive the illness, a ‘negative swab test’ is an important landmark, suggesting they are over the infection. However, in many patients, that’s not necessarily a signal of well-being, as symptoms and lassitude often remain for much longer . In a recent study, known as the COVID Symptom Study, which looked at more than 4 million people in the US, UK and Sweden after a COVID-19 diagnosis, they defined post-acute COVID-19 as the presence of symptoms, lasting more than 3 weeks from the initial onset of symptoms and chronic COVID-19 as extending beyond 12 weeks. These cases have colloquially been labelled as ‘long-COVID’ . The long-term effects tend to occur in four main body systems: -Pulmonary -Cardiac -Neurologic -Mental health Pulmonary As the name suggests, the virus primarily attacks the lungs, which is why a drop in oxygen saturation is observed, in most patients. One of the possible long term consequences of COVID-19 is pulmonary fibrosis, which is scarring of the lung tissues. Symptoms of breathlessness may persist, with diminished respiratory muscle strength and abnormalities in lung function tests. It’s a good idea to check your oxygen saturation levels on a regular basis, especially after exertion. A simple test to perform is a six-minute walk test. In this, you check your heart rate and saturation levels at rest, and then after walking for six minutes at the quickest pace you are able to sustain comfortably. The heart rate is expected to rise, but saturation levels should remain steady, above 95 percent. Cardiac Vijay Singh (name changed) is a 42-year-old marathoner and long-distance cyclist. He suffered from COVID-19 in early June of this year, and recovered within two weeks. He gradually got back to running, but noticed that he used to tire quicker than before. Also, he felt that his heart was racing, even at relatively low intensity. Initially he put it down to lack of exercise for a while, but when it persisted till September, he decided to get himself checked. The cardiologist labelled it as a case of myocarditis. The heart is made up of muscle, called myocardium. Inflammation of the myocardium is known as myocarditis, and the most common cause is infection with a virus. One of the long term effects of COVID-19 has been myocarditis, which has been seen in studies of even those patients who had mild or no symptoms. The signs and symptoms include chest pain, fatigue, shortness of breath, and abnormalities of heart rhythm. If you find that you are getting irregular heartbeats, commonly referred to as palpitations, please consult with your doctor. An unusually high resting pulse, especially over a 100 beats per minute, should also be reported. The good news is that myocarditis is often reversible, but it’s important to keep a close watch. Neurologic A couple of weeks ago, one of our patients, Rohit Shah (name changed), came to meet us after recovering from COVID-19. Mr Shah, is a 60-year-old stockbroker who prides himself on his photographic memory and the ability to recall numbers and stock prices of almost all the Sensex shares. While noting down his history, I asked him about any travel to other cities and he said he hadn’t been anywhere since six months. His wife was with him, and informed me later that they had gone for a few days to Pune, which he could not recall. He was making simple mistakes at work too, forgetting things which he never would earlier. This is being seen increasing frequently in post-COVID-19 patients, and has been labelled as ‘brain fog.’ Clearly, this affects day-to-day functioning, whether at work or socially. This sets off a chain of events, leading to anxiety or even depression, and the person gets caught in a vicious cycle. One of the common neurological manifestations of COVID-19 is a loss of smell. This is due to the virus invading the olfactory nerve. Often loss of smell, accompanied by loss of taste, lasts for several months. Strokes and seizures are rare, but serious complications do occur. Infection with COVID-19 tends to act as a precipitating factor for strokes in those who are already at high risk for it. Mental health This illness has taken a huge toll on mental health across the world, and not just in those who have been infected.

Besides the physical burden of the disease, the stigma that has often been associated with it and the social isolation has led to a large number of survivors grappling with issues such as anxiety and depression.

Our mental health team has spoken with hundreds of patients, and it found that much like COVID-19’s physical effects, there is a wide range of reactions and effects on the mental health of those infected. Loneliness, which is a terrible disease by itself, is experienced by many patients. That is one of the reasons why I dislike the term social distancing. I prefer calling it physical distancing, which in any case, is the scientifically accurate term for what’s needed to keep the illness at bay. The take-home message is that we need to be forever alert when dealing with this virus, which seems to be changing colours faster than a chameleon. While we do know that physical distancing, mask wearing and hand hygiene are our current strongest weapons in the fight, we need to be alert even after recovery. The road to recovery should include a focus on physical, mental and social well-being, which also happen to be the three pillars of the World Health Organisation’s definition of health. The author is Director, Rehabilitation and Sports Medicine at the Sir HN Reliance Foundation Hospital, Mumbai.