In the first few months of the Covid-19 pandemic, Dr. Laura Patricia Lozano Enríquez found herself locked at home, watching videos about the virus that was filling Mexico’s hospitals and emptying its streets.
“As patients, they were very afraid. As doctors, we were even more afraid, because we didn’t know how to attack [the virus], we didn’t know what else could happen,” she told me in her small consult room in Mexico City’s Roma neighborhood.
But little by little, video by video, Lozano Enríquez began learning more about the virus, how it could spread from person to person, how to detect it, how to treat it. The fear didn’t go away, but it became more manageable. In July 2020, she went back to work at the private school where she spends half of her days. It was there, chatting with administrative staff and families, that the consequences of the virus outlined in the videos she had been watching became real. She spoke with people who, weeks after “recovering” from Covid-19, couldn’t smell or taste, suffered from a persistent cough or trouble breathing, were constantly tired and couldn’t return to their normal activities.
It was hard to know what to do, but clear that she had to do something. Lozano Enríquez began working with colleagues to make videos of breathing exercises aimed at rehabilitating lung capacity. They posted the videos to the school’s Facebook page, and families and coworkers started emailing Lozano Enríquez, asking for more exercises, thanking her.
Lozano Enríquez had stumbled into helping patients suffering from long Covid-19, a persistence of symptoms weeks after their initial diagnosis. It’s hard to know exactly how common long Covid is, but a study from the U.K.’s Office for National Statistics published in April found that “13.7 percent [of COVID patients] continued to experience symptoms for at least 12 weeks,” while the nonprofit FAIR Health conducted research that found at least 30 days after initial diagnosis, “23.2 percent had at least one post-Covid condition.”
These numbers are significant, and point to a dual crisis: As cases climb throughout the world, we need to attend to new Covid-19 patients. At the same time, we can’t forget those who continue to suffer from the virus’ lasting effects. Officially, nearly 2.7 million Mexicans have caught Covid-19, but there’s no doubt the real number is much higher. The country is in the middle of a brutal and ever-intensifying third wave, and its health care infrastructure is insufficient to deal with current infections, much less the lasting footprints of former ones.
Furthermore, though health professionals have found interventions that have seemed to help long-Covid patients, a lack of research means that “few evidence-based treatments exist,” noted a June article in Nature.
In Mexico, universities, health systems, and private doctors have done their best to help long Covid-19 patients, but resources and capacity are insufficient. “For years, not enough specialists were trained to give regular care to the population, much less to confront a pandemic that can have long-term effects not only in the lungs but in many organs, including the heart and the brain,” reported Animal Político in December 2020. Pulmonary rehabilitation, continues the report, is a complex and rare specialization that requires years of training, and efforts to increase the number of medical professionals specialized in this area have only just begun to chip away at this shortfall.
Public health systems in Mexico focus narrowly on the rehabilitation of patients who have been hospitalized, reported Animal Político, though the universe of long-Covid patients is much larger. While there are plans to expand post-Covid clinics in Mexico and a patchwork of programs and doctors providing services—like the post-Covid rehabilitation program run by the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) —there are still enormous gaps. Meanwhile, universities like the Tecnológico de Monterrey, government organizations like Mexico City’s Instituto del Deporte and private foundations like Fundación Carlos Slim have made an effort to offer online educational materials to patients and family members.
“I started to hear their fear, their fear of not being the same, their fear of dying,” she said. As she worked with Covid-19 patients, Lozano Enríquez—who wasn’t able to receive the vaccine until May—felt herself experiencing similar fears.
“When I went back to work, I started to have a sort of anxiety, because … of the fear of bringing the virus home to my family,” she said. She watched patients oscillate from doing fine to very poorly, and she stayed up late thinking about them. She imagined her family members and herself in her patients’ place. She worked through her anxiety with a psychologist, determined not to transmit her own fears to her patients. She needed to be their rock.
Lozano Enríquez usually works with post-Covid patients for eight to 12 weeks, and charges about US $25 per session. She recognizes her program is inaccessible to many post-Covid patients in Mexico and for that reason insists on the need for more investment and a comprehensive strategy for public rehabilitation programs. Indeed, investing in a strategy for such programs is urgent not only in Mexico, but around the world. So too is more research to assess which interventions are most effective.
In the meantime, Lozano Enríquez will continue working with the tools she has, patient by patient. It’s worth it for the feeling she gets when she can finally clear a patient, confident they can return to some sense of normal.