Home / Opinion / The recovery path from ‘long covid’ is getting clearer

I was finishing my last consultation of the day when an old patient of mine rang me up for an urgent appointment. She said that she was experiencing unfamiliar and unexplainable symptoms, ranging from low mood to vague body pains and difficulty in doing her daily chores. A previous marathoner, she would now feel out of breath after walking slowly for just half a kilometre. She could not even match her dad’s pace during their evening strolls. She was stunned. Two months prior, she had tested positive for covid and had a rather aggressive course of illness. It was very likely that she was among the so-called ‘long-haulers’.

Long covid has a range of symptoms that can last weeks or months after first being infected. It can appear weeks after infection and can happen to anyone who has had covid, even if the illness was mild or free of symptoms. People with long covid report different combinations of the following: persistent tiredness, difficulty thinking or concentrating (sometimes referred to as “brain fog"), headache, loss of smell or taste, dizziness while standing, a pounding heart or abnormal awareness of one’s own heartbeat (palpitations), chest pain, shortness of breath, cough, multiple joint or muscle pains, anxiety, mood changes and fever.

It is important to differentiate anxiety from Inappropriate Sinus Tachycardia (IST), both of which can be secondary effects of covid and present themselves with a racing heart and palpitations. Their management is vastly different. A basic cardiac examination of post-covid patients with new-onset palpitations and tachycardia should be considered to rule out IST.

Researchers have analysed data from the Covid Symptom Study app to discover who is most at risk. Older people, smokers, women, obese individuals and those who had five or more of the aforementioned symptoms in the first week of covid illness were more likely to develop long covid. Around 10% of people aged 18-49 and 22% of people aged over 70 are likely to develop long covid. This study analysed half a million adults in England who reported having covid between September 2020 and February 2021. Larger studies incorporating the socio-demographics of the Indian population are needed to establish predictors.

Covid has a range of effects on our organ systems. Multi-System Inflammatory Syndrome (MIS), a condition in which different body parts get swollen, is being seen in post-covid patients. Autoimmune disorders are conditions wherein the body starts to attack itself. The immune system attacks healthy cells by mistake, causing painful swellings in the affected parts. Many feel better in some weeks, and most make a full recovery in 12 weeks. That said, in some people, the symptoms can last longer. With only limited data available as of now, it is difficult to arrive at a definitive conclusion about long covid leading to chronic health conditions. Some reports also mention the possibility of it lasting up to a year, but this is only in some vulnerable individuals.

The road to recovery, in some patients, can seem long. Do not get discouraged. Every individual’s body responds differently. Urgent medical attention should be sought if there is a sudden new-onset chest pain that persists and is accompanied by nausea, vomiting, sweating or shortness of breath, or a chest pain that is accompanied by loss of consciousness.

Do not over-exert yourself. Pace yourself for recovery. Break down longer tasks. Do the harder ones during that time of the day when you feel your energy levels are higher. Frequent bursts of rest are better than a few longer stretches of it. Gradually increase the amount of exercise that you do. Start with short walks or minimal- strength training exercises, and build up from there. Practise breathing exercises and build up their intensity slowly.

Diet, nutrition, exercise, yoga and meditation form a powerful combination to deal with any kind of stress, and not just long covid. Lockdowns have taught us that we can survive without junk food. Stick to home food, and include fresh fruit, green leafy vegetables, and adequate amount of protein in your diet. Once you have gained sufficient strength, regular yoga can boost the levels of the brain-derived neurotrophic factor (BDNF), which influences one’s cognition, mood and mental well-being. The Centers for Disease Control and Prevention in the US recommends 150 minutes of moderate-intensity or 75 minutes of vigorous exercise per week.

If it gets overwhelming, it is important to reach out to mental health professionals. There is no shame in reaching out to them. To deal with stress, stick to a healthy diet, manage regular sleep-wake schedules, get sufficient exercise, reach out to friends, and avoid unhealthy coping mechanisms such as turning to alcohol, smoking or any other substance that can be misused.

A combination of low-dose medications and psychotherapy for those with clinical depression and anxiety after covid can do a world of good. These medications are given only for 6-9 months and then gradually tapered off. Not addressing mental health problems runs the risk of these disorders becoming chronic and intractable.

Alok V. Kulkarni is senior consultant psychiatrist at Manas Institute of Mental Health, Hubli

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