It was late August. Twenty-four hours after attending to novel coronavirus patients, Ravinder Singh was sitting in his drawing room when he started feeling a little feverish. He dismissed it, blaming months of extreme exhaustion. The next morning, the thermometer showed 102 degrees Fahrenheit. Dr Singh instantly realised he had brought the virus home from west Delhi’s Guru Teg Bahadur Hospital. As the deputy medical superintendent there, he knew what to do, and retreated to a bedroom to quarantine.
A few days later, after testing positive for covid-19, he checked into an isolation ward. By mid-September, he was back in office, supervising the administration. One afternoon, a few days later, while searching for a file in a drawer, he suddenly forgot what he was looking for. “In a flash! And then the lapses became a bit regular. I used to forget where I kept my things, especially in the second half of the day. Like a mental fog,” says Dr Singh, 43, describing his first week back at work.
Even worse was the crushing fatigue. There were days when he would spend an hour just trying to move towards the bathroom. He was beginning to lose confidence.
“First the experience of isolation in the covid ward and then these lingering symptoms despite recovering…it’s like one hit after another,” he says. After checking with his doctor, he learnt he was a “long-hauler” or had “long covid”, a condition in which people continue to wrestle with alarming symptoms of covid-19 for weeks or months, even though they test negative for the novel coronavirus.
It has been more than nine months since SARS-CoV-2, the virus that causes covid-19, brought the world to its knees, yet there’s so much we still don’t understand about it. We do know thousands of people might not be showing any symptoms despite being infected, but we are still not clear why many patients, including young ones who did not require hospitalisation, are struggling with post-covid complications like severe fatigue, cognitive issues, short-term memory loss, body pain, sleeplessness, rashes, inflammation, erratic heart rate, diarrhoea, anxiety, even depression.
Though post-viral symptoms are common, what makes long-covid unique is the broad spectrum of symptoms and their duration. One theory blames this on the deep impact of the virus on the immune system, but scientists and health professionals believe there’s more to it.
“Covid is such a new disease that it’s very difficult to know about its long-term consequences right now,” says Anubhav Bhushan Dua, a neuropsychiatrist at Delhi’s Rajiv Gandhi Super Speciality Hospital. In August, it became the country’s first government hospital to have a ward dedicated to long-covid.
Since then, hospitals across cities, such as the All India Institutes of Medical Sciences and Apollo hospitals, have started offering consultations for long-covid.
A long road ahead
Of the 500-odd patients who have visited the Rajiv Gandhi hospital with complaints of long-covid, 30% have had neuropsychiatric problems, including loss of smell and taste, delirium and hyperventilation, says Ajit Jain, head of cardiology and nodal officer for covid-19 at the hospital. “This (long-covid) is going to become a serious concern and we are not giving it the attention it deserves. The only silver lining right now is that people are slowly recovering from it. But there are still many out there who are not reporting it. We might be staring at a major public health crisis if we don’t start talking about it more.”
Research published in the British Medical Journal in August says about 10% of those infected suffer from long-covid. A small April-May study of 143 patients in Italy, the first epicentre of the outbreak in Europe and the second in the world after Wuhan in China, found “87.4% reported persistence of at least one symptom, particularly fatigue and dyspnea”. These findings were published in the Journal Of The American Medical Association.
Dr Dua estimates that 30-40% of patients across India might be suffering from long-covid—a calculation he bases on personal experience, the number of people who have reported the condition at the Rajiv Gandhi hospital, and worldwide research.
As many studies internationally are currently tracking post-covid symptoms, it will take a year or two to fully understand the phenomenon. The biggest challenge for India is that there’s no way to know the spread and intensity owing to the dearth of follow-up and incomplete data on the number of people afflicted by the virus. “There’s no strong data with us (the health authorities),” says Dr Dua. “Forget coming forward for post-covid, people are still not reporting covid because of social stigma.”
Shama B., 52, was one of them. She delayed her hospital visit for three days in September despite running high fever and experiencing mild breathlessness. She was afraid of the “covid poster”, the now discontinued practice of health authorities sticking home isolation posters outside the homes of patients. “Log bahot baatein kartein hai, madam (people say too many things),” says Shama, who doesn’t want to share her surname. She still doesn’t want relatives and neighbours to know.
After some pressure from her 21-year-old son, however, she got herself tested and was admitted to a Mumbai government hospital. Three weeks later, she returned home with a negative report in hand, along with persistent body ache, loss of smell and high blood pressure. Like Dr Singh, she also suffered short-term memory loss. “Raat sabse mushkil hoti thi (the nights were the most difficult),” recalls the homemaker and mother of three, referring to the time spent in hospital and the days following her discharge.
For two weeks, she thought it was a result of the lonely, anxiety-filled nights she had spent in the isolation ward, and hoped things would improve. “Mujhe hospital wapas nahi jaana tha (I didn’t want to go back to hospital).” The third week, she called her doctor and was diagnosed with long-covid. After 14 days of medicines, including antioxidants and vitamins, and yoga, she says she’s feeling better.
“There’s no clear-cut treatment for post-covid,” says Dr Dua. “We are giving medicine based on the symptomatology, and high-protein diets are being encouraged for building the immune system.” Meditation and yoga are highly recommended, adds Dr Jain. “Any form of exercise is a must. The emotional impact of these long symptoms is so deep that it can affect mental health. In fact, doctors worldwide are preparing themselves for an epidemic of mental health crisis after covid.”
Dr Singh has been having antioxidants and vitamins and following a high-protein diet for two months—all the things his doctor advised. “I am still not back to my former self. I don’t know if I ever will be.” The thing with covid-19, he says, is “you need time to understand it. And time is what we can’t afford.”