I was finishing my last consultation that day when an elderly patient of mine called me for an urgent appointment. She said she was experiencing unfamiliar and unexplained symptoms, ranging from low mood to unexplained body aches and difficulty doing her daily chores. A former marathoner, she will now feel out of breath after running slowly for only half a kilometer. She could not even match her father’s speed during evening walks. She was shocked. Two months ago, he had tested positive for COVID and the disease had an aggressive course. It was quite possible that she was one of the so-called ‘long walkers’.
Long-term covids have a variety of symptoms that can last for weeks or months after being first infected. It can appear weeks after infection and can happen to anyone who has covid, even if the disease is mild or free of symptoms. People with chronic covids report various combinations of the following: persistent fatigue, difficulty thinking or concentrating (sometimes referred to as “brain fog”), headache, loss of smell or taste, standing Dizziness, pounding heart, or unusual awareness of oneself, heart palpitations (palpitations), chest pain, shortness of breath, cough, pain in several joints or muscles, anxiety, mood changes, and fever.
It is important to differentiate anxiety from inappropriate sinus tachycardia (IST), which can both be a secondary effect of COVID and present itself with a racing heart and palpitations. Their management is very different. A basic cardiac examination of post-COVID patients with new-onset palpitations and tachycardia should be considered to exclude IST.
Researchers have analyzed data from the Kovid Symptom Study App to find out who is most at risk. Older people, smokers, women, obese individuals and those who had five or more of the above symptoms in the first week of COVID illness were more likely to develop COVID for a longer period of time. Around 10% of people in the age group of 18-49 and 22% of people over the age of 70 are likely to develop covid for a long time. The study analyzed half a million adults in England who reported having COVID between September 2020 and February 2021. Larger studies involving socio-demographics of the Indian population are needed to establish the predictors.
COVID has a huge impact on our organ systems. Multi-system inflammatory syndrome (MIS), a condition in which different parts of the body swell, is being seen in post-Covid patients. Autoimmune disorders are conditions in which the body starts attacking itself. The immune system mistakenly attacks healthy cells, causing painful swelling in the affected areas. Many feel better in a few weeks, and most make a full recovery in 12 weeks. That said, in some people, symptoms can last longer. With only limited data available so far, it is difficult to reach a definite conclusion about long-term covid, which leads to chronic health conditions. Some reports also mention the possibility of it lasting up to a year, but it occurs only in some vulnerable individuals.
The road to recovery may take a long time in some patients. Don’t be disappointed. Each person’s body reacts differently. Immediate medical attention should be sought if sudden new-onset chest pain persists and is accompanied by nausea, vomiting, sweating or shortness of breath, or chest pain that accompanies loss of consciousness.
Don’t overwork yourself. Pace yourself to recovery. Break up long tasks. Work hard during those times of the day when you feel your energy levels are high. It’s better to have repeated bursts of rest than a few long stretches of it. Gradually increase the amount of exercise you do. Start with short walks or minimal-strength training exercises, and build up from there. Practice breathing exercises and gradually build up their intensity.
Diet, nutrition, exercise, yoga and meditation make a powerful combination for dealing with stress of any kind, not just for long periods of time. The lockdown has taught us that we can survive without junk food. Stick to homemade food and include fresh fruits, green leafy vegetables and adequate amount of protein in your diet. Once you gain enough strength, regular yoga can increase levels of brain-derived neurotrophic factor (BDNF), which affects one’s cognition, mood, and mental well-being. The Centers for Disease Control and Prevention in the US recommends 150 minutes of moderate-intensity or 75 minutes of vigorous exercise per week.
If it becomes overwhelming, it’s important to reach out to mental health professionals. There is no shame in reaching out to them. To cope with stress, stick to a healthy diet, manage a regular sleep-wake schedule, get enough exercise, reach out to friends, and avoid unhealthy coping mechanisms such as alcohol, smoking, or abusing any other substances. , which can be misused.
A combination of low-dose medications and psychotherapy can do a world of good for people with clinical depression and post-Covid anxiety. These drugs are only given for 6-9 months and then gradually reduced. Failure to address mental health problems puts these disorders at risk of becoming chronic and incurable.
Alok V. Kulkarni is Senior Consultant Psychiatrist at Manas Institute of Mental Health, Hublik
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