Photo: BBC

Dangers of Long COVID as most Bhutanese are set to get infected

International studies show between 10 to 50% of people can get long COVID

As it is clear that most Bhutanese will be infected with COVID-19 in the coming months as Bhutan opens up restrictions in phase two, based on high vaccination rate and milder nature of Omicron, a big question is on the impact of long COVID.

All international health bodies like the WHO, CDC, EMA and others recognize long COVID and its varied impact on various organs of the body.

10 to 50% could get long COVID

Research show anywhere from 10 to 30 to more than 50 percent of recovered COVID-19 patients getting some form of long COVID.

Long COVID basically means that people who have recovered from COVID see the resurgence of unexplained symptoms like fatigue, difficulty in breathing, brain fog, loss of sense of smell, insomnia, joint pains, depression and a host of other symptoms. The WHO says that there are as much as 200 different symptoms reported by people.

These symptoms could last for anything from a few weeks to some months to some years to even lifelong conditions.

There is a lot of research going on in the field, but the cause is in the nature of the COVID-19 virus, how it binds to the human body, the body’s defense against it and the extensive damage that it can do even for those who have mild COVID.

Vox media in a January 2022 article quoting experts and research on this field said that two likely causes are the body’s immune system being turned against the body and the second one being the virus or its genetic material persisting in the body’s tissues and organs long after a person has tested negative or ‘recovered’ from COVID-19.

Long COVID symptoms and impact

Long COVID affects a variety of human organs and systems from the brain to the heart to the kidneys.

WebMD points out that a study by University of Michigan in late 2021, that reviewed 40 studies from 17 countries covering 886,000 patients, showed that around 43 percent of COVID survivors have or had long COVID. Among those hospitalized it increased to 57 percent.

The most common symptom was fatigue at 23 percent followed by shortness of breath, insomnia, joint pain and memory problems at 13 percent.

Some COVID-19 survivors may develop other severe complications and conditions such as multisystem inflammatory syndrome in children, chronic kidney disease, heart disease and chronic fatigue syndrome.

Both the vaccinated and unvaccinated get long COVID but an article in Time Magazine points to a recent study from researchers at the U.K.’s Office for National Statistics (ONS) which found that adults who got infected after two doses of a COVID-19 vaccine were about 40% less likely to later report symptoms of long COVID than unvaccinated people who got infected.

In the study, about 9.5% of vaccinated people and 15% of unvaccinated people reported symptoms 12 weeks after infection.

The BBC reporting on the same ONS study said that those most likely to get long CIVID were 35-49 year olds, women, people with underlying conditions, those working in health, social care or education and people in poorer areas.

A recent and important study by researchers from Oxford University published in Nature showed that during at least the first few months following a coronavirus infection, even mild cases of Covid-19 are associated with subtle tissue damage and accelerated losses in brain regions tied to the sense of smell, as well as a small loss in the brain’s overall volume.

Gwenaëlle Douaud, an associate professor at the Nuffield Department of Clinical Neurosciences at Oxford and the paper’s lead author, said that the excess loss of brain volume she and her colleagues observed in brain scans of hundreds of British individuals is equivalent to at least one extra year of normal aging.

Children and long COVID

Though it is acknowledged that children are less likely to get long COVID, a 16 March 2022 report in Reuters showed that a study pooled from 21 studies in Europe, Asia, Australia and South America of 80,071 children with coronavirus saw 25 per cent developed symptoms that lasted at least 4-to-12 weeks or new persistent symptoms that appeared within 12 weeks.

The five most prevalent were mood symptoms (16.5 per cent), fatigue (9.7 per cent), sleep disorders (8.4 per cent), headache (7.8 per cent) and respiratory symptoms (7.6 per cent).

Other commonly reported symptoms included nasal congestion, cognitive symptoms such as faltering concentration and memory, loss of appetite and altered smell.

Omicron and long COVID

On the link between Omicron and long COVID a report in The Mint cited WHO experts in a question and answer session in February 2022 who said that the chances of suffering from long COVID after Omicron, is high (as compared to other variants), though still more study is needed on that. 

The Harvard Gazette quoting  Jason Maley, director of Beth Israel Deaconess Medical Center’s long-COVID clinic, which is part of a multicenter study funded by the National Institutes of Health to explore the causes of the condition, said “I don’t think there’s anything that has been seen about the virus itself, the Omicron variant, to say that it won’t cause long COVID.”

Shibani Mukerji, an assistant professor of neurology at Harvard Medical School and associate director of Massachusetts General Hospital’s Neuro-infectious Diseases Unit, echoed Maley’s assessment, saying that her clinic has been extremely busy, and that she expects future cases to follow patterns set by previous variants.

England has set up 90 long COVID assessment centers while senators in USA are calling on President Biden to provide disability assistance to those suffering from long COVID given how disabling it can get.

PM explains long COVID

The Prime Minister Dasho Dr Lotay Tshering said there is long COVID and post COVID syndrome and these are two different things.

He said in long COVID the symptoms during COVID like flu symptoms like fever get all right, but others continue to get a sore throat while others say they cannot smell properly for months.

Lyonchhen said some say if such symptoms go beyond six weeks then it is long COVID. He said right now internationally there is no cut off duration for long COVID and so the definition itself is not clear.

While the PM is right that there is no internationally accepted definition the WHO on October 2021 put up a working definition which says the symptoms shows up within three months of COVID infection and lasts at least two months. It said common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning.

PM acknowledges dangers of long COVID

Lyonchhen said that, when minor symptoms continue it is called long COVID, but he said that in other major viral illness symptoms also tend to get prolonged.

“For example, in tuberculosis even when people recover they can still have symptoms of the illness. COVID is a viral pneumonia but when you get bacterial or fungal pneumonia and stay in the ICU in the hospital for 5 or 6 days the patient will not be the same,” said Lyonchhen.

He said there is strong global doubt that if one gets long COVID one can get dementia, loss of memory, sterility, higher chance of diabetes and higher chances of cancer in the lung but there is no conclusive research and research is ongoing. He said Bhutan does not have the technical and financial capacity for such research.

He said there is international research going on for long COVID.

 “We are keeping an eye on such research. There is a danger of long COVID, but at the same time the opportunity to avoid COVID is even lesser unless we stay under a zam (big pot) inside the house,” said the PM. 

“However, if you do get COVID then 15 or 20 years down the line I cannot guarantee there will be no risks. It is evolving and we need to see. The only way to avoid this is for all Bhutanese not to get COVID and for this if anyone has a solution then do let me know,” he added.

Bhutan ties up with Moderna for long COVID research

“In Bhutan we have not done laboratory research on this but we do symptomatic follow up of most positive cases. Bhutan and Moderna have signed an MoU for long term research. Moderna will provide financial grant, experts and they will come here and do research and its comes to around UDS 3 mn worth of research,” said the PM.

Lyonchhen said while Bhutan is doing clinical research it cannot do laboratory research at the cellular level as it is resource and expert intensive and will cost billions.

He said the technical cooperation with Moderna will include training and Ph. D programs and research exchange program including lab to lab program.

In the absence of any research by the government on long COVID this paper In January 2021 talked to 7 recovered COVID-19 patients and 5 of them suffered from long COVID symptoms like loss of smell, fatigue, brain fog, breathing issues and anxiety.

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