Long Covid can be heart-wrenching

This phenomenon, commonly known as Longcovid, has been observed since the first wave of 2020 and appears to continue in the 2021 variant. Omicron The family of mutants still needs to be evaluated, as the first illnesses caused by them have been reported to be less severe. This may be because the virus has mitigated its pathogenicity, or because immunity from previous infections or vaccinations has slowed its effects. In either case, the risk of long covid seems to be lower for Omicron than for previous forms of the virus.

The definition of Long Covid took time to evolve. The World Health Organization (WHO) defines it as a symptom caused by Covid that appears 3 months after an acute infection. According to WHO, “post-Covid 19 conditions occur in individuals with a possible or confirmed medical history of SARS-CoV-2 infection, usually 3 months after the onset of Covid-19. Symptoms last for at least two months, explained in another diagnosis. “The US Center for Disease Control and Prevention (CDC) considers symptoms that last more than four weeks after an acute illness as an indicator of Long Covid. The United Kingdom National Health Service (NHS) classifies the subsets into “ongoing symptomatic Covid-19” (4-12 weeks) and “Post-Covid-19 syndrome” (12 weeks or longer).

Scientific Reports published from around the world have different Long Covid estimates depending on the criteria used. A recent analysis by the CDC has millions of health records and reports an estimate of 20% of this distress in Covid survivors. It may have missed or missed someone who couldn’t or couldn’t access health care for a variety of reasons. A previous CDC household survey reported in June of this year identified a proportion of 1 in 3 people. A meta-analysis of global data pooled from several studies, published in March 2022, found that the prevalence of Long Covid was close to 50% of all survivors. The total number is a major concern, as the health and well-being of the vast number of Covid survivors appears to be compromised, regardless of the actual proportions.

Covid’s long-term health effects can result from one or more of the following: (1) Effects of organ damage directly caused by the virus. (2) Residual effects of injury caused by a vigorous immune response caused by the body while fighting the virus. (3) Exacerbation of other related health conditions, especially diabetes, due to inflammation caused by Covid. (4) Ignoring other health conditions by medical care focused solely on Covid management. (5) Side effects of medicines and techniques used in Covid care, such as psychological stress caused by steroids and intensive care. Reactivation of latent infections by the Epstein-Barr virus has also been blamed for the cause of Long Covid.

Long-term illness has also been observed, as chronic fatigue has been observed with several other viral infections. coronavirus In relation to SARS-1 and MERS, many of Long Covid appear to be associated with the interaction between the virus and the human body. The early tendency of physicians to dismiss Covid survivor complaints as purely psychological has proven to be a false and unfair assessment.

Some clinical features of Long Covid have been described and involve diseases of various organs, from the brain and heart to the gastrointestinal system and pancreas. Apart from the direct tissue damage caused by the virus, there is some evidence suggesting that the tenth cranial nerve (vagus nerve) may be affected. It is so named because it is the longest cranial nerve and is the “wanderer” who innervates and regulates many important organs from the brain to the chest and abdomen.

Long Covid can affect the functioning of some organs and bodies, but its effects on the heart and blood vessels have received considerable attention. Myocardial inflammation (“myocarditis”) can result from the direct effects of the virus on muscle fibers or immunological damage caused by the body’s own defenses. The pericardium, the membrane that covers the heart, can also become inflamed (“pericarditis”). Myocardial damage was detected in a person who died in Covid. Among survivors, evidence of cardiac involvement is by elevated blood levels of enzymes released by the injured myocardium, decreased myocardial pumping capacity as shown by echocardiography or radionucleus imaging, and magnetic resonance imaging. It comes from evidence of myocardial damage observed (MRI). Cardiac dysfunction is reflected in symptoms of fatigue, decreased exercise tolerance, and deep chest pain, but clinical signs of heart failure are rare in people without pre-existing heart disease.

It is difficult to quantify the incidence of cardiac involvement in Covid, as only some Covid survivors can be evaluated in detail. In the pre-Omicron era, Valentina Puntman of Frankfurt studied 100 consecutive patients about 10 weeks after the virus-positive test. They performed a cardiac MRI with a gadolinium contrast agent. They observed heart abnormalities in 3 of 4 patients. Impaired cardiac pumping, myocardial inflammation or fibrosis, and pericarditis were among the findings. Most patients improved in 6 months, but symptoms lasted up to a year in a few years.

Abnormal heart rate can also occur. The vagus nerve, which lowers the heart rate, usually suppresses the heart rate. When the suppressive effect disappears and the stressed body sends out adrenaline and other catecholamines, the heart can start racing like crazy. This can be exacerbated when a person is standing — a condition called postural orthostatic tachycardia syndrome (POTS). In this pain, within 10 minutes of standing up, your heart rate rises by more than 30 beats in adults and more than 40 beats in children. Heart rate irregularities can also occur (“missing heart rate” or “arrhythmia”).

When the lungs are affected by Covid, the heart can also be stressed. Pulmonary fibrosis creates great resistance to the heart as it pumps blood into the heart, and even damaged lungs do not efficiently oxygenate the blood returning to the heart. Blood clots formed by damage to blood vessels during the acute phase of Covid can later come off when a person becomes active. The migration of blood clots from the veins into the blood vessels of the lungs (“pulmonary embolism”) can cause severe circulatory collapse. Survivors of Covid are at increased risk of a heart attack even one year after the initial infection because of the increased tendency to damage blood vessels and form blood clots.

The inner layer (endothelium) of blood vessels is a dynamic structure that responds to different conditions of blood flow requirements by dilating or constricting arteries while maintaining blood pressure within the desired range. Covid causes endothelial dysfunction and loses the ability of blood vessels to dilate when needed. It can cause high blood pressure, accelerated atherosclerosis, and a heart attack. Covid has also been observed to increase the risk of long-term erectile dysfunction in men due to the loss of endothelial vasodilation in the blood vessels of the male reproductive organs.

Although some heart and blood vessel disorders have been observed in Longcovid, most survivors of Covid do not have to be afraid to experience them or their effects will be permanent. Many people who show the benefits of Long Covid will recover over time, especially if the initial infection is mild and there is no reinfection. The time it takes to recover depends on the severity of the initial infection, the age of the person, and the associated comorbidity. To avoid serious illnesses that could be the stage of Long Covid, it is best to avoid the risk of infection by wearing a mask and vaccination according to the advice. Although no specific treatment is available yet, Long Covid’s research is still a developing area. For now, “masking up” and “getting vaccinated” are the best preventive advice.

(Professor K. Srinath Reddy, a cardiologist and epidemiologist, is the president of the Indian Public Health Foundation (PHFI). The expressed views are personal.)