The Covid-19 pandemic is posing one challenge after another as it continues to rage across different parts of the world. We first overcame the challenge of the scarcity of personal protective equipment and diagnostic tests. We are now slowly overcoming the challenge of the rapid surge of cases witnessed during the second wave. We have vaccines to protect us against moderate to severe illness. We have genomic surveillance tools to detect variants of concern. We are now preparing ourselves for a possible waning of immunity over time with talks about booster doses of vaccines.

Even as we continue to deal with the many facets of the novel coronavirus, “Long Covid” is slowly emerging as a challenge that the world is preparing itself to face says Dr. Krishna Reddy Nallamalla, President, InOrder, Country Director, ACCESS Health International.

After testing positive for Covid-19, people with symptoms normally see a complete recovery to good health following an acute infective illness over a few days. However, nearly one-third of patients across the world who had Covid are being found to experience symptoms and not feel well even after as long as three months. Long Covid is becoming the widely accepted term globally for this puzzling phenomenon. While symptoms noticed up to three months after the Covid illness are labeled as the post-Covid phase, symptoms persisting beyond three months are being grouped and labeled as Long Covid.

The symptoms experienced by patients are highly variable, ranging from a general sense of feeling unwell to specific symptoms like breathlessness, palpitations on minimal exertion, extreme weakness and fatigue, mind fog, sleeplessness, and generalized aches among others. Many people are unable to resume their professional engagements due to continuing symptoms greatly impacting their productivity. In some cases, patients with mild illness or asymptomatic infection are also developing symptoms of long Covid.

Ongoing research on long Covid has been throwing up various hypotheses but without a specific underlying pathology. Few patients, especially those who had a prolonged stay in intensive care, are presenting with symptoms that mimic post-traumatic stress disorder (PTSD), a condition that is known to commonly affect war veterans. Few patients have definite underlying pathology like lung fibrosis, decreased heart and kidney function, damage due to blood vessel clots, etc., that resulted either from the virus, hyperimmune response, hypercoagulable state, secondary infections, or irrational use of drugs. Autoantibodies are being implicated in some cases. Autoantibodies result when the immune cells mistake self-proteins as foreign due to unknown reasons. The persistence of the virus in the gut is also being studied as a possible cause.

Whatever may be the underlying mechanism, long Covid is a reality that the world is currently being faced with. It not only has implications on health systems but also on various other social systems. As of 25^th July, India has recorded a total of 31.37 million reported cases of Covid-19. As per the fourth national serosurvey conducted by the Indian Council of Medical Research, nearly two-thirds of Indians have evidence of antibodies against Covid, i.e., nearly 900 million people might have been infected in the past. While we can project a possibility of ~10 million long Covid cases (assuming one-third of positive cases only) as per recorded cases, we still do not know how many of mildly symptomatic or asymptomatic infections will end up developing long Covid.

The country should make plans to face the reality of long Covid in terms of the increased healthcare needs. This is likely to put increased pressure on the existing capacity, lead to a significant rise in health costs, and decreased productivity with an associated economic impact on families and on the nation as a whole. The country should invest in research to understand long Covid better so that specific therapies can be developed. It should increase the financial protection for the poor, against both impoverishing health expenses as well as loss of jobs and productivity.

People should be made aware of long Covid so that they know how to handle it and are sympathetic to those afflicted by it. Physicians should keep abreast of scientific developments on the subject so that they can apply appropriate therapies to mitigate the burden of long Covid. Employers should be sensitized about it so that they are empathetic in their response towards affected employees. Policymakers should be made aware of it so that they make appropriate policies to mitigate its impact on the country and its people.

About the author- Dr. Krishna Reddy Nallamalla, President, InOrder, Country Director, ACCESS Health International