Following the more than 275,000 COVID-19 cases nationally over the last year, we are seeing the emergence of a second new group of conditions: Long COVID. It is a chronic disease, meaning a condition present for more than six months.

This illness is associated with levels of cognitive and physical impairment incompatible with work and many activities of daily living.

At this time, we have very limited data in Nepal, and marginally more data worldwide, which suggest that perhaps 50,000 Nepalis (or about 20% of those testing positive for COVID) will develop and suffer from Long COVID. This total number of cases will be over 2 times the number of new cases of cancer diagnosed among Nepalis in 2020.

Long COVID is a group of syndromes primarily affecting four major organ systems of the body. Some Long COVID patients experienced no symptoms and were diagnosed only by tests for COVID infection.

Others experienced severe infections that required hospital care. An acute episode of COV- ID with apparently usual and complete recovery at, say, two months, can be followed by sudden onset of Long COVID.

The most common form of Long COVID is a neuro-inflammatory syndrome. Its symptoms include fatigue, unrefreshing sleep, diffuse aches and pains, including headache, problems thinking clearly called "brain fog" and a delayed severe fatigue response, occurring the day after increased physical or social activity. This syndrome is essentially synonymous with Chronic Fatigue Syndrome.

The second Long COVID condition is an auto-immune syndrome with aches and pains, often primarily in muscles and joints, fever, fatigue and gastrointestinal symptoms.

The third and fourth Long COV- ID syndromes involve the lungs and heart and follow serious acute COVID illness. With the lung syndrome, patients have shortness of breath, cough and reduced capacity for physical activity, while the cardiac syndrome is characterised by rapid or irregular heartbeat and reduced capacity for physical activity.

Available data indicate that patients often have mixtures of these four syndromes.

In Nepal, we have little rigorous data about the frequency of Long COVID and the frequencies of the different syndromes and the range of symptom severities found in these syndromes.

Together with doctors and team members at the Shukraraj Tropical and Infectious Disease Hospital in Kathmandu, we have done studies in men and women. Based on what we learn, we hope to be able to develop effective ways to treat the symptoms of Long COVID.

A version of this article appears in the print on April 05, 2021, of The Himalayan Times.