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He was fit and healthy, and practiced martial arts when he had free time from his job as an IT engineer.

He didn’t eat out or go for drinks, taking necessary coronavirus precautions as he hadn’t been able to get vaccinated yet because older people were prioritized in the vaccine rollout.

Still, the Kanagawa Prefecture man and his wife contracted COVID-19 about two months ago, at a time when cases were peaking across the country amid Japan’s fifth and largest wave of infections.

Within weeks, the man, in his 30s, had recovered from the most acute effects of the disease, but other symptoms lingered, including feelings of fatigue, a lack of smell and taste, poor balance and sleep deprivation. Even now, light exercise or the occasional one-hour train ride to his office makes him feel exhausted, even though he is an expert in iaido, a Japanese martial art that demands its practitioners have the skills to quickly draw a sword and strike down an opponent.

“My cardiopulmonary functions are still way down,” said the man, who declined to give his name for privacy reasons.

The man is one of a growing number of “long haulers” in Japan and abroad who are experiencing long-term health issues as a result of COVID-19 that leave them struggling to handle even tasks that used to be routine.

While most coronavirus patients recover within four weeks, some of them, including asymptomatic and mild patients, can have what’s called long COVID-19, which can last for months.

According to a study led by the University of Oxford published at the end of September, 37% of more than 270,000 COVID-19 survivors still had at least one lasting symptom in the three-to-six-month period after they were infected with the disease.

Hospitalized patients are more likely to have these long COVID-19 symptoms with chances slightly higher for women, the study showed.

Another study from King’s College London has shown that fully vaccinated people who contract COVID-19 face half the risk of developing long-term symptoms compared to unvaccinated people.

A long COVID-19 patient at Harajuku Rehabilitation Hospital in Shibuya Ward, Tokyo, in August | KYODO
A long COVID-19 patient at Harajuku Rehabilitation Hospital in Shibuya Ward, Tokyo, in August | KYODO

Long COVID-19 can have a substantial negative impact on a patient’s life and treatment options are scarce, as the cause remains unclear. Many patients feel fatigued and lose their sense of smell, while some experience hair loss, pain in their joints, severe cognitive impairments or brain fog, a condition referred to as a sluggish cognitive acuity.

Others have debilitating symptoms including shortness of breath, abdominal pain and depression, sometimes lasting for more than a year. In some cases people cannot go to work or school and severely ill patients can be bedridden.

There is no one-off remedy to treat the diverse long-lasting symptoms — said to number around 100 — of COVID-19. The typical approach in Western countries has been to rely on specific remedies to address each symptom, such as over-the-counter painkillers for pounding headaches or steroids to counter hair loss. But doctors recommend that patients see their primary physician if over-the-counter medications don’t work.

In Japan, some are touting traditional kampo medicine for treating long COVID-19.

Some doctors say that when patients complain of a number of persistent episodes despite no abnormalities having been detected through a physical examination, kampo medicine, which has been shown to improve conditions for patients experiencing shortness of breath or chest pain, could provide relief. The medicine, which is said to enhance a person’s self-healing power using natural herbs, has its roots in traditional Chinese medicine, which was imported to the country around the sixth century, though kampo medicine diverged greatly from those roots over the centuries that followed.

Keiko Ogawa, a specially appointed professor at Hiroshima University Hospital and a leading expert in kampo medicine, has stressed the traditional medicine’s importance as a tool to possibly prevent and treat COVID-19, including its lingering symptoms.

A study published in Wiley scientific online journal led by Akita University researchers has also shown that most of the patients treated with the kampo drug saikatsugekito recovered within a week without the worsening of symptoms. The study says the results indicate it could be used as an option to treat mild to moderate cases of COVID-19.

Kitasato University Oriental Medicine Research Center in Tokyo is one of the few premium health care providers in central Tokyo that prescribes kampo medicine to long haulers, and in a sign that long COVID-19 cases are becoming more common, the clinic is seeing growing demand for the treatment.

The government offers some drugs and antibody cocktails as a treatment for acute COVID-19 symptoms, with expenses coming out of public coffers, but there are no long COVID-19 treatments covered by the government. Some doctors, including members of the Tokyo Medical Practitioners Association, have urged the government to include kampo treatment for long-haulers as part of national insurance.

Hiroshi Odaguchi, the director general of Kitasato University Oriental Medicine Research Center, says his clinic mixes hundreds of herbal medicines, which are boiled down and infused. This is done to best suit the needs of each individual case, Odaguchi says. The treatment is not covered by national health insurance, although kampo treatment offered at most hospitals is covered.

Before the pandemic, the main clientele of Odaguchi’s clinic were older, affluent residents. But now, the majority of the clinic’s patients are in their 20s, 30s and 40s, as long-haulers whose symptoms haven’t improved through standard kampo medicine turn to his clinic as a last resort, Odaguchi says.

A long COVID-19 patient goes through a rehabilitation exercise at Harajuku Rehabilitation Hospital in Shibuya Ward, Tokyo, in August. | KYODO
A long COVID-19 patient goes through a rehabilitation exercise at Harajuku Rehabilitation Hospital in Shibuya Ward, Tokyo, in August. | KYODO

Odaguchi says about 80% to 90% of patients prescribed with the clinic’s specialized kampo medicine treatment have seen their conditions improve. Still, some have symptoms lasting for more than six months. The clinic declined to make any of its patients available for an interview.

Amid growing demand, Juntendo University Hospital in Tokyo opened a new kampo outpatient program for long COVID patients on Oct. 1. The hospital is planning to treat long-haulers with kampo medicine and Western medicine, depending on an individual’s symptoms.

Shigeru Omi, the government’s top coronavirus adviser, has called on young people to take thorough measures to prevent infection as new variants have made them susceptible to severe disease and lasting symptoms.

“Even young people can suffer from serious illness and even those who had only mild or no symptoms can have lingering symptoms,” he told his followers during an Instagram Live appearance in late September. Omi urged young people to get vaccinated in order to protect themselves.

Vaccination may also offer hope for long-haulers and scientists at the Yale School of Medicine are trying to collect data on whether there is a correlation between recovery from long COVID-19 and vaccines.

At least, it appears to be working for the Kanagawa man, giving him hope that he can practice martial arts again.

Even though he still has a nagging headache that forces him to take a break from work from time to time, there are signs his long COVID-19 symptoms have improved since he got his first shot on Friday last week.

“After being infected with the coronavirus, I had a hard time falling asleep and could sleep for only three to four hours (every night),” he said. “After the vaccine shot, I slept for 15 to 16 hours on the first night and eight hours the following day. It’s been a while since I slept this much.”

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