Now the Covid resurgence in China makes news, it has been identified BF.7 is the new mutant causing the re-emergence. Since China has not achieved herd immunity through effective vaccination regime, at least one million people are reported dead in this wave. This has adversely affected the Chinese government and their economy immensely. According to reports, the BF.7 Omicron variant is a highly transmissible one and already spread to near by countries.
Since the pandemic of Covid-19, different mutants of SARS corona virus attacked human race causing mortality or devastating effects. A minority of those infected with the virus develop long covid. If the symptoms lasting longer than three weeks are collectively called Post Covid Conditions (PCC). Long covid symptoms can persist for months or years, and sometimes fully resolve but reappears after a month. The most common symptom of PCC is ‘fogy brain’ whereby the sufferer cannot concentrate on anything.
Post-COVID conditions are found more often in people who had severe COVID-19 illness, but anyone who has been infected with any strains or mutated version of SARS Coronavirus virus can develop post-COVID conditions. A lot of people do not believe in medical science and stubbornly decline to take vaccination. People who are NOT vaccinated against COVID-19 are at a higher risk of developing PCC compared to people who have taken stipulated courses of vaccination. People with PCC can have a wide range of symptoms that can last more than four weeks or even months after the infection. Sometimes the symptoms can even go away or come back again. Tiredness or fatigue that interferes with daily life are almost as common as ‘fogy brain’ in PCC. The next common symptom is anosmia or loss of sense of smell. Breathlessness, cough and palpitation are found in PCC affecting cardiac and respiratory systems. A range of symptoms such as headache, insomnia, dizziness, lack of taste, depression and anxiety are also found in long covid sufferers. Some others complain symptoms such as diarrhoea, joint and muscle pain.
It has been reported by Centre for Disease Control (CDC) that 13.3% of those who contract Covid-19 will have PCC symptoms for one month after the infection. Unfortunately 2.5% continue to suffer some of the symptoms enumerated above for three months or longer. Even though the SARS-CoV-2 virus has an affinity for nerve tissue, the neurological features of Long COVID do not necessarily result from direct infection of the Central Nervous System (CNS) or Peripheral Nervous System (PNS). Viral encephalitis and meningitis have been reported due to direct attack of virus on the nerve cell, which is similar to many other virus attacking the brain and spinal cord.
95% of the CNS complications are due to aggressive systemic inflammatory and immune response to COVID-19 infection outside the neurological system. This is akin to reaction after penicillin in those who are allergic to penicillin, therefore not all will suffer long covid. The pathogenesis in these rare group has been linked to a disproportionate response of the immune system. Cytokine mediated chemicals and thrombin like materials clog arterioles supplying blood to an end organ. This may affect multiple systems like CNS, Cardiovascular and Respiratory systems or just one system.
Recently I have come across several long covid sufferers with paraplegia. In paraplegia the function of spinal cord is cut off at certain level. In one case the patient was 61 years fit and healthy female who developed paraplegia after contracting Covid in January 2022 in spite of taking two courses of vaccination. The husband recovered from Covid within a week, while the patient slowly developed spasm and weakness of legs ultimately she became immobile. Now she is bed ridden and has made no recovery even after taking anti viral drugs for covid.
In another instance, the patient with associated healthcare conditions such as diabetes, obesity and hypertension developed covid which deteriorated into paraplegia. This patient is 75 years and now he is moribund. The patient was admitted in intensive care unit and was positive for covid test. Both patients developed neuropsychiatric disorders and do not cooperate with rehabilitation measures. Both developed incontinence of bowel and bladder requiring personal care.
Paraplegia in post covid conditions are seen in 2-4 patients in one million infected cases of covid-19. Therefore it is less common than other long covid conditions. The pathogenesis for paraplegia is due to Acute Transverse Myelitis (ATM). This is due blockage of blood supply to spinal cord by substances associated with inflammatory and chemical response to the infection. The initial symptoms of ATM include body pain, spasms,sensitivity, muscle weakness and loss of bladder control. These symptoms may resolve or develop into partial or total paralysis. Rarely ATM is also caused by polio, influenza, rabies, measles, hepatitis and rubella, either through direct infection or through vaccination.
As described above, long covid causes devastating effect not only to the sufferers, but also to the community as a whole. The government should leave no stones unturned to enforce measures to stop the spread of Covid, through mandatory mask wearing in public places and through vaccination programme. Also there should be relentless campaigns by the government to make people aware of the seriousness of the infection, as the pandemic has the potential to re emerge.
Dr.C.J.George FRCS
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