The long Covid

* Union home minister Amit Shah was admitted to AIIMS on August 18 after he complained of fatigue and body ache

* Some recovered Covid-19 patients can suffer from crushing fatigue, lung damage and other problems

* The damaged lungs can lead to secondary bacterial or fungal infections, which may be life-threatening

Little was known beyond the headline. Union home minister Amit Shah had been admitted to New Delhi’s premier All India Institute of Medical Sciences (AIIMS) for post-Covid-19 care, the media reported. But what had exactly happened?

Shah had tested positive for Covid-19 on August 2, necessitating treatment in a private hospital. He was discharged on August 14, but admitted to AIIMS on August 18 after he complained of fatigue and body ache. He was there for 13 days. On September 12, he was re-admitted to AIIMS, for what the hospital said was a “complete medical check-up... for 1-2 days”.

It is not clear what Shah is suffering from, but clinicians treating patients as well as researchers studying the new SARS-Cov2 virus say that some recovered Covid-19 patients can suffer from crushing fatigue, lung damage and other problems long after they have been cured of the infection. This has prompted many infectious diseases experts to name it the ‘long Covid’.

A top health ministry official states that the government has no comprehensive data on what percentage of recovered Covid-19 patients in the country may have developed post-Covid-19 complications.

“There is no centralised data on this, but we have received information that our Central government hospitals have encountered patients who have come back with certain complications,” health secretary Rajesh Bhushan tells BL ink . “Based on this information and technical inputs we received from the Joint Monitoring Group [a body of experts overseeing efforts to curb the infection] and other domain experts, the Ministry has recently released a guidance note for post-Covid-19 recovered patients on how to counter these complications.”

The guidance note advises those who have recovered from Covid-19 to exercise only moderately, eat freshly cooked soft food and shun tobacco and alcohol. It recommends a follow-up visit, physical or telephonic, to the facility where the patient was treated a week after discharge, and suggests a more stringent follow-up for severe post-Covid-19 cases.

Doctors in other hospitals, too, are finding recovered patients returning with complaints long after they have been discharged. Doctors at the Goa Medical College in Panaji have found residual changes in the lungs of some recovered patients. They told the media they hoped the scars would go away in 2-3 months.

“Lung scarring, or lung fibrosis, as we call it, is seen in a section of those severe patients who required ventilatory support of some kind,” explains Dr Sumit Ray, head of critical care medicine at the New Delhi-based Holy Family Hospital.

Lung scarring may be found in 15-20 per cent of severe Covid-19 patients but significant scarring may be seen in only 8-10 per cent of those who had to use ventilators or high oxygen support when they were infected, he says. He is quick to bust the misconception that this scarring is because of ventilator use, pointing out that it was caused by the severity of the infection. Without a ventilator, a patient in such a case might not have survived, he says.

To cope with this problem, these days when patients are discharged, they are often given home oxygen support and medication to reduce the scarring. “There is no medication available for curing fibrosis. Some medication may help, but evidence is weak on it,” Dr Ray observes.

Similar problems, he points out, are also seen in other infectious diseases that affect the respiratory system. But the problem in Covid-19 is a little more severe, he adds. “Many get better when they are on oxygen at home for two weeks. The worst cases that we have seen so far required home oxygen support for more than two months,” he says.

The problem, according to doctors, is seen mostly in people suffering from diabetes and obesity. While some of the fibrosis goes away on its own, not all of it does. When the lungs are damaged, breathing gets affected. And this can lead to secondary bacterial or fungal infections later, which may be life-threatening.

The lungs are not the only organs affected post Covid-19. “There can be a domino effect. If your lungs are damaged for a prolonged time, the next organ to be affected may be the kidneys. But this is found only in a minuscule percentage and happens mostly while the patient is undergoing treatment in a hospital,” Dr Ray says.

Other complications seen in recovered patients include muscle damage, fatigue and nerve damage. In severe illnesses, the metabolism of the body changes, as sources of nutrition and body proteins get converted into energy to help the body fight the infection. That is why there is a loss of muscle mass when there is a critical illness, he explains.

Similar problems have been observed in other countries, too. A study on Italian Covid-19 patients, reported in The Journal of the American Medical Association in July, showed that out of 143 recovered patients studied, over 85 per cent faced some kind of a health problem.

In the US, too, doctors have witnessed complications in patients post Covid-19, triggering concern that the pandemic will leave a significant number of people battling illnesses and disabilities long after the infection is gone. Even if a small percentage of recuperated patients develop such long-lasting health complications, it will be a large number of cases. The pandemic, after all, has affected more than 5 crore people all over the world so far.

TV Jayan

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