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Doctors in India are facing an uphill battle to identify and manage long Covid symptoms, citing insufficient guidelines and sparse research as significant obstacles.

Despite growing global awareness of the enduring impact of long Covid, Indian healthcare professionals say that few studies delve into the complexities of the condition in the country.

After the World Health Organisation declared the end of the global Covid emergency in May last year, nations began focusing on understanding long Covid’s impact on their populations.

This syndrome encompasses a range of persistent symptoms that remain long after the acute infection has cleared. Common symptoms include lingering cough, muscle and joint pain, fatigue, cognitive impairment, and brain fog, with many of these symptoms severely affecting quality of life.

Recent research suggests that approximately one-third of patients who suffered moderate or severe Covid-19 may endure long Covid.

However, regional data highlight notable differences. According to a study by Harvard Medical School researchers, an estimated 31 per cent of infected individuals in North America, 44 per cent in Europe, and 51 per cent in Asia are grappling with long Covid symptoms.

One such study, led by Maulana Azad Medical College in New Delhi, surveyed 553 patients from May 2022 to March 2023, all of whom had previously tested positive for Covid.

This study, published in Cureus in May, found that around 45 per cent of patients experienced lingering symptoms, with fatigue and dry cough most commonly reported.

The authors highlighted the scarcity of data on the long-term impacts of Covid-19. "There is limited exploratory research on the long Covid syndrome with scarce data on long-term outcomes," the researchers noted.

Dr Rajesh Sagar, a professor of psychiatry at AIIMS, New Delhi, underscored the difficulties of addressing the condition.

"Looking at the current state of long Covid studies in India, it is too premature to say that we understand the condition well enough to know how to diagnose or treat it," he stated.

There is also rising concern regarding neurological issues in long Covid patients, noted by Dr Animesh Samanta, assistant professor at Shiv Nadar University’s School of Natural Sciences.

“While studies in India highlight the growing recognition of neurological complications in long Covid patients, more focused research on neuroinflammation is needed,” he observed.

Doctors report seeing more patients with symptoms that were previously rare in their medical history.

For example, respiratory issues such as asthma-like symptoms are emerging in patients with no history of asthma prior to Covid.

Dr Neetu Jain, a senior consultant at Pushpawati Singhania Hospital’s post-Covid care clinic, remarked, "People who never had asthma in the past, post-Covid, with every viral infection, they get a long cough, shortness of breath and wheezing, which require the use of inhalers or nebuliser."

Neurological conditions have also become a concern. Dr Arun Garg, chairman of neurology and neurosciences at Medanta-The Medicity in Gurugram, has observed a surge in stroke cases among young patients without the usual risk factors like diabetes, hypertension, or obesity.

"Similarly, we are seeing more cases of encephalopathy (swelling of the brain) without reason and having a confused state of mind following one or two days of fever. Their MRI scans show no changes. These patients have increased significantly after Covid," he said.

With no established guidelines for diagnosing long Covid, doctors often rely on non-specific tests and questionnaires. These measures assess patients' "quality of life" rather than offering a conclusive diagnosis. Long Covid-related fatigue has been likened to that of cancer patients, with studies showing quality-of-life impacts comparable to Parkinson’s disease.

"We really do not have any test to diagnose long Covid, even though it is definitely a clinical diagnosis. We diagnose long Covid for people who had at least moderate to severe infection, following which they could never regain the quality of life pre-Covid. Checking for inflammatory markers like C-reactive proteins (CRP) can support the diagnosis," Dr Jain explained.

Testing approaches currently include routine blood tests measuring inflammation and antibody assessments. "Other than routine blood tests that measure inflammation, we do antibody tests to look for direct markers. In many of these patients, we are finding rare antibodies which are very new to us and were not there pre-Covid," added Dr Garg.

In response to the growing urgency, researchers are exploring novel approaches to assess long Covid’s lingering effects. At Shiv Nadar University, a research team led by Dr Samanta has developed a fluorescent probe to measure inflammation in brain cells.

This probe detects levels of nitric oxide within microglia, the brain’s immune cells. Microglia cells produce nitric oxide in response to infection, which the probe then measures, providing insight into neuroinflammation.

This probe has shown promising results in laboratory settings, but animal studies and clinical trials are required before it can be tested in human subjects. "Patients with pre-existing conditions such as Alzheimer's, Parkinson's disease, or multiple sclerosis may experience prolonged neuroinflammation and brain cell loss following Covid infection," Dr Samanta said.

Globally, the World Health Organisation International Clinical Trials Registry Platform lists 587 clinical studies focused on long Covid, of which 53 per cent are investigating possible treatments.

These trials examine a range of interventions, including physical exercise, psychotherapy, and drugs like Paxlovid and fluvoxamine. India has conducted 55 such trials, the second-highest number globally.

However, only 11 of the 312 treatment trials have reported results so far, and these findings remain inconclusive, according to the Harvard researchers. They call for further studies into sleep disorders, often overlooked in clinical trials, and a targeted focus on the biological mechanisms underlying long Covid.