By Dr Md. Shakeel, Head-Emergency & Trauma, Hiranandani Hospital, Vashi-A Fortis Network Hospital
The COVID19 pandemic has hit the world hard, with patients succumbing to the infection, developing complications like organ damage, and having a prolonged stay in the ICU before making complete recovery. A study conducted in Italy showed an overwhelming 87.4% of patients, who has recovered from COVID19, reported persistence of at least one symptom – particularly fatigue and Dyspnoea (laboured breathing); this was reported even after two months of being discharged from the hospital!
Some patients who have recovered from COVID19 infection had to be rushed back with low oxygen saturation levels to the emergency department just a day after discharge! These patients were admitted to the hospital for atleast 10 days and had been discharged after they were doing well, and all the symptoms had been resolved. These patients came back to the hospital emergency with a whole spectrum of Lung diseases – from Fibrosis (formation of hard fibrous tissues as the Lung heals from an injury) to secondary infections and Pneumonia. It was also noted that, after recovering from COVID19, some patients came back to the hospital’s Emergency Room with reduced heart function, Heart Attack or even Stroke.
COVID19 is known to attack the Endothelial Cells that line the blood vessels, leading to excessive blood clotting across the body. Now that the disease has been in the country for over five months and we understand it slightly better, we need to start looking at post-COVID rehabilitation, which has become a must, especially after having dozens of patients coming back into the Emergency Room with post-COVID symptoms. These long and short term impact of COVID19 is called ‘Post COVID Syndrome’. This means, after the acute phase of COVID19 is over, patients come back to hospitals with symptoms such as lethargy, body aches and itchy throats even four to six weeks later. Patients are also seen to have had psychological impact of the infection, leading Anxiety and Depression. It is of utmost importance to monitor such cases, and a proper post-discharge rehabilitation plan be put in place, to monitor the patient’s health, so timely intervention could be done.
WHY SO PATIENTS EXPERIENCE POST-COVID SYNDROME/ DISTRESS DESPITE MAKING FULL RECOVERY FROM THE COVID19 INFECTION?
The extent of post-COVID distress would likely depend on the extent and impact of the infection the patient suffered. Other factors such as smoking history, advanced age and comorbid conditions like Diabetes, Hypertension, Renal Disorders also come into the picture, which further reduce the immune response of patients.
DO MEN & WOMEN REPORT SAME ISSUES POST DISCHARGE?
Men and women report same post-COVID issues, but the incidence of Post COVID Syndrome/ Distress is seen more amongst males, than females
WHAT ARE TOP 10 CHECKS THAT COVID SURVIVORS NEED TO UNDERGO TO ENSURE THAT EVERYTHING IS IN RANGE & WHEN SHOULD THESE CHECK’S BE DONE?
- Daily check of oxygen saturation, it should be maintained at >94% on room air
- Watch for respiratory symptoms i.e. persistence or worsening of symptoms like cough &breathlessness
- Persistent rise of body temperature above 100F
- Watch for signs of lethargy, drowsiness, and altered sensorium
- Regular monitoring of blood sugar in known diabetic patients is needed. COVID infection (as any other infection) alters blood sugar levels of the body. Strict monitoring once in 3 days and regular consultation with your doctor is required
- Regular blood pressure monitoring in known Hypertensive patients is required to avoid accelerated Hypertension-related complications. Weekly blood pressure monitoring in case of controlled Hypertension, or more frequently in case of abnormal readings is required
- Follow up consultation with your doctor within 7 days of discharge
- Blood investigations like CBC, CRP at first follow up, and subsequent follow ups, if advised by your physician
- Repeat CT scan of chest after 3 months to look the extent of Lung recovery post the COVID infection
WHAT WOULD HAPPEN IF ONE WAS TO SKIP THESE ASSESMENTS?
- Patients may go into ‘Cytokine Storm’ – Immune cells flood and attack the Lungs they should actually be protecting!
- Blood vessels could leak, or the blood starts clotting
- Blood pressure could plummet and organs could start to fail
- Secondary complications are highly common in post COVID infections like Pulmonary Fibrosis, Pulmonary Embolism, Renal Failure, Liver Dysfunction, Coagulopathy (excessive bleeding or clotting), Acute Stroke, and Myocardial Infarction
CASES OF SOME PATIENTS IN THE POST COVID PHASE:
- A middle aged man, post-COVID discharge, presented to us with complaints of pain and swelling in his left leg. He was diagnosed to have Deep Vein Thrombosis (DVT) – a condition causing clots in venous circulation of the legs, despite being on blood thinners! This is a known complication of COVID infection and needs to be addressed in a timely manner
- An elderly patient, known to have Hypertension and Diabetes, presented to us one month after being treated for COVID19 infection, with complaints of breathlessness and progressive cough. CT scan of his chest revealed Pulmonary Fibrosis. The patient had to be put on long-term oxygen support due to poor lung compliance, he is now doing much better
- A young patient came back to the Emergency Dept. just a day after being discharged completing their COVID treatment, with sudden onset of agitation and restlessness, causing high blood pressure. The patient was found to be in acute Psychosis, which is a very known complication of post viral illness.
