Doctors in India Struggle to Treat Long Covid Amid Research Shortcomings
Limited Guidelines Hinder Effective Management
Healthcare professionals in India are facing significant challenges in diagnosing and treating long Covid patients due to a lack of comprehensive treatment guidelines. The World Health Organization's announcement in May 2023 that Covid is no longer a global health emergency has not led to adequate focus on the long-term effects of the virus, leaving many patients with unresolved symptoms.
Prevalence of Long Covid Symptoms
Long Covid encompasses a range of lingering symptoms that can affect multiple body systems, including chronic cough, muscle and joint pain, debilitating fatigue, and cognitive difficulties often referred to as "brain fog." Research suggests that approximately one-third of individuals who experienced moderate to severe Covid infections may develop long Covid, with the prevalence varying regionally. A study involving researchers from Harvard Medical School indicated that the rates of long Covid are 31% in North America, 44% in Europe, and alarmingly 51% in Asia.
Scarcity of Local Research
In India, however, research on long Covid remains limited. A notable study conducted by Maulana Azad Medical College from May 2022 to March 2023 revealed that nearly 45% of the 553 patients surveyed reported persistent symptoms, primarily fatigue and dry cough. The authors emphasized the urgent need for more exploratory research to understand long Covid better and to improve management strategies.
Expert Opinions Highlight Research Gaps
Dr. Rajesh Sagar, a professor at AIIMS in New Delhi, remarked that the current state of long Covid research in India does not provide sufficient understanding for effective diagnosis and treatment. Similarly, Dr. Animesh Samanta from Shiv Nadar University pointed out the necessity for focused studies on neuroinflammation in long Covid patients, as many individuals are experiencing new neurological complications post-infection.
Emerging Symptoms Reported by Patients
Clinicians have observed a rise in patients presenting with symptoms they did not experience prior to their Covid infection. For instance, Dr. Neetu Jain noted that some individuals, previously free from asthma, are now encountering persistent cough and shortness of breath following respiratory infections. Dr. Arun Garg from Medanta-The Medicity has also reported an increase in stroke cases among younger patients without known risk factors, as well as cases of encephalopathy that seem to arise suddenly after mild fevers.
Challenges in Diagnosis
In the absence of clear medical guidelines for diagnosing long Covid, healthcare providers are often forced to rely on broad, non-specific tests and patient questionnaires to evaluate quality of life. The fatigue associated with long Covid has been likened to that experienced by cancer patients, with affected individuals exhibiting a quality of life comparable to those with Parkinson's disease. According to Dr. Jain, diagnosing long Covid typically involves identifying patients with a history of moderate to severe infection who cannot return to their pre-Covid quality of life.
Research Initiatives Underway
Amid these challenges, researchers are making strides in understanding the mechanisms underlying long Covid. A team at Shiv Nadar University has developed a fluorescent probe to detect inflammation in brain cells caused by Covid infection. This tool measures nitric oxide levels in microglial cells, the brain's immune cells, which play a role in the body’s response to infection.
Global Research Landscape
As of now, the World Health Organization International Clinical Trials Registry Platform indicates that there have been 587 clinical studies related to long Covid, with approximately 53% testing potential treatments. While many of these studies are conducted in the United States, India is also a significant contributor with 55 trials underway, exploring various interventions, including physical exercise, psychotherapy, and pharmacological treatments like Paxlovid and fluvoxamine.
Conclusion
Despite the increasing recognition of long Covid, the path forward necessitates more focused research efforts and the establishment of clear medical guidelines to provide effective management and support for those affected by this complex condition.