Covid and after

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Covid and after

Sunday, 23 May 2021 | MUSBA HASHMI

Covid and after

More than half a million people may have to go through the horrifying struggle to latch on to dear life after recovering from Corona, writes MUSBA HASHMI

A 69-year-old male Diabetic and hypertensive patient got down with fever earlier this month. At first, he thought of it as viral, but when the fever didn’t go even after two days, he underwent an RT-PCR test. Positive, the report said. He had mild COVID and was treated in home isolation with oral anticoagulants and other supportive drugs. The symptoms went away soon and he recovered in 15 days. The man and his family took a sigh of relief. However, this is not the end of the story.

To everyone’s surprise, one week later he complained of acute pain in the right leg. Something neither the patient nor his family members anticipated. Investigations revealed very high d dimer levels and deep venous thrombosis. It is a condition that occurs after a blood clot forms in a large vein, most often in the calf. Pain, swelling and sometimes pulmonary embolism (or a sudden blockage in the lung) can occur, making deep vein thrombosis a life-threatening condition. But, fortunately the doctors were able to save the patient because of early treatment.

However, not everyone might be as lucky as this man. Though the number of Corona cases is declining in India, the country is staring at the horrendous possibility of patients recovering from COVID, but succumbing to a heart attack or organ failure soon after.

Millions at risk

“It is estimated that 26 per cent of the COVID patients can exhibit post covid complications,” says Dr Mubasheer Ali, Senior Internal Medicine Consultant, Apollo TeleHealth. The long-term effects may include fatigue, cardiac, respiratory symptoms, and neurological symptoms.

Looking at the current figures of recovered cases, more than half a million people may have to go through the horrifying struggle to latch on to dear life. Currently, India has seen 22,712,735 recovered cases, which is 99 per cent of the total cases with just one per cent deaths. The latest post-Covid complications story is giving a twist to the tale as the country might see more deaths in the months to come.

The post COVID complications are common in vulnerable patients such as patients above 60 years with or without comorbidities such as Diabetes, hypertension and cardiac disorders. The country has about 54.5 million cardiovascular diseases patients (according to a previous data), 77 million Diabetics, as of 2020, and similarly people struggling with serious ailments that are likely to get aggravated post COVID. Not only people with comorbidities, but the ones who have suffered severe COVID symptoms are equally at risk.

“It is found that individuals with a severe disease at the start of their illness have a greater risk of long-term cardiac complications secondary to COVID-19. But, recent scientific data suggests that even people with mild COVID-19 may develop long-term health complications that go well beyond the lungs,” Ali adds.

Dr Shuchin Bajaj, Founder & Director, Ujala Cygnus Group of Hospitals, says that deaths in such cases is not new in the second wave. It happens due to heart attack or because of developing severe post Covid pneumonia leading to low oxygen levels in the patient, requiring ventilator support and then dying. The reason for cardiac arrests in such cases is the increased thrombogenicity in the blood.

“The Covid-19 infection increases the thrombogenicity in the blood. This leads to thickening of blood owing to prothrombotic conditions. This virus makes the blood thicker, which leads to formation of blood clots which can later result in cardiac arrest. Also, COVID-19 has endothelial disease qualities that damage the inner lining of blood vessels of the heart and arteries which makes it difficult for the heart to pump blood as it is supposed to do,” Dr DK Jhamb, Director & HOD Cardiology, Paras Hospitals, Gurugram, tells you.

Struggle with Long-haul COVID

“It is found that individuals with a severe disease at the start of their illness have a greater risk of long-term cardiac complications secondary to COVID-19. But, recent scientific data suggests that even people with mild COVID-19 may develop long-term health complications that go well beyond the lungs,” Ali adds.

Although most people with COVID-19 get better within weeks of illness, some people experience post-Covid conditions. “Post-Covid conditions are a wide range of new, returning, or ongoing health problems people can experience more than four weeks after first being infected with the virus that causes COVID-19. These post-Covid health conditions are known as “long Covid” or “long-haul Covid”. In such cases, a patient continues to experience symptoms of the disease four weeks after initial recovery,”  Dr Deepak Verma, Internal Medicine, Columbia Asia Hospital, Ghaziabad, tells you.

He agrees with Ali and tells you that Covid-19 is also affecting multiple organs and body systems, including heart and blood vessels, lungs, kidneys, skin, brain and nerves. This virus has the potential to directly involve lung cells, leading to lung fibrosis. They stimulate the fibroblasts, causing fibrosis of the lungs and that is a tripling problem. “That is, you land with a ‘triple lung’, leading to fatigue and you always pant for breath,” Verma says.

Available data indicates that about a quarter of those with COVID-19 suffer from symptoms four-five weeks after testing positive, and about one in 10 experience symptoms after 12 weeks.

“While there is no conclusive evidence, people may experience post-Covid conditions due to persistence of the virus in some parts of the body that are sheltered from the immune system,” Verma adds.

Certain post Covid complications can be quite severe ranging right from death to continued breathlessness, post Covid pneumonia, inappropriate sinus and anxiety. These can last anywhere between two weeks and five months.

“We have seen hundreds of cases till now. And, one of them was a famous paediatrician, who was admitted in our hospital. He suffered from inappropriate sinus tachycardia for about four months after recovering from COVID. Every time he stood up and walk, his heart rate would shoot up to 150 per minute. He would develop severe palpitations and would have to sit down immediately. A visit to the toilet was like preparing for a marathon for him. He would think 10 times before standing up. It was a severe case and quite unfortunate too because it was a helpless situation. Thankfully, he has recovered now and is doing perfectly great,” adds Bajaj.

Be alert, Be Safe

The only way, Jhamb says, to avoid these deaths is to take proper care even after recovering from the virus.

“The increased deaths can also be attributed to heart attacks and multiple organ failure as a result of post-Covid complications. It is disheartening to say that people with CVDs are at a higher risk of losing the battle against COVID. In such a scenario, patients with underlying diseases should be more careful than ever and should take proper care of themselves even after they have recovered from the infection. This is the only way deaths related to post-Covid complications can be reduced in the coming months,” Jhamb opines.

While, Ali suggests it is important to diagnose and treat the post-Covid complications early, in order to reduce mortality. “Early signs of post-Covid complications depend on the organ or the system involved post recovery. Complications range widely involving cardiac, neurological and respiratory systems. Take for example, if there is an impending cardiac complication then the patient can experience typical cardiac symptoms such as chest pain, palpitations, heaviness in the chest and others. This can further lead to increased chances of heart attacks. So, one has to be alert and should keep a watchful eye on the symptoms,” he says.

Mystery of Black Fungus

While we are still fighting the deadly second wave of COVID-19, many States are reporting a rash of mucormycosis aka black fungus cases.

While some doctors believe it is a post-Covid complication, there are no reports to back the fact. Also, several doctors disagree with the notion and say that it is simply an opportunistic infection and attacks people with a compromised immune system. It is also said to be a hospital acquired infection.

“Black fungus is an opportunistic infection and attacks people with a compromised immune system. Certain people like transplant patients, cancer patients and people on immunosuppression are at high risk. The fungal spores are present in our environment but can infect only when the immune system is down. Hence, we generally see these infections limited to a particular patient group,” Dr Sumana Arora, Vice President, Clinical Services, DayToDay Health, tells you.

However, we are seeing an explosion of black fungus infections lately in our country, especially with the COVID pandemic. Why, you ask?

“The novel Coronavirus infection by itself is diabetogenic. Further, the covid infection has two phases — the viral phase and the inflammatory phase. And not necessarily the infected patient goes through both phases. Most of the patients go through only a mild illness in the form of the viral phase and do not enter the inflammatory phase at all. However, for the patients who do enter the inflammatory phase of the illness, steroids are the standard of treatment. Unfortunately, we are seeing indiscriminate use of steroids even in the viral phase, which is doing more harm than good. This is leading to more patients entering the inflammatory phase,” she adds.

Additionally, poor sugar monitoring control and improper tapering of steroids add to the problem. The fact that India is the Diabetic Capital of the world doesn’t help either. “It is also suspected that the use of industrial oxygen, dirty masks and unclean tubes when using oxygen therapy is also leading to this infection, not to mention the unclean water for humidification for oxygen therapy,” she says.

Dr Archana Dhawan Bajaj, Gyneacologist Obstetrician and IVF expert, Nurture IVF, agrees with Arora and says that this is not per se a complication of COVID-19 alone, it can happen to anybody whose immunity is compromised.

“Patients with malignancies or HIV also have compromised immune system and are at a higher risk of getting fungal infection,” Bajaj says.

This fungus can enter through the sinuses into the brain and the lungs and from the brain. It could damage the eyes also. A very high mortality rate as high as 50 per cent found to be associated with mucormycosis. The disease can be easily cured if it is picked up at the early stages with drugs.

“If the disease gets at advanced stage which often happens in people with COVID-19, it becomes difficult to treat it. People with COVID and mucormycosis may have headache, breathlessness, difficulty in timing well or difficulty in vision along with other symptoms. Mucormycosis is potentially life-threatening condition and should be treated timely with adequate emphasis on all possible curative drugs and procedures,” Bajaj says.

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