Corona Daily 014: Long Covid: Part One

The pandemic is now over 18 months old. Out of the nearly 200 million coronavirus cases, 15 million are currently active, either isolated, or in hospitals; asymptomatic, mild or serious. Out of the remaining 185 million cases, called closed cases, over 4 million have died. The surviving 180 million+ are classified as recovered. 2% of the closed cases have died. 98% have recovered.

Sequela is a medical term that describes a condition resulting from a disease, injury or other trauma. The disease or trauma is over, but a chronic condition follows as its consequence. A rape victim may feel a post-traumatic stress disorder for years. That disorder is a psychological sequela of rape.

Long Covid is a long term sequela of Covid-19. No pandemic dashboard gives you the “Long Covid” patient numbers. If not dead, patients are classified as recovered.

Not all of them have recovered.

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In July 2021, there was a flood of articles on Long Covid. Enough time has passed to understand covid’s “longness”. When the pandemic started, many thought covid would be similar to flu – once over, everything would be fine.

In May 2020, Melissa Heightman started the UK’s first post-Covid clinic. BBC’s David Cox talked to her at length. More than a year after setting up the clinic, one third of the clinic’s patients are still unwell, and mostly unable to work. More than half the clinic’s patients were never hospitalized for covid-19.

The clinic regularly gets patients, relatively young, without comorbidities or health conditions. Most of them had a mild covid infection. However, after the virus supposedly leaving their bodies, their new ailments continue for weeks or months.

The most common long covid symptom, experienced by 80% of Heightman’s patients, is a crippling fatigue, making even the simplest tasks difficult to execute. Research studies elsewhere find persistent fatigue in 62% of long covid patients.  Scientists now estimate that one in every 10 covid patients will still have symptoms 12 weeks later. (Despite testing negative).

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The medical fraternity classifies the long covid patients into two groups: those who were admitted to a hospital and those who weren’t. Ironically, doctors find it easier to manage the patients who were hospitalized. As a rule, their lungs or heart were damaged by an acute viral infection, or the damage was caused by cytokine storm, where an overreacting immune response attacks the patient’s own tissues. CT (computerized tomography) and MRI (magnetic resonance imaging) scans clearly show the extent of the damage. Drugs such as colchicine are used to treat the lingering inflammation. It takes up to six months to see improvements in the scans. Except those who were in the ICU for a long time, all are expected to have no permanent abnormality.

The non-hospital patients display a puzzling variety of symptoms. Dr Heightman says the peak age for this group is 35-49, and some surveys have identified 98 different symptoms. The top ones are fatigue, brain fog, muscle and joint pain, sleep disturbances, migraines, chest pain, skin rashes, sensitivities to smells and tastes, and dys-autonomia, a rare condition causing rapid, uncomfortable increase in heartbeat during any activity.

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Globally, there are still very few clinics like Heightman’s. PLRC (Patient-Led Research Collaborative) is a self-orgnised group of “Long Covid” patients who share their symptoms and experiences. They published two papers last year. Anyone suffering from long covid is welcome to join the group.

Their recent survey presents a depressing picture. Out of 3,762 long covid patients, 77% still experienced fatigue after six months, 72% struggled with post-exertion discomfort and pain, 55% suffered from cognitive dysfunction and 36% of female patients experienced issues with their menstrual cycles. Hannah Wei, one of the PLRC leaders, said her own cycle disappeared for three months.

For many non-hospital long covid patients, symptoms came and went in three different waves. (Wave 1): dry cough and fever. (Wave 2): dysautonomia for about two months. (Wave 3): skin rashes, muscle pain, new allergies and brain fog. Usually happening four months after the initial infection, this wave just keeps going.

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Tomorrow, I will write about the different theories around this mystery. What may be causing Long Covid?

Ravi