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.

By  Kamayani Naresh, Founder Zyropathy(Zyro Healthcare Pvt Ltd.)

With the change in weather, there had been a steep rise in the number of cases related to respiratory issues. As per a recent study, there had been a rise of 20-25 percent patients with respiratory health issues. As per reports issued by hospitals, they are amidst a huge crisis, as hospitals are filed with COVID patients, the sudden spike in pollution has lead to a scarcity of beds in hospitals.

The cases of respiratory problems are on the rise and the biggest problem is the rise in air pollution. It has been proven through researches that as the temperature dips, the dust particles come down, and these air pollutants directly enter our lungs causing nose blockage, sinusitis, lung congestion, Bronchitis, Asthma, Pneumonia, Chronic Obstructive Pulmonary Disease (COPD), Interstitial lung disease (ILD), Shrinking Lung Syndrome (SLS), Systemic Lupus Erythematosus (SLE) and Lung Cancer.

The second reason for respiratory problems is environmental change. The change in environment results in the decay of old vegetation and growth of new ones, similarly it also results in the growth of new viruses & bacteria and the decay of old ones.

Our body’s immunity system is geared up for dealing with the viruses & bacteria of the earlier environmental conditions so whenever new viruses & bacteria attack the body’s immunity system is not ready for it and therefore respiratory problems start. Since the respiratory system is directly open to the environment any change in the environment directly affects it.

The third issue is low immunity and the basic reason for it is an inbuilt nutritional deficiency in the food besides adulteration. Most of the grains, vegetables, and fruits we consume are poisoned due to the uncontrolled usage of fertilizers and pesticides. Immunity, whose basic job is to protect the body from external aggression and internal disorder, diversifies its resources to absolve the emergency situation created because of polluted food, air, and water. As the basic input to the body is progressively deteriorating in quality and is becoming unpalatable it is unlikely that our immunity will be in a position to perform its basic role resulting in increased ailments. The change in lifestyle has adversely impacted immunity which is the root cause of most ailments.

The fourth aspect which is continuously declining is regular physical exercise. The job requirements are changing and do not have consideration for the natural daily routine. The metabolic activity has reduced cellular functionality, which is the root cause of declining health. In such difficult habitat conditions, the body requires additional support for the upkeep and maintenance of immunity and health.

As far as remedies are concerned, it is suggested to avoid antibiotics, as they might give you immediate relief, but in the long run, they weakens the system and can have adverse effect on the body. It is recommended to go back to the roots and look at your kitchen as the key source of natural means of remedies. From ginger to garlic and turmeric to cinnamon we are blessed with very effective means of boosting the respiratory system.

Start having citrus fruits, which are rich in vitamin C and helps build up your immune system and also increase the production of white blood cells, which are key to fighting all sorts of infections.

From early civilizations, garlic has been recognized for its value in fighting infections. It helps slow down the hardening of the arteries and is also effective in lowering blood pressure.

Ginger is another effective and natural remedy that can protect your respiratory system and helps decrease inflammation, which can help reduce a sore throat and inflammatory illnesses. It is also effective in nausea and cough. It also helps decrease chronic pain and might even help decrease cholesterol-lowering properties.

Apart from all these, you can also rely on natural herbs that are loaded with health benefits and can work as a shield of protection against your respiratory system. You can include herbs like Holy Basil (Tulsi),Eucalyptus, Thyme, Oregano, Peppermint and Mullein in the form of tea, balm, extract, and even essential oil to gain maximum benefits and keep the body safe from all side effects of respiratory problems.