Doctors In India Face Challenges Treating Long Covid Due To Lack Of Adequate Research

Doctors in India are grappling with the challenge of diagnosing and treating long Covid patients due to a lack of clear medical guidelines and comprehensive research. As the world shifts focus from the pandemic to recovery, attention is now on the persistent and unexplained symptoms seen in many COVID-19 survivors. Although the World Health Organization (WHO) declared the end of Covid-19 as a global health emergency in May 2023, long Covid remains a significant concern globally, including in India, as the condition continues to affect millions of people.

Long Covid refers to a range of lingering symptoms that persist well beyond the acute infection phase. Common symptoms include fatigue, muscle and joint pain, brain fog, difficulty concentrating, and respiratory issues such as a persistent cough. These symptoms can affect various parts of the body and significantly impact a person’s quality of life, even after the initial COVID-19 infection has cleared.

Globally, studies suggest that about one-third of people who experienced moderate or severe COVID-19 infections may suffer from long-term Covid. However, the prevalence of the condition varies across regions. According to a study by researchers from Harvard Medical School, approximately 31 per cent of people in North America, 44 per cent in Europe, and 51 per cent in Asia have experienced long Covid symptoms. The study, published in the International Journal of Infectious Diseases in September 2023, highlighted that long COVID-19 is overwhelming healthcare systems, with limited guidelines for diagnosis and treatment.

In India, the situation is particularly challenging due to the scarcity of studies on long Covid. One notable study, conducted by Maulana Azad Medical College in New Delhi, examined 553 patients who had recovered from Covid-19 between May 2022 and March 2023. The findings revealed that 45 per cent of participants continued to experience lingering symptoms, with persistent fatigue and dry cough being the most common. The study, published in Cureus in May 2023, emphasized the need for further research into the long-term effects of COVID-19 to develop effective management strategies and optimize healthcare delivery.

In India, the understanding of long Covid is still evolving, with many healthcare professionals acknowledging the difficulty in diagnosing and treating the condition. According to Dr Rajesh Sagar, a professor of psychiatry at the All India Institute of Medical Sciences (AIIMS), New Delhi, the current state of research on long Covid in India is insufficient to provide a clear understanding of the condition. "It is too premature to say that we fully understand how to diagnose or treat long Covid," Dr Sagar said.

The need for focused research on the neurological complications of long-term COVID-19 is also critical. Animesh Samanta, an assistant professor at the School of Natural Sciences at Shiv Nadar University, Greater Noida, noted that while some studies in India have shown the neurological symptoms experienced by long Covid patients, more research is needed to understand the underlying causes, particularly neuroinflammation.

Doctors across the country have reported an increase in patients presenting with symptoms they never had before contracting Covid-19. For instance, individuals who never had asthma are now experiencing prolonged bouts of coughing, shortness of breath, and wheezing after recovering from COVID-19. These patients often require the use of inhalers or nebulizers to manage their symptoms, according to Dr Neetu Jain, a senior consultant who runs a post-Covid care clinic at Pushpawati Singhania Hospital and Research Institute, New Delhi.

Another concerning trend is the rise in stroke cases among young patients without any known risk factors such as diabetes, hypertension, or obesity. Dr Arun Garg, chairman of neurology and neurosciences at Medanta-The Medicity in Gurugram, noted that the incidence of encephalopathy, a condition characterized by brain swelling and confusion, has also increased. These patients often experience a confused state of mind after a mild fever, yet their MRI scans show no abnormalities.

One of the biggest hurdles in managing long-term COVID-19 is the absence of standardized diagnostic tests. Currently, doctors rely on non-specific tests and questionnaires to assess a patient’s "quality of life" and detect potential long Covid symptoms. "We don’t have a definitive test for long Covid, though it is recognized as a clinical diagnosis," said Dr Jain. "We diagnose long Covid in people who had moderate to severe infections and have not regained their pre-Covid quality of life."

Blood tests to check for inflammation markers, such as C-reactive protein (CRP), are commonly used to support the diagnosis of long-term COVID-19. In some cases, doctors are finding rare antibodies in patients that were not present before their COVID-19 infection, suggesting that these antibodies may be linked to the long-term effects of the virus.

Persistent inflammation is believed to play a key role in long-term Covid. However, there are no tests specifically designed to measure the immune response driving this inflammation. Researchers globally are working to develop diagnostic tools, such as a fluorescent probe developed by a team at Shiv Nadar University, which detects nitric oxide levels in brain cells. Elevated nitric oxide levels in microglia cells, which are immune cells in the brain, have been linked to SARS-CoV-2 infection and may indicate ongoing inflammation.

Despite some advancements in understanding long Covid, there is still much to learn. According to the Harvard Medical School study, 587 clinical trials have been conducted worldwide on long-term COVID-19, with 55 of these trials taking place in India. However, only 11 of these trials have published conclusive results. The researchers stressed the need for more studies on interventions targeting sleep disorders and other biological processes associated with long-term COVID-19.

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