Key points you should know:
- While global studies highlight the prevalence and debilitating effects of Long COVID, India lacks comprehensive research, standardized diagnostic tools, and treatment guidelines.
- Poor living conditions, undernutrition, and pollution in urban slums amplify the impact of Long COVID on India’s marginalized communities.
- For marginalized workers like daily laborers and cleaners, Long COVID symptoms severely impact their productivity and income.
- Experts emphasize the need for systemic solutions tailored to low-wage workers in India, including community-based healthcare centers, employer-mandated flexible work policies, financial aid programs, and targeted research.
Sunaina Kumari, a 35-year-old daily wage laborer from Uttar Pradesh, a state located in Northern India, has always been the backbone of her family. For years, she toiled under the harsh sun in Bahraich, working in the agricultural fields near her village. Her earnings of 300 rupees a day (approximately $3.60 USD) for 10 hours of hard labor were meager but enough to keep her family of six afloat.
But her life took a drastic turn in 2021 when she contracted COVID-19. “The fever wouldn’t go down for weeks, and it felt like I was drowning with every breath,” she recalled, sitting on the mud floor of her home.
While research on Long COVID in India is scarce, studies and people’s experiences suggest that the pandemic has deepened socioeconomic inequalities in the country. Among the hardest hit are marginalized workers, including daily wage laborers and cleaners, whose livelihoods depend on intense physical labor. For them, Long COVID is not just a health and disability issue — it is an economic catastrophe that pushes families into cycles of poverty.
For Kumari, it took three months of rest and borrowed money for medication before she could return to work. Just when she thought she had recovered, she was reinfected in 2022. Reinfections can cause further disability, as reinfections have been found to be associated with a higher likelihood of Long COVID and new related diagnoses.
“I keep coughing, and some days my head spins so much that I can’t stand. My body has become so weak,” Kumari said, wiping her hands on her faded saree. Since her second bout of COVID-19, Kumari’s productivity has plummeted. She now manages only five hours of fieldwork a day before fatigue overtakes her. Her daily income has been halved to 150 rupees ($1.80 USD), forcing her family to cut down on food.
“We used to eat dal with rice every day. Now, it’s just rice and salt most of the time,” she said. With four children to feed and no savings to fall back on, Kumari has little room to maneuver.
While many Long COVID experts, including Kumari’s doctor, advise rest and pacing, she cannot rest at home. Her family’s needs only force her to work more.
“Last week, I fell unconscious while returning from work. My doctor said that my blood pressure was very low,” Kumari said. Her doctor advised her to include more fruits and protein in her diet, but: “I don’t know how I can have it when there is no money to survive.”
Poverty heightened by PEM
When Long COVID strikes daily wage laborers, it pushes them into a cycle of poverty, said Dr. Akash Srivastava, a myalgic encephalomyelitis (ME) expert who runs a private clinic in New Delhi, India. He’s treated people with Long COVID for whom work leads to post-exertional malaise (PEM), a key feature of ME and many cases of Long COVID in which severe fatigue, cognitive difficulties, exercise intolerance, and other new or existing symptoms worsen after physical, mental, or emotional activity.
One 2024 study by international researchers estimated that Long COVID affects 31% of individuals previously infected with SARS-CoV-2 in North America, 44% in Europe, and 51% in Asia. Another study, conducted by Maulana Azad Medical College in New Delhi, examined 553 people after their COVID-19 recovery and found that approximately 45% experienced lingering symptoms, with persistent fatigue and dry cough being the most prevalent.
These workers need government support, Srivastava said. For example, he recalled a patient who became fatigued after taking a bath and getting dressed: It was difficult for us to understand in the beginning what was happening to him. The exhaustion reached a point where his performance was severely impacted at work and he had to take a leave of six months to cope up with PEM.
However, not everyone is privileged enough to take a break of six months, Srivastava said. Finance and health insurance from the government could help people whose lives have been upended by Long COVID — like Kumari and many others in India’s workforce.
Despite the growing number of Long COVID cases in India, there is a significant gap in data and resources dedicated to studying the condition’s impact on low-wage laborers. This lack of research not only hinders effective diagnosis and treatment but also prevents the development of policies tailored to the needs of those most affected.
As millions of workers continue to experience debilitating symptoms and disability from Long COVID, the urgent need for targeted research, accessible healthcare, and systemic support becomes increasingly evident.
“There is haphazard research happening in India with no coordination… The government of India should focus on creating an ecosystem where all such research can be combined and used for the larger good of the people who are suffering from Long COVID,” said Animesh Samanta, a chemistry professor working on Long COVID research at Shiv Nadar University.
There is haphazard research happening in India with no coordination.
Animesh Samanta
Diagnosing the economic impact
Gudia Rani, 25, a cleaner earning 11,000 rupees (approximately $132 USD) per month, has been experiencing Long COVID since contracting the coronavirus in 2022. Despite repeated visits to doctors, her condition remained undiagnosed until she collapsed one day. A brain MRI revealed abnormalities that could explain her neurological symptoms.
“I feel lost and confused most of the time,” Rani said. “Even simple tasks are exhausting, and I can’t work the way I used to.”
Her reduced productivity has significantly cut her income, leaving her struggling to make ends meet.
Despite the rising burden of Long COVID in India, doctors struggle to diagnose the condition due to a lack of clear guidelines and standardized tests. “There is no specific diagnostic test for Long COVID,” said Dr. Neetu Jain, who runs a COVID-19 care clinic in New Delhi. “We rely on clinical diagnosis and tests tailored to the patient’s symptoms, like inflammatory markers or C-reactive proteins, but these are not conclusive.”
Recent research from the National Institutes of Health’s (NIH) RECOVER has found that routine lab tests cannot distinguish Long COVID. When tests come back “normal,” it has led to many people with Long COVID experiencing disbelief and gaslighting from clinicians even though researchers have found numerous abnormalities in people with Long COVID. The authors of the RECOVER study stated the importance of novel biomarkers.
This diagnostic uncertainty leaves many patients, especially low-wage workers, without proper validation or treatment, exacerbating their health and economic challenges. While researchers in the U.S. and Europe are working to identify reliable biomarkers for Long COVID, such advancements are yet to be widely accessible in India.
For marginalized workers in India, the lack of diagnostic clarity not only delays treatment but also affects their ability to receive social support or workplace accommodations. This creates a vicious cycle of illness, job insecurity, and poverty.
“Every time I get sick, the doctor asks me to get a different test done. Sometimes it’s a blood test, sometimes it’s ECG and whatnot. This is an additional financial burden for us,” Kumari said.
Still, there is some novel Long COVID research taking place in India that may help address the diagnostic challenge. At Shiv Nadar University, Samanta and his colleagues have developed a fluorescent probe designed to detect inflammation in brain cells caused by COVID-19.
This tool measures nitric oxide levels, a chemical produced by immune cells in the brain when they are fighting off infections like SARS-CoV-2. By tracking these levels, researchers hope to better understand how Long COVID affects the brain, potentially leading to improved diagnosis and treatment options.
Every time I get sick, the doctor asks me to get a different test done … This is an additional financial burden for us.
Sunaina Kumari
Systemic solutions are needed
Samanta has observed, from his Long COVID research, that better outcomes from Long COVID depend on the person’s economic background, he told The Sick Times. He’s also observed that living in a polluted environment leads to worse outcomes.
“Every winter, I have patients who have difficulty breathing. While Long COVID has impacted their lungs, the pollution further deteriorates them and moves them to a point where they have to use nebulizers,” he said.
The disease can be exacerbated even further when people have to work in polluted air, Srivastava added.
Kumari and Rani know this challenge well. Research has also shown that coronavirus infections disproportionately impacted low-income areas (or slums) in India, during major surges like the Delta wave in summer 2021. A 2021 study published in the Journal of Urban Economics found that SARS-CoV-2 has disproportionately impacted poorer urban communities in India, with higher infection rates observed in these areas.
India’s latest National Family Health Survey reveals that approximately one-third of children under five in India are underweight. Undernutrition is notably more prevalent in urban slums, where stunting and underweight rates are significantly higher than in non-slum areas. This highlights the widespread impact of poor socioeconomic conditions and limited access to adequate nutrition on children living in urban slums.
Long COVID clinicians and people with the disease say significant support is needed from the government to address these systemic issues. For example, Kumari emphasized the need for local healthcare centers that don’t require long travel, as commuting costs add to her financial burden. “If there was a clinic nearby where I could get treatment without losing a day’s wage, it would change everything,” she shared. She also wishes for government subsidies on medicines, which currently eat into her meager income.
Rani hopes for greater awareness among employers about Long COVID, urging for flexible work policies or lighter duties on days when her symptoms are overwhelming.
“I don’t want to lose my job, but some days, I just can’t push through the fatigue,” Kumari said. “Some days, I feel like my body has given up, but my family is counting on me.”
Some days, I feel like my body has given up, but my family is counting on me.
Sunaina Kumari
Rishabh Jain is a freelance journalist. He writes on health, human rights, climate change, and sustainability. He is also a recipient of the Earth Journalism Network Grant.
All articles by The Sick Times are available for other outlets to republish free of charge. We request that you credit us and link back to our website.
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