Covid-19 as a pandemic has left but the footprints are likely to remain with us for long. The feeling of elation that the pandemic has left is not complete. Understanding the post-effects of Covid-19 has put the world on a straitjacket. Part of it is known already but a lot of new information is still emerging bringing the medical system on its toes. It is a rude shock to know that the post- effects of COVID-19 will have many long-term implications. This is going to apply to all populations in general regardless of whether they had previous COVID-19 infection or not. The majority are due to COVID-19 infection the rest are related to altered immunity either due to vaccination or antibodies. These are anticipated to have long-term effects on us hence the term “long Covid-19”.

Fundamentally COVID has altered the core structure of human cells the most DNA/RNA. Through this, it is going to influence the protein structures and other metabolic apparatus of the body. The functioning of mitochondria, ribosomes, and cell membranes is going to be affected. As a consequence energy, metabolism, and cell division will be altered all over the body. These changes can affect many organs or systems of the body. It is expected that a few systems are going to be affected specifically.

Primarily the brain will have several implications called neuro Covid-19. Seizures, brain fog, stroke particularly in young, dementia, memory loss, energy loss, and behavioural disturbances are some of them. Similarly, lung and vascular system affection can lead to coronary disease increased heart attacks, and lung failures, gastrointestinal abnormalities affecting the digestive system. Increase in renal failure infertility and rashes in finally various problems due to an altered immune system. The effects of immune variability are difficult to predict. A lot of work to identify such variations and their short and long-term effects are being evaluated by several researchers across the world.

Future research can only guide us to take appropriate measures. Meanwhile lot of variants of the same virus with variable transmission and disease causing ability are going around in cycles. This also can influence primary pathophysiology and immunity and as a result, we may witness several combinations of effects. This looks like a long journey. We do not have specific solutions for many. At the same time, we are learning from every experience. Till then taking universal precautions, keeping the environment clean, good nutrition, vitamin supplements, a healthy lifestyle, and deep breathing exercises, can tide over the crisis. Reporting all such medical incidents is also very important. Then only we can recognize new problems, understand their magnitude, and find relevant solutions. Similarly sharing knowledge is the only way to put the world on alert and to be at it.

Neuro Covid-19 as it is specified now can affect many parts of the brain, spinal cord, and peripheral nerves. Apart from causing strokes and brain haemorrhage, it can cause functional disability in many areas. Brain fog is where there is confusion, memory disturbances, sleep disturbances, inability to cope with work, and decreased learning capabilities. It is known to cause disturbance of cranial nerves and brainstem. Spinal cord dysfunction can mimic transverse myelitis or GB syndrome causing paralysis of the limbs. Peripheral Neuropathy causes decreased or altered sensations in both feet and hands, burning sensation (paraesthesia) is very common. Though all of them are self-limiting can take variable periods to recover, all these can occur either independently or in combination making the diagnosis very difficult at times. However, systematic and periodic evaluations may be needed to establish the diagnosis.

Meanwhile, we are jolted by the possibility of another wave of Covid-19. The viruses are capable of undergoing mutations as many times as possible and can change their haracteristics. This is essentially a survival technique so that they continue to coexist. The mutant virus can become milder or more virulent. The present variant seems to spread similarly and cause significant respiratory illness. The real severity and the effects on other systems of the body need further clarity. Meanwhile, it is appropriate to follow all the known precautions without fail. It can help in preventing as well as propagating the virus. One should not take these things lightly till we get the validated information. The precautions are very useful for those who are vulnerable such as the elderly and immune compromised.