Covid-19 cases might have gone down but long covid remains

Twenty-two-year-old Alina Raut recovered from Covid-19 three months ago, yet she still feels its lingering effects. 

“Sometimes, I feel out of breath for no reason. I can no longer work long hours. My body feels weak and I am constantly exhausted,” said Raut.

Binit Bana, a 30-year-old filmmaker and writer, has also been going through something similar ever since he contracted the coronavirus. 

“I tested positive twice and since the second infection, which was during the second wave, it has been difficult to get back to the same routine. I get exhausted easily these days and experience shortness of breath even walking up four floors,” said Bana. 

With an average of just about a dozen new cases every day, the immediate threat of Covid-19 appears to have subsided in Nepal. Vaccines and precautionary measures have returned daily life to normalcy but for the many who contracted Covid-19, symptoms continue to persist, a condition that has come to be known as ‘long covid’.  

“Usually, the side effects of the coronavirus persist even after testing negative because it takes time for the virus to die down. PCR tests will come negative when the CT value is above 30, but this doesn’t necessarily mean that the body is free of the virus,” said Dr. Prem Pandey a physician at Alka Hospital and a consultant with the government’s Covid-19 Crisis Management Coordination Center (CCMC). “Long covid, however, can be understood as Covid symptoms that persist for more than three months.” 

With a spike in new cases across the border in India and in parts of China, and with local elections nearing, there are fears that Nepal too could see a significant rise in Covid-19 cases. But Nepal’s low number of daily cases and relatively high vaccination rate, at over 67 percent of the total population, could prevent another significant wave. A pressing concern now is understanding and dealing with long covid. 

According to a new study by researchers from the University of Michigan, more than 40 percent of Covid-19 survivors, which means over a million people, across the world have had or continue to have long-term effects even after recovering. Such data is currently unavailable in Nepal but doctors report anecdotal evidence of patients coming to them with persistent symptoms even after recovering from Covid-19.

“I had witnessed the increasing trend of long covid during the first and second waves. A patient had come to me after six weeks of getting discharged complaining about shortness of breath,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Teku’s Sukraraj Tropical and Infectious Disease Hospital.

According to Pun, long covid isn’t fully understood but its symptoms can include irregular heartbeat, hair loss, brain fog, and exhaustion.

“British experts consider long COVID as an infection that persists for more than three weeks. American experts think it persists beyond four weeks while WHO believes it to persist for three months,” he said.

WHO defines long covid as a “post COVID-19 condition [that] occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.” However, according to WHO, more than 200 symptoms have been reported in patients including chest pain, trouble speaking, muscle aches, fever, loss of smell, and loss of taste. One study even suggests that long covid may affect the brain, with a slight shrinkage in size visible after infection. Another suggests some people with long Covid develop lung abnormalities.

This condition is tougher on the elderly. Elderly patients suffering from diabetes and stroke have a more difficult time recovering and can even develop lung fibrosis, said Dr Pandey. Aside from physical effects, patients also experience changes in their mental health and even go through anxiety and depression.

That doesn’t mean young people are let off easy. 

“I was infected thrice and that too after immediately testing negative for the previous infection. I am young and recovered comparatively faster than my family, but it was frightening. I never expected that it would take me such a long time to heal. I still don’t have a sense of smell,” said Shishir Wagle, a 23-year-old student.

Pranjali Kanel, a 22- year-old student, also reported feeling exhausted most of the time having difficulting concentrating. 

“I have been experiencing brain fog,” she said.

Given the diversity of symptoms and the fact that long covid is still not understood very well, there’s no real treatment. The best thing to do is to exercise, keep a balanced diet, be careful and alert, and seek medical help when the symptoms get too strong, say doctors. 

“I have heard that Bir Hospital has started a clinic dedicated to post-Covid assistance but I don’t know if people have visited it,” said Dr. Pun, who believes that more research on post-Covid effects is necessary, especially in Nepal.

With Covid-19 cases at an all-time low, people are now slowly accepting that the worst has passed and the pandemic is over. But doctors say that we have to remain vigilant. 

“The vaccination process across the country is still not completed, and we cannot assume the decrease of cases to be the end of Covid-19. We still need to be cautious and take precautions,” said Dr. Pandey.

It is also important to remember that two years of a pandemic have affected thousands of people in myriad ways, which are often not visible. While many have stopped wearing masks in public and have gone back to life as normal, for many, normalcy will remain impossible for a long time to come. 

“I know of a distant family member who lost both his sons to Covid-19,” said Wagle, the 23-year-old student. “ His life is now forever changed. It will take years to get over that mental trauma.”