With Limited Research and Understanding, Doctors Struggle to Treat Long Covid Patients

The Wire

5 hours ago

Banjot Kaur
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Several Long Covid patients say their problems have been ignored completely by clinicians. But even sympathetic doctors say the path forward is unclear.
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New Delhi: As we mark five years of the first wave of the COVID-19 pandemic, 'Long Covid' remains the most challenging issue to deal with. Though our understanding of the Sars-Cov-2 virus has evolved quite a bit by this time, the phenomenon of Long Covid remains an enigma, by and large.
Dr Ameet Dravid is an infectious diseases expert who practices in Pune. He has been treating Long Covid patients ever since the first wave of the pandemic started in 2020. Dr Dhruva Chaudhry is the head of the pulmonary and critical care department at Pt BDS Post Graduate Institute of Medical Sciences (PGIMS), Rohtak. Like Dravid, he, too, has been working with Long Covid patients. Working in two different parts of India, unknown to and independent of each other, both are grappling with one common question: Has Sars-Cov-2 fundamentally changed anything in our bodies, especially in our immune systems?
Speaking to The Wire, both these clinicians said that they are launching studies with the help of other institutions to try and answer this question. Chaudhry said he was in touch with a renowned private university in Delhi-NCR to investigate whether something has "gone wrong with the functioning of our T-cells and B-cells that form our immunity'. These are the cells which are main components of the human immune system and allow it to do what it does.
Dravid is working with the Pune-based National Institute of Virology (NIV). 'We want to check the blood samples of those who tell us that their capacity to carry out daily deeds has dramatically gone down which has seriously affected their lives [with those who haven't reported this problem]. And we want to know whether their B cells, their T cells, their antibodies, their gut bacteria, their nose viruses — whether they are any different from others. So we are in the process of doing a biorepository,' he said.
Dravid says the initial tests are already providing some hints. The T cells are in smaller numbers than those who don't suffer from Long Covid Issues. In simple terms, if these 'very initial results' hold true, it would mean the long haulers have weakened immune systems now. This, in turn, may explain a number of problems these people are grappling with – from heart issues to gut diseases and many more in between.
Dravid says the remnants of the dead virus have remained inside the bodies of those suffering from Long Covid for quite some time, even after they got a Covid-negative test report.
Dr B.V. Murali Mohan, a pulmonologist who headed a Long Covid clinic in a private Bengaluru hospital, shares this opinion.
Since the remnants of the virus were dead, they did not make the patient sick, per se. But they remained inside the body, and therefore kept triggering the immune system to mount a battle despite them being dead, simply because they are foreign elements.
This, according to Dravid, might have resulted in the exhaustion of immunity – known as immunosense. Due to this exhaustion, the system could not adequately do its job when a new infection happened, thus making long haulers more sick.
Range of diseases
Long Covid is an umbrella term for a host of medical conditions. According to World Health Organisation's definition of Long Covid: 'Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARSCoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.'
According to the WHO, 6% of all COVID-19 patients suffer from Long Covid. In absolute numbers, this can be extremely high. The US-CDC estimated this number to be 6.9% in 2022 in the country. In India, an Indian Council of Medical Research (ICMR) study published in 2023 reported 6.6-11.9% prevalence of three specific Long Covid conditions – fatigue, dyspnoea (breathing difficulty) and mental health. The Wire wrote an email to ICMR on March 24 asking if it has conducted a study to know the broader prevalence rate in India, after this one. The ICMR did not reply despite repeated reminders.
In the first part of this series, The Wire spoke to people suffering from Long Covid about their symptoms and difficulties. Doctors The Wire spoke to also listed a range of issues – most of them overlapping with what the patients had said.
Murali Mohan of Bengaluru Hospital found most Long Covid patients to be recovering in the long term, but Pune's Dravid said many of his patients are suffering even now.
All the doctors that The Wire spoke to made it clear that five years down the line, the number of new Long Covid patients has declined dramatically. According to the World Health Organisation, Long Covid conditions can develop a maximum of three months after infection.
Like all other viruses, Sars-Cov-2 is still around, but with its intensity significantly reduced. People are still getting COVID-19 – and so the possibility of Long Covid in new patients isn't zero just yet.
One of the most common issues is cognitive decline, commonly known as 'brain fog'. 'Professors have come up to me saying they frequently lose their train of thought during lectures,' Dravid said. Murali Mohan has had some patients who still haven't recovered from cognitive decline.
There is no consensus on the pathway of virus causing brain fog. Dr Chaudhry believes that if a virus entered the bloodstream via the lungs, it could have breached the barrier between blood and brain in some cases. The virus could have also impacted the nervous system, known scientifically as 'micro-neural damage', thus affecting the brain. He said that some of the damage in the brain is also reflected in MRIs and other scans.
One of the triggers that led doctors to ask for these scans was loss of sense of smell. The virus, according to studies like this, can negatively impact the olfactory bulb – the part of the brain which is responsible for activating the sense of smell. So once a patient reported loss of smell, doctors asked for brain scans. These scans showed that some parts of the brain were affected.
Whenever an infection takes place, the immune system mounts a response. At times, it goes into overdrive and affects otherwise healthy organs of the body, by mistake. The diseases caused by this act are called autoimmune diseases.
Long Covid patients have reported neurological conditions like multiple sclerosis. It is an autoimmune disorder in which the spinal cord and the nerves in the brain suffer abnormalities.
Chaudhry is also particularly worried about the long persistence of pneumonia in Long Covid patients or even those who don't fit under this broad umbrella term. 'In my 30 years of practice, I have never seen this big a number of patients suffering from pneumonia,' he said.
Murali Mohan says interstitial lung disease, a long-term ailment which "cripples the lives of people", is something he has commonly observed after the pandemic. Past experience suggests that some viruses have also triggered this disease, and therefore, Sars-Cov-2 doing the same shouldn't surprise clinicians.
'The autoimmune phenomenon can impact the brain, the nervous system, the lungs and so on,' Murali Mohan said.
The gut, which holds the key to many digestion-related functions, also seems to get affected because of the COVID-19 virus. The good bacteria in the gut does not let toxins enter the bloodstream. With the gut suffering, its 'gatekeeper' role goes for a toss. Consequently, the body's internal systems are exposed to a whole range of toxins, which can cause a number of diseases.
Some Long Covid patients come to Dravid with psychiatric problems like nervousness, hopelessness and excess anxiety. 'Family members say their patient was such a calm person before COVID. Now s/he is like a cat on a hot tin roof — completely anxious, keeps shouting at us for simple things.'
Apart from the issues mentioned, all these doctors spoke of seeing patients with the most common Long Covid problems like an increased heart rate, chronic fatigue, chest pain, breathlessness, palpitations, etc. which substantially affect the quality of life.
Matters of the heart
A group of problems related to the heart have been a key issue for Long Covid patients.
The American Heart Association says the risk of heart attack and strokes following a COVID-19 infection remains increased at least up to three years later in adults. Even children's and adolescents' hearts can be adversely affected, says this study published on April 11, 2025.
Dr K. Srinath Reddy, former head of the Public Health Foundation of India and former head of AIIMS' cardiology department, says COVID-19 infection can wreak havoc on the heart in multiple ways. One among them is inflammation.
As a result of any infection, when the immune system rushes to do its job, it leads to inflammation. In most cases this inflammation subsides on its own, but in some it does not. This is true for infections with various pathogens; Sars-Cov-2 is no exception.
Inflammation can damage the inner lining of blood vessels. Veins transport blood from the heart to different organs and arteries do the reverse. They are both vessels, and if vessels are affected, clotting, also known as thrombosis, takes place. This causes heart attacks.
The second pathway to heart attack due to COVID-19 could be the autoimmune. As explained above, an autoimmune scenario destroys healthy organs of the body, in some cases the heart and blood vessels..
Deranged lipid profile (three types of cholesterol indicators and triglycerides) and abnormal sugar levels can also affect blood vessels adversely. High blood sugar is a noted post-Covid complication.
Reddy says a combination of all these pathways can lead to heart attacks. To know the exact pathway, more research is needed.
Link with Covid
One of the biggest challenges is to establish that the patients developed these conditions because of COVID-19 and hence can be treated under the Long Covid umbrella.
Doctors like Murali Mohan believe that patients may have developed some of these problems anyway, with or without Covid. The other possibility is that they existed before COVID-19 infection, in a latent manner. The infection worsened the symptoms, leading to their full-fledged manifestation. The third possibility is that the COVID-19 virus itself caused these problems.
There are several reasons why a direct link is difficult to establish. One is that most investigations, including scans and bloodwork for testing biomarkers, show nothing wrong with the body. Biomarkers are molecules in the blood – if their levels are outside of the normal range, it shows that the body isn't functioning normally. But Long Covid patients, as all of those who spoke to The Wire said, continue to suffer – despite their 'clean' test results.
Dravid says physicians need to think out of the box. The CD4 count is a biomarker that marks the status of immunity, especially for HIV patients as their immune system is heavily compromised.
There are indications now to suggest that COVID-19 may have altered immune systems to a greater extent. Dravid says if the count is tested for Long Covid patients, and it turns out to be low, then it may give an understanding of an underfunctioning immune system. That itself can be a clue to many of the conditions that Long Covid patients grapple with.
'If patients are coming with allergies following a COVID-19 infection, how about checking the IgG, IgA, IgM levels — that is, immunoglobulin levels — which we otherwise use to check for allergy patients. This is something that many of us may not be doing now for Long Covid patients,' he said.
'Maybe biomarkers for Long Covid conditions are different, which we have not been able to find out yet. We are only trying to test those biomarkers which are commonly associated with a particular disease,' he said.
The medical community worldwide is grappling to fill the gaps of biomarkers.
This study, a 'global expert consensus' published on April 20, 2025, lists a whole range of biomarkers that doctors must look into for Long Covid patients. It indicates investigations for every system of the body.
The other difficulty is to establish a cause-and-effect relationship between these conditions and COVID-19 infection. Because the pathway isn't usually clear, doctors are hesitant to come to such conclusions.
Sometimes, doctors have found that nutrient deficiency also causes similar conditions – thus delinking 'Long Covid' symptoms from a COVID-19 infection. 'The significant deficiency of Vitamin D as well as Vitamin B12 can have specific and nonspecific effects causing a number of diseases,' Chaudhry said. These deficiencies are examples of the 'confounders' which render doctors unsure what caused the diseases – Long Covid or other reasons. Confounders are findings that may not align with the conclusions one would normally have drawn.
Delhi-based Dr Hitakshi Sharma, a community medicine specialist, stresses on checking minerals levels to rule out their deficiency, because that can also lead to some of these conditions.
Despite the existence of these confounders, Sars-Cov-2 is not an anomaly as far as post viral and bacterial illness are concerned. Other viruses too have been known to cause complications when patients have recovered from infections caused by them.
Long-term joint and muscle pain in patients post a chikungunya infection is a common occurrence. Even after fully recovering from a tuberculosis infection, some people continue to have impaired lung functioning. Ditto for swine flu. Doctors say since COVID-19 affected so many patients in a span of just a few years, they see more patients suffering with post-viral illness and the word 'long' got prefixed to these diseases – which is not the case with other infections.
Clinicians' dilemma
With these uncertainties, doctors are hesitant on two counts as far as Long Covid patients are concerned.
First, they aren't sure if all the problems that Long Covid patients face indeed happened following a Covid infection, and so, how to treat the issues.
Second, and more importantly, investigations don't reveal anything for a lot of these patients, and so doctors end up rejecting the possibility that illness exists.
'I agree it is very difficult to decide whether COVID-19 is the cause or something else is. But if the patient is saying there is a temporal association with COVID-19, we should give those symptoms credence – at least hear them out – and not just dismiss their conditions,' Dravid said.
Murali Mohan says doctors are being 'close-minded' when they refuse to recognise Long Covid patients' symptoms just because they can't see anything obviously wrong. "The most hurtful thing for any patient is rejection with contempt,' he said.
Both Dravid and Murali Mohan stressed on doctors giving adequate time to Long Covid patients in their OPDs. They said that these patients may need to be heard for half an hour or even more to understand what they are saying. This is made even more important by the fact that investigations don't always reveal the issue. Asking the right questions and taking down a detailed history is vital for these patients, they believe.
"Look at their physical issues. Rule out any underlying cause [which could have been present before COVID-19 infection]...that can be the first step,' Murali Mohan advises. It is definitely a difficult thing to do, though, he said.
Dravid came across Long Covid patients who had already seen multiple consultants before visiting him. They were, therefore, exhausted by repeating their history again and again. 'That is when we doctors need to be sympathetic,' he said. This Pune-based physician added that it is impossible to quantify many of their conditions, say fatigue, cognitive decline or breathlessness. The absence of quantification makes clinicians sceptical about the problems of Long Covid patients.
The road ahead
When doctors themselves have not yet understood Long Covid and the issues it presents, treatment protocol becomes complicated. For example, autoimmune diseases, in general, are treated with steroids. However, when the autoimmune pathways to Long Covid conditions are not undeniably proven, it is difficult for doctors to prescribe steroids to patients, says Murali Mohan.
Dravid says occupational therapy could be a graded way to help Long Covid patients suffering from chronic fatigue. 'And, then of course, psychological support to them can go a long way in helping them,' he said.
Adopting a multidisciplinary approach that includes the services of a rheumatologist (for autoimmune conditions), immunologist, physical medicine specialist, cardiologist and physiotherapist can be the key, he feels. A Long Covid patient The Wire spoke to said she received such a treatment when she was in the US.
But the road ahead can be bumpy for Long Covid patients despite the best of intentions of a section of doctors. They say while these patients can recover to some extent, their quality of life may not recover to levels they were at before. Dravid, though, adds a rider to this thought: ongoing research on Long Covid may potentially throw up solutions that could reverse the problem completely. Until then, a sympathetic clinician could help manage the symptoms.
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