The wave we are witnessing today is washing away lives, hopes, and future promises.

We are seeing acute cases of Covid in such large numbers. The daily count in India surpassed 400 thousand in early May. . We are focussing on testing, treating the Covid positive patients but there is a Tsunami of patients who have recovered and suffering from post covid symptoms.
Post covid symptoms are not just related to any of the places where the infection had stuck. People have thoroughly recovered from respiratory issues and gained back their aerobic strength. But there are many symptoms to which the health care system is inattentive. Some of these symptoms include Tiredness, Extreme fatigue, difficulty in concentration or brain fog, irritability. These symptoms are classified as Long covid along with other physiological ones.

Neuropsychiatric symptoms in covid recovered patients.


We now focus on the symptoms that affect our productivity.

We all have become familiar with the Spanish flu of 1918 which devastated the world a century ago. Now we are walking the same lane. Coronavirus whose ancestry is traced back to the Spanish flu has very similar symptoms mimicking as flu and affecting the respiratory system but was very lethal. Spanish flu ransacked the world and affected the whole worlds economy not just by the dreadful pandemic but also the chronic fatigue which it left.


Tanganyika(modern-day Tanzania)

After the Spanish flu receded it left many with extreme tiredness and mental exhaustion. In Tanzania it helped cause a famine because so many people were too debilitated to pick the harvest. This famine had domino effect in after years.

PCS is effecting working age adults, and it is dragging for months.

While similar symptoms have been recorded in Covid-19 recovered patients, its nature of effects is still evolving. Experts have called it POST-COVID SYNDROME (pcs) and defined it as signs and symptoms that develop during or after an infection consistent with covid19, continue for more than 12 weeks and are not explained by an alternative diagnosis. PCS is still hidden in India but has been very visible in the UK and USA were the peak of the second wave has just passed.
A PCS sufferer typically has several symptoms at a time, with the most debilitating usually being one of three: severe breathlessness, fatigue, or “brain fog” .

Broadly speaking, there are three types of long covid patients. The are characterized by

  • “exercise intolerance”, meaning they feel out of breath and exhausted from even small tasks involving physical activity.
  • The second are characterized by cognitive complaints in the form of brain fog and memory problems.
  • The third are characterized by problems with the autonomic nervous system, a set of nerves that control things like heartbeat, breathing and digestion. Patients in this group suffer from symptoms such as heart palpitations and dizziness.

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Impairments of the autonomic nervous system are known as dysautonomia, an umbrella term for a variety of syndromes.

Chronic fatigue syndrome (cfs)

The classic example of such a mystery illness is chronic fatigue syndrome (cfs), which often seems to follow a viral or bacterial infection. Chronic migraines and other symptoms often seen in long Covid-19 would, in normal years, also strike lots of people out of the blue. The data do, nevertheless, suggest that the effects of long Covid-19 are swamping this symptomatic background. 
Did you know Chronic fatigue syndrome is clinically called myalgic encephalomyelitis.

Based on these patterns of symptoms, and various laboratory tests of long covid patients, doctors are focusing on possible biological explanations. One is that long covid is a persistent viral infection. Meaning that few Covid recovered patients do not completely shed off the virus. A small portion of it still resides in the body but does not replicate or mutate thus undetectable by the tests. But it does keep producing some viral loads which the body is fighting.

At the moment rehabilitation is the only available treatment for long covid. Research at Yale University suggests taking measures in initial viral treatment and vaccination that curb the effects of long covid. We see such treatments in Hepatitis where patients are treated for the viral infection post being asymptomatic to curb the after effects of the disease. A symptom centric approach is possible way on treating long covid.

Very few of the long covid patients had carbon dioxide levels that were too low. This may sound surprising, given that CO2 is a waste product derived from respiration, and is harmful if present in too high a concentration. But it also helps regulate acidity, and incorrect acidity can disrupt all sorts of metabolic processes. Low CO2 levels are also often seen in dysautonomia and CFS. The solution is breathing exercises to help with CO2 retention.

Treatment for Long covid patients is suggested to be 150 days of rehabilitation which includes at least two hours of therapy each week. Treatment is painstaking. One has to keep in mind that even if he/she is fully recovered from Covid-19 infection and tests show negative results, one is susceptible for long covid. This only indicates that with already collapsing medical infrastructure, people may not get appropriate treatment for long covid, and patients will continue to suffer post covid.

Therapy

One of the promising techniques used to treat Chronic fatigue syndrome is Adaptive pacing therapy. In adaptive pacing therapy (APT) patients are advised to adjust the level of activities to match their energy levels and not to over do by pushing themselves. This therapy has proven to work against the CBT (Cognitive behavior therapy). In CBT, for Chronic fatigue syndrome, patients are administered and given therapy on fear avoidance against the physical activity. Fear against any activity creates a perpetual symptoms fatigue.

Adaptive Pacing TheoryCognitive Behavior Therapy
APT is based on the envelope theory of chronic fatigue syndrome. This theory regards chronic fatigue syndrome as an organic disease process that is not reversible by changes in behavior and which results in a reduced and finite amount of available energy. The aim of therapy was to achieve optimum adaptation to the illness, hence APT. This adaptation was achieved by helping the participant to plan and pace activity to reduce or avoid fatigue.
Therapeutic strategies consist of identifying links between activity and fatigue by use of a daily diary, with corresponding encouragement to plan activity to avoid exacerbations, developing awareness of early warnings of exacerbation, limiting demands and stress, regularly planning rest and relaxation, and alternating different types of activities, with advice not to undertake activities that demanded more than 70% of participants’ perceived energy envelopes. Increased activities were encouraged, if the participant felt able, and as long as they did not exacerbate symptoms.		CBT is based on the fear avoidance theory of chronic fatigue syndrome. This theory regards chronic fatigue syndrome as being reversible and that cognitive responses (fear of engaging in activity) and behavioral responses (avoidance of activity) are linked and interact with physiological processes to perpetuate fatigue. The aim of treatment was to change the behavioral and cognitive factors assumed to be responsible for perpetuation of the participant’s symptoms and disability.
Therapeutic strategies guide participants to address unhelpful cognitions, including fears about symptoms or activity by testing them in behavioral experiments. These experiments consisted of establishing a baseline of activity and rest and a regular sleep pattern, and then making collaboratively plan gradual increases in both physical and mental activity.
Comparison between ACT and CBT

Special Medical Care (SMC)

SMC was provided by doctors with specialist experience in chronic fatigue syndrome. In SMC therapy, participants are given a leaflet explaining the illness and the nature of this treatment. Treatment consisted of an explanation of chronic fatigue syndrome, generic advice, such as to avoid extremes of activity and rest, specific advice on self-help, according to the particular approach chosen by the participant, and symptomatic pharmacotherapy (especially for insomnia, pain, and mood).

Even after the pandemic is over or near over, post-viral symptoms of this scale will affect not only those suffering from it but also many indirectly.

While long covid patients continue to suffer from post viral symptoms, Lets us vow to be as safe as possible and avoid the infection at all costs.

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