‘The long shadow of Long Covid has taken its toll on mental health,’ expert says

ALONG with the Covid-19 pandemic, it’s Long Covid that has emerged as the new challenge for the medical fraternity.

Brain fog, anxiety, constant fatigue, breathlessness, depression, muscle weakness, sleep difficulties, palpitations, joint pains or discomfort, and chest pain, are some of the signs and symptoms of Long Covid that continue or develop after acute Covid-19, affecting people’s ability to resume normal life and a capacity to fulfill their personal, social and professional commitments.

With still no definite consensus on how different Long Covid is from other viral syndromes, no measured medical markers for diagnosis, and no proven treatments or roadmap for recovery, the condition is now a growing public health concern. Parul talks to Dr Debasish Basuprofessor and head of the Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, to discuss the neuropsychiatric symptoms of Long Covid, the probable causes, how psychological factors like fear and uncertainty may play an added role and how these should not be dismissed as happening, ‘all in the mind.’

How would you define Long Covid?

Long Covid was not initially a medical disease term. It was generated by some patients who had initially suffered from Covid, but persisted with some symptoms or started having new symptoms long after the infection, usually weeks to months. So, it was called ‘Long Covid.’

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Initially, it was only popularized by Covid sufferers on social media platforms. Medical science took serious notice of it very late and lately there is a lot of research going on. Medically there are many other terms such as, ‘Post acute Covid-19 syndrome’ or ‘Post-acute sequelae of Covid-19’. The World Health Organization (WHO) calls it the ‘Post Covid-19 condition.’ However, Long Covid is the common term that is now accepted by medical authorities in the UK, USA, and India.

The WHO defines post-Covid-19 condition as, “The illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; Usually within three months from the onset of the disease, with symptoms and effects that last for at least two months. The symptoms and effects cannot be explained by an alternative diagnosis.”

The minimum duration of symptoms beyond acute Covid-19 to qualify as Long Covid varies from three weeks to three months and beyond. Typically, acute Covid
symptoms subside within two to three weeks, hence any symptoms persisting beyond that tend to be clubbed as Long Covid. more strict criteria,
like that of the WHO, demand that the symptoms should last beyond at least two months.

The most common symptoms are persistent fatigue, shortness of breath, and lack of concentration or mental slowness (brain fog). Long Covid also affects many systems and organs, including the heart and blood vessels, lungs, kidneys, joints, gastrointestinal system, and immune system in general.

How common is Long Covid?

Long Covid, however loosely or strictly it is defined, is quite common. Following Covid-19, around one in three people have been found to have Long Covid, even in those with mild variants of the disease that does not require hospital admission.

The global prevalence of Long Covid, according to the latest and largest synthesis of data from all over the world, is 43 per cent.

However, the figures can go much higher for those with severe Covid needing hospital care, the elderly, females, and with comorbid physical conditions — up to 60-70 per cent.

What are the psychological implications of Long Covid?

People feel very tired all the time, lacking in energy, and easily tired. They may feel that their mental sharpness is impaired and that they have difficulty focusing, remembering, recalling, doing mental math, or organizing things in their mind.

They often have difficulty doing two or more things together in their mind or holding information for use shortly. These symptoms are often referred to as ‘brain fog’.

Many also suffer from anxiety, which is partly explainable by their fear of having the disease again. This may occasionally become excessive and interfere with daily functioning.

What are the neuropsychiatric symptoms of Long Covid that you have observed?

Fatigue, sleep disturbances, cognitive impairment of various types as mentioned above, mood changes like irritability or sadness, anxiety, and rarely, delirium, dementia, or post-traumatic stress disorder. Headache or a sense of fullness of the head is also common. Neurological symptoms may consist of persistent lack of smell (anosmia) or taste (ageusia), tingling and numbness (paresthesia), or muscle weakness. The long shadow of Long Covid has taken its toll on mental health.

What causes these symptoms?

We do not know for sure. There are a number of factors that have been suspected, giving rise to many theories.

One is the persistence of the virus in the body, which then drives the immune system to cause persistent inflammation in the body parts.

Another is an autoimmune phenomenon, whereby parts of the body organs are ‘fooled’ to be perceived as foreign agents, hence mounting an immune response against themselves.

Yet another is the alteration in the normally resident flora of microbes (viruses, bacteria, protozoa, etc) in the gut by the infection. Psychological factors like fear and uncertainty may play an added role in some of the Long Covid symptoms, but I need to emphasize that these symptoms are real for the patients, causing distress.

So these should not be dismissed as happening ‘all in the mind.’

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How long do the symptoms last?

Again, we still do not know because the syndrome is still evolving and it’s only two years since the onset of the pandemic. Yes, some of the earliest sufferers of Covid from the first wave still show symptoms. The frequency and severity of the symptoms generally decreased from three to six months though, but more research is ongoing. A recent study from France reported that 85% of Long Covid sufferers still had symptoms even after one year.

Are mental health symptoms linked to physical symptoms as well?

Yes, but only partly. Physical symptoms may explain (partly) fatigue and insomnia, but not anxiety or mental slowness.

Compared with patients with a range of other medical events, do Covid sufferers have a higher rate of mental illness?

Covid is associated with higher rates of mental symptoms compared to other similar medical conditions, such as lung infections or other viral infections. However, we cannot say that yet for Long Covid. We need more data.

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