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Iqra Mazhar

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A Short, Bloody Story About Long COVID

Introduction

The first case of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> came forward in November of 2019. However, it wasn&rsquo;t until March 2020 that the World Health Organization (WHO) declared the outbreak a pandemic.

&nbsp;

Over the past year, several people have begun travelling to countries across Europe. Considering the recent ease in lockdown measures and international travel restrictions, this may not come as a surprise to many people. But what&rsquo;s surprising is the fact that thousands of them are spending all their life savings on these European destinations. Do they need a vacation that badly? Or are they in search of something bigger?&nbsp;

According to a BMJ study, thousands of patients with long COVID are traveling to Switzerland, Cyprus, and Germany for &lsquo;blood washing&rsquo;<a href="#accordion">[1]</a>. While this may sound like a satanic ritual, it&rsquo;s an experimental treatment being offered across private clinics in these countries. Patients report spending &euro;15,000 to &euro;40,000 on the treatment, just for a slight relief of their debilitating symptoms<a href="#accordion">[1]</a>. Although there is a lack of research on blood washing for treating <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a>, long COVID sufferers are desperate. After having their symptoms dismissed by several healthcare professionals, and trying every treatment in the book, they are willing to try anything.&nbsp;

This makes us wonder: how bad could long COVID possibly be that people are willing to travel to far-off locations for an unproven &lsquo;blood washing&rsquo; treatment?

Throughout the pandemic, researchers have discovered significant information on the virulence, transmission, and mechanism of the novel coronavirus (SARS-CoV-2). Thus, with time, COVID-19 has evolved from a respiratory illness to one with multi-system effects. While many of our questions regarding the novel coronavirus and COVID-19 have been answered, several things remain a mystery. One such mystery is long COVID.&nbsp;

&nbsp;

Understanding Long COVID

The first case of COVID-19 came forward in November of 2019. However, it wasn&rsquo;t until March 2020 that the World Health Organization (WHO) declared the outbreak a pandemic<a href="#accordion">[2]</a>. As of 29th July &lsquo;22, the world has recorded more than 57 million COVID-19 infections and 6.3 million deaths<a href="#accordion">[3]</a>.

Typically, a mild or moderate coronavirus infection lasts two weeks. However, in some individuals, the symptoms can persist for months after, or return after recovery. This is called long COVID.&nbsp;

Over the years, researchers have referred to the condition by several names: long-haul COVID, chronic COVID, post-acute COVID-19, long-term effects of COVID-19, and post-acute sequelae of SARS CoV-2 infection (PASC). According to WHO, long COVID develops in people with a history of probable or confirmed coronavirus infection, typically 3 months from the onset of COVID-19<a href="#accordion">[4]</a>. The symptoms last for at least 2 months and cannot be explained by some other illness.&nbsp;

Approximately 10-20% of COVID-19 patients go on to develop long COVID<a href="#accordion">[4]</a>. As per a Lancet study, 1.5% of the UK&rsquo;s population had self-reported long COVID in July 2021<a href="#accordion">[5]</a>. Moreover, the greatest prevalence was reported among people aged 35-69 years. In contrast, the prevalence of long COVID in South-East Asia largely remains unknown; likely due to a limited number of studies. One study in India reported long COVID in 29.2% of patients; another from Pakistan found residual symptoms in 83.7% of patients, even a month after COVID<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

These symptoms are often debilitating and affect one&rsquo;s overall quality of life. The WHO has issued a list of 33 symptoms of long COVID<a href="#accordion">[4]</a>. The most common symptoms are:

<ul>
	<li>Fatigue</li>
	<li>Shortness of breath</li>
	<li>Brain fog&nbsp;or difficulty concentrating</li>
	<li>Headache</li>
	<li>Altered smell or taste</li>
	<li>Sleep disturbances</li>
	<li>Heart palpitations</li>
	<li>Joint or muscle pain</li>
	<li>Menstrual irregularities</li>
	<li>Abdominal pain</li>
	<li>Diarrhea</li>
</ul>

&nbsp;

According to a survey conducted in Pakistan, body aches, low mood, and cough were the most common residual symptom among COVID-19 survivors<a href="#accordion">[7]</a>. Recently, researchers at the University of Birmingham analyzed health records of COVID-positive people in the UK<a href="#accordion">[8]</a>. The study aimed to determine symptoms most commonly present in non-hospitalized patients, 12 weeks after infection. As per the results, loss of smell, hair loss, sneezing, ejaculation difficulties, and reduced libido were the most common long COVID symptoms among the study participants<a href="#accordion">[8]</a>.&nbsp;

But that&rsquo;s not all. Long COVID is also associated with long-term psychological manifestations. A preprint study, analyzing long-term trajectories of psychological symptoms over 22 months of follow-up, reported heightened depressive symptoms and anxiety levels among long COVID patients<a href="#accordion">[9]</a>. Thus, highlighting the importance of mental health monitoring and support for such patients.&nbsp;

&nbsp;

Regardless of whether you have a mild or severe infection, you may be at risk of long COVID. The exact cause behind why the condition develops in some and spares others remains unknown. Moreover, the symptoms and their severity also vary from person to person.&nbsp;

Researchers have proposed various theories regarding the cause of long COVID. While multiple studies are currently underway, the following factors may increase one&rsquo;s risk[10]:

<ul>
	<li>Severe COVID-19 infection</li>
	<li>Underlying health conditions</li>
	<li>Unvaccinated individuals</li>
	<li>COVID-19 re-infection</li>
	<li>Presence of neurological symptoms during acute COVID infection</li>
	<li>Hospitalization or ICU admission during infection</li>
</ul>

However, several cases of long COVID have emerged among healthy individuals without any of the above factors. Therefore, further research is required to gain a deeper understanding of the condition.

&nbsp;

<h4>"COVID infections can lower oxygen saturation. Check out your oxygen levels with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!"</h4>

Researchers hypothesize that the presence of neurological symptoms in long COVID patients points to nerve fiber damage. Therefore, assessing for small nerve fiber damage in the cornea can likely help identify patients with the conditions<a href="#accordion">[11]</a>. However, currently, there is no test to diagnose long COVID in suspected individuals. Moreover, the varying symptoms make it difficult for doctors to correctly diagnose patients.&nbsp;

&nbsp;

&lsquo;Blood washing&rsquo;, also called apheresis, is the process of filtering out individual components of the blood with the help of a machine. It has been used to treat diseases such as sickle cell anemia and leukemia. The procedure involves removing blood through a needle from one arm, passing it through a filtration system, and then returning the filtered blood through a needle into another arm.&nbsp;

In long COVID, doctors use apheresis to remove lipids and inflammatory proteins from the person&rsquo;s blood. Researchers hypothesize that microscopic blood clots, also called micro clots, are to blame for the clogging of capillaries, which then reduces the oxygen supply and leads to long COVID symptoms<a href="#accordion">[1]</a>. Therefore, they propose the removal of inflammatory proteins from the person&rsquo;s blood. Moreover, patients are prescribed blood thinners or anticoagulants along with blood washing. However, the procedure is yet to be proven effective for the condition.&nbsp;

While some people have reported an improvement in symptoms, many have seen no difference. Nevertheless, without any clinical trials, one cannot properly evaluate the procedure&rsquo;s risks and benefits.&nbsp;

&nbsp;

While there is no treatment for long COVID, several prevention strategies can help prevent infections and ultimately post-COVID symptoms. The following is the best way to protect yourself:<ul><li>Wear a mask in crowded areas, especially in indoor settings</li><li>Wash your hands with soap and water</li><li>Cough or sneeze in your elbow</li><li>Get vaccinated against COVID-19</li><li>Avoid close contact with someone experiencing symptoms of COVID-19</li></ul>

Conclusion

Although the novel coronavirus is given a bad name for causing long-term complications, it is not alone. Several other infectious diseases can also have post-infectious sequelae e.g. Epstein-Barr virus (EBV), Lyme disease, Giardia lamblia, and several viral infections. The post-infection sequel in these diseases can result in fatigue, cognitive dysfunction, muscle pain, mood disorders, and neurological symptoms. Furthermore, chronic fatigue syndrome commonly follows viral infections.&nbsp;It is important to acknowledge any new symptoms that may occur after an acute COVID infection, and not dismiss them as a ‘thing in our head’. Moreover, since long COVID can affect anyone irrespective of their health status, it is important to remain cautious of catching the infection. Thus, continue practicing social distancing, wearing a mask, washing your hands, and staying up to date with your COVID-19 vaccines.&nbsp;

Key Points

<ul>
	<li>Long COVID is defined as the persistence of symptoms in a person with a history of COVID-19, usually 3 months from the onset of the infection. Moreover, the symptoms last for at least 2 months and cannot be explained by any other diagnosis.&nbsp;</li>
	<li>The WHO has a list of 33 symptoms of long COVID. Fatigue, shortness of breath, joint or muscle pain, sleep disturbances, brain fog, hair loss, altered taste or smell, and mental health disorders are the common symptoms of long COVID.&nbsp;</li>
	<li>Researchers hypothesize that certain factors may increase the risk of long COVID. These include severe acute COVID infection, underlying health conditions, unvaccinated status, ICU admission, and repeated COVID infections. However, these factors do not explain why long COVID continues to affect people with mild infections or without any of the mentioned factors.</li>
	<li>Due to a lack of available treatments, many long COVID patients have turned to various unproven treatment procedures such as &lsquo;blood washing&rsquo;, or apheresis.&nbsp;</li>
</ul>

&nbsp;

[1] Davies M. Long covid patients travel abroad for expensive and experimental “blood washing” BMJ 2022; 378 :o1671 doi:10.1136/bmj.o1671

[2] Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta bio-medica : Atenei Parmensis, 91(1), 157–160.

[3] World Health Organization. (n.d.). WHO Coronavirus (COVID-19) Dashboard. WHO Health Emergency Dashboard.

[4] World Health Organization. (2021, October 6). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. WHO | World Health Organization.

[5] The Lancet. (2021). Understanding long covid: A Modern Medical Challenge. The Lancet, 398(10302), 725.

[6] BMJ 2022;377:e069676

[7] Qamar, M. A., Martins, R. S., Dhillon, R. A., Tharwani, A., Irfan, O., Suriya, Q. F., Rizwan, W., Khan, J. A., & Zubairi, A. (2022). Residual symptoms and the quality of life in individuals recovered from COVID-19 infection: A survey from Pakistan. Annals of medicine and surgery (2012), 75, 103361.

[8] Subramanian, A., Nirantharakumar, K., Hughes, S. et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med (2022).

[9] Fancourt, D., Steptoe, A., & Bu, F. (2022). Long-term psychological consequences of Long Covid: A propensity score matching analysis comparing trajectories of depression and anxiety symptoms before and after contracting long covid vs short covid.

[10] CDC. (2022, July 11). Long COVID or Post-COVID Conditions - Long COVID or Post-COVID Conditions. CDC.

[11] Bitirgen G, Korkmaz C, Zamani A, et al. Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID. British Journal of Ophthalmology Published Online First: 26 July 2021.

Nimrah H. Sattar

Madeeha Syed

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

The Types Of Covid-19 Variants And The Effects They Have On Your Body

Overview

The year 2020 started with a blast. We all had our new year&rsquo;s resolutions, ready to kickstart a new year with new hopes. It all came crashing down when we heard about the &lsquo;bat virus&rsquo; in China. People went from wearing masks in the operation theatres only to doing so 24/7 even in their houses. Everything shut down, Europeans and North Americans stocked up on toilet paper whereas the rest of the world struggled financially to somehow make ends meet, especially daily wage earners.&nbsp;

All of this caused by a single microorganism, the Coronavirus-19. We&rsquo;ve come a long way since then, with multiple vaccines and their boosters providing some much-needed added protection to our immune system. But since then, this virus too has and continues to evolve, coming up with newer and newer varients from time to time.&nbsp;

&nbsp;

Notable Variants

Here are some of the most notable variants and what is known about them:

<ul>
	<li>Alpha Variant (B.1.1.7): This variant was first identified in the United Kingdom and has since become widespread around the world. It has been shown to spread more easily and quickly than other variants and has been linked to increased severity of illness. Some research has also suggested that the Alpha variant may reduce the efficacy of certain Covid-19 vaccines, though the exact extent of this impact is still being studied. 
	&nbsp;</li>
	<li>Beta Variant (B.1.351): This variant was first identified in South Africa and has since spread to other countries. It has been associated with reduced efficacy of certain Covid-19 vaccines and may be more resistant to immune response generated by previous Covid-19 infections. 
	&nbsp;</li>
	<li>Gamma Variant (P.1): This variant was first identified in Brazil and has since been detected in other countries. It has been shown to be more transmissible and may cause more severe illness than other variants. Some research has also suggested that the Gamma variant may reduce the efficacy of certain Covid-19 vaccines. 
	&nbsp;</li>
	<li>Delta Variant (B.1.617.2): This variant was first identified in India and has since become widespread around the world. Like the Alpha and Gamma variants, it has been shown to spread more easily and quickly than other variants, and may cause more severe illness. Some research has also suggested that the Delta variant may reduce the efficacy of certain Covid-19 vaccines. 
	&nbsp;</li>
	<li>Omicron Variant (B.1.1.529): The omicron variant is of particular concern due to its high number of mutations, which may make it more tranmissble and potentially more resistant to vaccines and previous immunity. Some mutations of the Omicron variant were found to affect the spike protein of the virus. This is the part that allows its entrance in the human cells. However, it is also believed that the variant may cause less severe illnesses compared to the earlier variants.&nbsp; 
	&nbsp;</li>
</ul>

Vaccines

There are currently several COVID-19 vaccines available on the market, including:

<ul>
	<li>Pfizer-BioNTech: This vaccine uses messenger RNA (mRNA) technology to help the body produce a protein that triggers an immune response against the virus. It requires two doses, given 21 days apart. The Pfizer-BioNTech vaccine has shown to be approximately 95% effective in preventing COVID-19. 
	&nbsp;</li>
	<li>Moderna: This vaccine also uses mRNA technology and requires two doses, given 28 days apart. The Moderna vaccine has shown to be approximately 94.1% effective in preventing COVID-19. 
	&nbsp;</li>
	<li>Johnson &amp; Johnson: This vaccine uses a modified virus to deliver genetic material from the COVID-19 virus to the body, triggering an immune response. It requires a single dose. The Johnson &amp; Johnson vaccine has shown to be approximately 72% effective in preventing COVID-19. 
	&nbsp;</li>
	<li>AstraZeneca: This vaccine uses a weakened version of a virus that causes the common cold in chimpanzees to deliver genetic material from the COVID-19 virus to the body. It requires two doses, given 4-12 weeks apart. The AstraZeneca vaccine has shown to be approximately 70% effective in preventing COVID-19. 
	&nbsp;</li>
	<li>Sinovac: This vaccine uses inactivated virus particles to trigger an immune response against COVID-19. It requires two doses, given 2-4 weeks apart. The Sinovac vaccine has shown to be approximately 50.7% effective in preventing COVID-19. 
	&nbsp;</li>
</ul>

All of the vaccines mentioned above have undergone extensive clinical trials and have been shown to be safe and effective in preventing COVID-19. However, the efficacy of each vaccine may vary depending on factors such as age, underlying health conditions, and the prevalence of COVID-19 in the population.

In addition to these vaccines, there are also several other COVID-19 vaccines currently in development or undergoing clinical trials, including vaccines from Novavax, Bharat Biotech, and others.

It&#39;s important to note that even if someone is fully vaccinated, there is still a chance they may contract COVID-19. However, vaccines have been shown to be highly effective in reducing the risk of severe illness, hospitalization, and death from COVID-19.

It&#39;s important for individuals to speak with their healthcare provider about which vaccine may be right for them, as well as to continue following public <a href="https://merisehat.pk/article/clarity-in-my-butter-the-health-benefits-of-ghee">health</a> guidelines such as wearing masks, washing hands frequently, and practicing social distancing.

&nbsp;

Umna Salah

Daily Practices To Adopt To Remain Healthy And Safe!

Pakistan and many other countries are in the grips of a cholera epidemic. This disease has been around for ages, causing several deaths across the globe. The WHO has also declared the monkey pox as a Public Health Emergency of International Concern (PHEIC).&nbsp;

Needless to say, we&rsquo;re living in an era where we cannot afford to let go of the practices we adopted in the early days of dealing with the <a href="https://merisehat.pk/disease/covid-19">Covid-19</a> pandemic. These practices keep us safe from possible infection.&nbsp;

Don&rsquo;t let your guard down just because you think you might not be at risk for contracting other illnesses! As long as you&rsquo;re around other people who could be infected (and most people are), there&rsquo;s always a chance that they could pass it on to you &mdash;especially if they don&#39;t know they&rsquo;re sick yet themselves. Here are some ways to protect yourself: 
&nbsp;

Adopt To Remain Healthy

In this age of coronavirus and cholera, what daily practices can you adopt to remain healthy and safe?

Avoid public gatherings, especially at this time. Avoid crowded places, hospitals, schools, airports, shopping malls, restaurants and theatres as much as possible. Do not travel unless absolutely necessary and avoid being in public transportation such as buses, trains or taxis. 
&nbsp;

It&rsquo;s important to use hand sanitizers as an alternative to hand washing. Hand sanitizers are more effective in removing bacteria, viruses and fungi than soap and water.&nbsp;

If you don&rsquo;t have access to running water, use a paper towel or cloth to dry your hands thoroughly before touching anything else. As for handwashing, a liquid soap antibacterial soap is going to be your best friend since it avoids the bacteria or viruses sitting on the bar of the soap itself, leaving the cleaning practice ineffective in many cases.

As much as possible, avoid touching your face with dirty hands. Your nose and mouth are two of the most common places for germs to enter your system (the third being any open wounds). If your hands are dirty, it&rsquo;s best not to touch those areas until you&rsquo;ve washed them thoroughly with soap and water or used a hand sanitizer. 
&nbsp;

Of course, staying home can be difficult if you feel like you&rsquo;re going through something serious. But it&rsquo;s a good idea to avoid public places such as stores, restaurants, and airports where there may be sick people. It&rsquo;s also a good idea to stay away from anyone who has symptoms of a cough or flu. 
&nbsp;

For example, it&rsquo;s advised not to go to hospitals or clinics where coronavirus cases have been reported as well as in countries where cholera outbreaks are on-going.

If your trip is unavoidable, you should take extra precautionary measures against getting infected: wash hands frequently with soap and water; avoid close contact with people who are ill or have symptoms associated with the new respiratory virus (such as fever, cough); avoid touching your eyes, nose and mouth; eat food that has been cooked thoroughly; drink only boiled or bottled water; do not go near animals (especially cats) without wearing gloves. 
&nbsp;

Here are some other crucial practices to adopt to avoid chances of any infection be it viral or bacterial

Keep A Safe Distance Between You And Other People: Leave adequate space between you and them

<ul>
	<li>Ensure Proper Cleaning and cooking of your food before consumption</li>
	<li>Drink Treated Or Bottled Water: Water is a huge breeding ground for bacteria and in most cases, we do not realize the impact it can have until it is too late.</li>
	<li>Avoid Touching Other People Or Objects That Have Been Touched By Others: Animals and insects like mosquitoes that may transmit infection-causing pathogens.</li>
	<li>Avoid Attending Public Gatherings: Such as concerts and festivals where there are large number of people sharing air-space which increases chances of infection transmission.</li>
	<li>Wear Protective Gear: such as masks to avoid inhaling airborne droplets from other people&rsquo;s sneezes and coughing.</li>
	<li>When You Have A&nbsp;Cold Or Other Respiratory Illness: Wear a surgical face mask and/or eye protection while outside and when around others. Keep your distance from patients with the flu or other infectious diseases.</li>
	<li>Wear A&nbsp;Surgical Face Mask And/Or Eye Protection While Outside And When Around Others:&nbsp; Keep your distance from patients with the flu or other infectious diseases.&nbsp;</li>
	<li>When There&rsquo;s Been An Outbreak Of Cholera: Avoid eating raw or undercooked seafood or food contaminated by water (including ice cubes) that has been contaminated by sewage runoff from another area where there was an outbreak of cholera &mdash; this includes shellfish harvested from coastal waters during this time period (May-November). 
	&nbsp;</li>
</ul>

Bottom Line

And that&rsquo;s a wrap on our health and safety tips! We hope that by using these daily practices, you can stay safe from the threat of disease and illness, whether it be from bacteria or viruses. And remember: if someone does get sick, don&rsquo;t worry too much about yourself &mdash; just keep your hands clean.&nbsp;

Globally, a total number of 14 billion vaccines have been administered as of October 7, 2023 [14]. However, around 5&ndash;50% of survivors continue to experience long-term symptoms<a href="#accordion">[3]</a>. This is because of Long Covid (LC), also known as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), or Post-Covid Syndrome (PCS).

There&rsquo;s a lack of consensus on a definition of LC; however, WHO defines it as:

&ldquo;Diverse symptoms that are present 3 months after initial infection with SARS-CoV-2, which last for at least 2 months, and which cannot be explained by an alternative diagnosis.&rdquo;<a href="#accordion">[4]</a>

The time it takes to recover from LC is extremely variable. Most people recover by 12 weeks and some may end up visiting several doctors before seeing any improvement. The main goal of treatment for LC cases is aimed at symptomatic control with painkillers, antipyretics (for fever), and anti-allergic medications<a href="#accordion">[7]</a>. It&rsquo;s also been noted that the COVID-19 vaccine is extremely effective against developing long-term complications and getting even a single dose can have a protective effect<a href="#accordion">[2]</a>. 
&nbsp;

LC tends to attack multiple systems together<a href="#accordion">[7]</a>. Some people might have a constant barrage of symptoms while others experience a relapsing and remitting course. These can either be new symptoms after initial recovery or they might persist from the initial illness<a href="#accordion">[4]</a>. These include but aren&rsquo;t limited to:

<ul>
	<li>Fatigue, weakness, and activity intolerance</li>
	<li>Breathlessness</li>
	<li>Cough</li>
	<li>Joint and muscle pain</li>
	<li>Chest pain</li>
	<li>Concentration impairment (aka Brain Fog)</li>
	<li>Depression and anxiety</li>
	<li>Sleep disorders</li>
	<li>Loss of smell and taste</li>
	<li>Skin problems such as rashes<a href="#accordion">[6]</a> 
	&nbsp;</li>
</ul>

The complicated case presentation, the variability in symptoms, and insufficient knowledge about how and why it happens tend to hinder the diagnosis, treatment, and predicting recovery timings. This is where biomarkers come into play<a href="#accordion">[13]</a>. 
&nbsp;

Biomarkers are biological indicators, certain substances and cells present in your blood, that can be measured to assess various conditions. Biomarkers are crucial in diagnosing LC as they can offer a quantitative measure of the ongoing symptoms<a href="#accordion">[11]</a> <a href="#accordion">[12]</a>. Blood tests are the most common method for identifying biomarkers. Higher levels of certain biomarkers often correlate with more severe symptoms<a href="#accordion">[9]</a>. These can help predict the likely course of LC, aid in treatment planning, help develop more personalized treatment plans, help assess the effectiveness of treatments, and help discover novel treatment modalities. However, these are not foolproof and can sometimes give false readings. Another setback is that not everyone has access to the advanced tests needed to identify these biomarkers. 
&nbsp;

The most frequently reported biomarkers include:

<ul>
	<li>Interleukin (IL)-6, IL-10, interferon (IFN)-&gamma;, T regulatory cells (Treg) C-reactive-protein (CRP) &ndash; these are linked with inflammation<a href="#accordion">[5]</a> <a href="#accordion">[9]</a>. These are raised in patients with muscle and joint pain, fatigue, sleep disturbances etc.</li>
	<li>&alpha;2 antiplasmin (&alpha;2AP), von Willebrand factor (vWF), D-dimer &ndash; these are linked with blood clotting<a href="#accordion">[6]</a>. These are raised in patients with symptoms such as chest pain. 
	&nbsp;</li>
</ul>

Having a chronic illness with an unpredictable course can not only be frustrating but also lead to loss of work, income, and social interaction. This can lead to a poor quality of life and often results in poor mental health. Furthermore, structural inequalities such as poverty, overcrowding, poor working conditions, poor sanitation, and inability to access appropriate medical help further hinder recovery<a href="#accordion">[1]</a>. Individuals can practice self-management by implementing the following:

<ul>
	<li>Adopt pacing and energy conservation strategies by prioritizing, planning, taking small breaks/daytime naps and avoiding multitasking.&nbsp;</li>
	<li>Practice breath control exercises, for this you can get help from various online resources that help direct your breathing or visit chest physiotherapists.</li>
	<li>Ensure having proper fluids, electrolytes, and a healthy balanced diet.</li>
	<li>Take precautionary measures to avoid falls such as walking aids.</li>
	<li>Smell training can be done by experimenting with different foods and menus to find palatable options.</li>
	<li>Practice sleep hygiene measures such as; structured routines, avoiding shift work, excessive caffeine intake, and blue light exposure.</li>
	<li>Seek talk therapy, group therapy, and meditation.</li>
	<li>Seek immediate medical attention for worsening symptoms such as; breathlessness at rest, chest pain, etc. 
	&nbsp;</li>
</ul>

Recommendations And Suggestions

Healthcare authorities and media organizations can form a synergistic partnership to execute comprehensive public health strategies. Here are some proposed measures: 
&nbsp;

1. Establish clear guidelines for the identification, diagnosis, and treatment of LC for primary care physicians, ensuring that they are well-equipped to address this condition.

2. Adopt or develop guidelines, such as those recommended by the World Health Organization (WHO), for self-management of symptoms like breathlessness and pain. These guidelines can empower individuals to better manage their health.

3. Promote and support workplaces in offering return-to-work resources and accommodations, including flexible hours, ergonomic office designs, and comfortable seating arrangements, to aid individuals in their recovery.

4. Create and sustain support groups and social services aimed at educating and assisting patients, providing them with a strong network to lean on during their journey with LC.

5. Collaborate with healthcare authorities to establish institutional policies, including guidelines for medical leave, that cater to individuals affected by LC.

6. Ensure easy access to essential hand hygiene resources such as hand sanitizers and masks, either at no cost or at reduced prices, to enhance public safety and hygiene.

7. Maintain and reinforce protocols related to physical distancing and sanitation measures, including the use of disinfection tunnels, to prevent the spread of LC and other diseases.

8. Partner with media organizations to disseminate information about LC through various channels, including television broadcasts, official websites, scrolling tickers on TV channels, and printed materials like pamphlets, flyers, and public notices. This will help raise awareness and educate the public about LC and its prevention.

[1] Berger, Z., De Jesus, V. A., Assoumou, S. A., & Greenhalgh, T. (2021). Long COVID and health inequities: the role of primary care. The Milbank Quarterly, 99(2), 519.

[10] Merad, M., Blish, C. A., Sallusto, F., & Iwasaki, A. (2022). The immunology and immunopathology of COVID-19. Science, 375(6585), 1122-1127.

[12] Su, Y., Yuan, D., Chen, D. G., Ng, R., Wang, K., Choi, J., Li, S., Hong, S., Zhang, R., Xie, J., Kornilov, S. A., Scherler, K., Pavlovitch-Bedzyk, A. J., Dong, S., Lausted, C., Lee, I., Fallen, S., Dai, C., Baloni, P., . . . Heath, J. R. (2022). Multiple early factors anticipate post-acute COVID-19 sequelae. Cell, 185(5), 881-895.e20.

[13] Tsilingiris, D., Vallianou, N. G., Karampela, I., Christodoulatos, G. S., Papavasileiou, G., Petropoulou, D., ... & Dalamaga, M. (2023). Laboratory Findings and Biomarkers in Long COVID: What Do We Know So Far? Insights into Epidemiology, Pathogenesis, Therapeutic Perspectives and Challenges. International Journal of Molecular Sciences, 24(13), 10458.

[14] WHO Coronavirus (COVID-19) dashboard. (n.d.). WHO Coronavirus (COVID-19) Dashboard With Vaccination Data.

[11] Peluso, M. J., Lu, S., Tang, A., Durstenfeld, M. S., Ho, H., Goldberg, S. A., Forman, C. A., Munter, S. E., Hoh, R., Tai, V., Chenna, A., Yee, B. C., Winslow, J., Petropoulos, C. J., Greenhouse, B., Hunt, P. W., Hsue, P. Y., Martin, J. N., Kelly, J. D., . . . Henrich, T. J. (2021). Markers of immune activation and inflammation in individuals with postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. The Journal of Infectious Diseases, 224(11), 1839–1848.

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