Uttam Maharjan

THE COVID-19 pandemic has not shown any sign abatement ever since it first emerged in China in December 2019. If anything, the second wave of the pandemic has been wreaking havoc with Nepal and the rest of the world. Only seven countries have remained unaffected by the disease: North Korea, Turkmenistan, Kiribati, Tonga, Palau, Tuvalu and Nauru.
Most COVID-19 patients are recovering even without medication. As per data, only a little over two per cent of the patients have died of the respiratory disease on a global scale. In Nepal, the fatality rate is a little over one per cent. However, those who have recovered from the respiratory contagion may still be suffering from malaise or discomfort associated with the disease for weeks or months. This is the case of long COVID. Long COVID is the condition in which the symptoms of COVID-19 persist in the patients for over 12 weeks or four months from the initial illness. Some consider the persistence of the symptoms for over eight weeks to be long COVID.

Symptoms
The symptoms of long COVID include a cough, dyspnoea (shortness of breath), fatigue, headaches, anosmia (loss of smell), ageusia (loss of taste), myalgia (muscle aches), arthralgia (joint pain), mild fever, anxiety and depression, palpitations, angina (chest pain), cognitive dysfunctions and so on. Long COVID may affect many parts of the body: the heart, brain and intestines. It may also cause pins and needles, numbness and brain fog (inability to think or focus). Long COVID may also induce respiratory system disorders, nervous system disorders, neurocognitive disorders, mental health disorders, cardiovascular disorders, gastrointestinal disorders and other conditions like anaemia. It may be noted that other viral illnesses may also have long-lasting effects, which are called sequelae in medical parlance.
Long COVID has not been fully understood. Medical scientists are studying the condition. However, they have hyphothesised some contributory factors to the condition. The major causes outlined are permanent damage to the heart and lungs, post-intensive care syndrome, post-viral fatigue (myalgic encephalomyelitis and chronic fatigue syndrome) and persisting COVID symptoms. Other causes identified include the virus overstaying the usual time due to a weak immune response, reinfection, damage caused by inflammation and a strong immune response to the infection, physical deconditioning for lack of exercise during the period of illness and post-traumatic stress or mental sequelae.
The risk factors associated with long COVID are age, obesity, asthma and the existence of other symptoms besides a cough, fatigue, headaches, diarrhoea and anosmia in the first week of the infection. Other risk factors include chromosomal genetics, sex-dependent differences in immune system behaviour and non-biological factors.
Older people, women and those showing other symptoms over and above the five symptoms (a cough, fatigue, headaches, diarrhoea and anosmia) as described above in the first week of the infection are considered vulnerable groups. Further, people with underlying medical conditions such as asthma, cardiovascular ailments and diabetes mellitus are also prone to long COVID. What is more, long COVID has been seen even in children. Fatigue, a cough, headaches, myalgia, anosmia, ageusia and the like are seen in some children even after five weeks of the initial infection. In fact, long COVID can affect anyone, whether older people, youths or kids, or whether they have underlying medical conditions or not. However, women are more likely to develop long COVID than men although they are less likely to develop severe acute COVID. This is due to hormonal differences.
Long COVID may have grave implications. Those affected by this condition may have their regular activities hampered, affecting their performance. A survey by the UK Office of National Studies shows that ten per cent of COVID patients show one or more symptoms of long COVID for over 12 weeks. In the United Kingdom, three out of five COVID patients have regular work hampered and one out of five has regular work greatly affected. The study conducted by the UK's National Institute for Health Research shows that eighty per cent of the patients suffering from long COVID have their working capacity impaired and one third have their regular income slashed.
It is imperative to cope with not only COVID-19 but also long COVID, the byproduct of the former. The persistence of long COVID in working groups may affect the economy of a country. Even in Nepal, some people who have recovered from COVID-19 have complained that they are still feeling the symptoms of the respiratory disease. It can be surmised that long COVID is also affecting some people in this part of the world but no studies have been conducted in this regard.

Action plan
The government and employers can collaborate to draw up an action plan to cope with long COVID experienced by employees. Work from home and flexible timetables for work could be some of the means for dealing with long COVID. On the other hand, health facilities designed for dealing with long COVID should be set up. The Netherlands has formulated a joint action plan in collaboration with employers to deal with long COVID cases. In the USA, the National Institutes of Health (NIH) has launched a research initiative with a funding of USD 1.5 billion for the treatment of long COVID. Likewise, in the UK, the National Health Service has set up a network of long COVID-dedicated clinics.
It has been speculated that the treatment of long COVID is not only costly but also complicated as the condition may undermine the immune system, cause arthritis and damage particular tissues of the brain. Rehabilitation of long COVID patients through treatment is essential. It not only improves the health of the patients but also lessens the impacts of the condition on the economy. In fact, managing long COVID is a challenge not only in developed countries like the USA and the UK but also in poor countries like ours. Anyway, it is imperative to cope with both long COVID and COVID-19 simultaneously.

(Former banker, Maharjan has been regularly writing on contemporary issues for this daily since 2000. uttam.maharjan1964@gmail.com)