Explore the lasting effects of COVID-19 with Meri Sehat. Learn about Long Covid symptoms and coping strategies for a healthier recovery.

Long Covid - The Lingering Effects Of COVID-19

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

As of 5:57pm CEST, 25 October 2023, there have been 771 million confirmed cases of COVID-19 reported to WHO. Globally, a total number of 14 billion vaccines have been administered as of October 21, 2023<a href="#accordion">[14]</a>. 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;

Sign and Symptoms

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: 
&nbsp;

<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;

What Are Biomarkers?

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;

<h5>Common Biomarkers In Long Covid</h5>

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> [9]. 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>

Guidelines and Recommendations

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 <a href="https://merisehat.pk/article/Mental%20Health">mental health</a>. 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: 
&nbsp;

<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<a href="https://merisehat.pk/article/the-healing-power-of-meditation-easing-depression-from-within"> meditation</a>.</li>
	<li>Seek immediate medical attention for worsening symptoms such as; breathlessness at rest, chest pain, etc. 
	&nbsp;</li>
</ul>

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.

[2] Ceban, F., Kulzhabayeva, D., Rodrigues, N. B., Di Vincenzo, J. D., Gill, H., Subramaniapillai, M., Lui, L. M., Cao, B., Mansur, R. B., Ho, R., Burke, M. J., Rhee, T. G., Rosenblat, J. D., & McIntyre, R. S. (2023). COVID-19 vaccination for the prevention and treatment of long COVID: A systematic review and meta-analysis. Brain Behavior and Immunity, 111, 211–229.

[3] Chen, C., Haupert, S. R., Zimmermann, L., Shi, X., Fritsche, L. G., & Mukherjee, B. (2022). Global Prevalence of Post-Coronavirus Disease 2019 (COVID-19) Condition or Long COVID: A Meta-Analysis and Systematic Review. The Journal of Infectious Diseases, 226(9), 1593–1607.

[4] Clinical Services and Systems. (2021). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021.

[5] Dennis, A., Wamil, M., Alberts, J., Oben, J., Cuthbertson, D. J., Wootton, D., ... & Lord, J. M. (2021). Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study. BMJ Open, 11(3), e048391.

[6] Espín, E., Yang, C., Shannon, C. P., Assadian, S., He, D., & Tebbutt, S. J. (2023). Cellular and molecular biomarkers of long COVID: a scoping review. EBioMedicine, 91, 104552.

[7] Greenhalgh, T., Sivan, M., Delaney, B., Evans, R. A., & Milne, R. (2022). Long covid—an update for primary care. BMJ, e072117.

[8] Health Workforce and Service Delivery (HWD). (2021). Support for rehabilitation: self-management after COVID-19-related illness, second edition.

[9] Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., ... & Cheng, Z. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497-506.

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

[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.

[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.