The post-COVID-19 syndrome

COVID-19 is a respiratory infection who has set not only records in infectivity and mortality but also in long term sequelae leading to increased mortality and morbidity. As we are moving from various phases of COVID-19 community transmission, these complications are being more evident in our day to day practice. The post covid 19 syndrome can be characterized by prolonged malaise, headaches, generalized fatigue, painful joints, dyspnea, chest pain and cognitive dysfunction. There are geographical variations to the incidence as well severity of complications. Approximately 10% of patients experience prolonged illness after Covid-19. We have seen multiple cases of post-COVID-19 syndrome causing a significant mortality or delayed complications despite a stable vitals at time of discharge. Almost half of patients who have received oxygen support are reporting reduced quality of life or a persistent requirement of oxygen in their due course. One of the most common and difficult to treat part is Post COVID-19 Lung. The Post COVID-19 Lung / Pulmonary Fibrosis is also part of COVID-19 syndrome in which patient develops Pulmonary fibrosis after COVID-19 organizing pneumonia. In simple term it means part of damaged lung which are not able to take part in oxygenation. This damaged part heals very slowly and may not heal at all making patients oxygen dependent for entire life. This fibrosis not only leads to the requirement of Long term home oxygen [LTOT], it also leads to severe limitation of physical activity for day to day activities [like changing clothes going to washroom]. In a country like India it is seen as a significant economic burden to the patient and their family members. Sad part is that there is hardly few things which can be done once this complications have completed their course causing irreparable damage. Antifibrotic therapies like perfenidone and Nintedanib are being used at present for same, but their actual outcome is yet to be seen. Most usefull method i.e. Lung transplant is in Nut Shell at present in our country with a very high cost and limitations regarding availability of donors. As per government resources basic Yoga practice [Basically breathing exercises] and herbal methods are being advertised for same, result or benefit of which is yet to be confirmed. There have been incidents of sudden death despite stable vitals at discharge, which shows the reuirement of medical care or observation after discharge. Now question arises who are risk groups for these complications. All patients who required oxygen support during their hospital stay or in active illness or who are >60 years, or having co-morbidities like diabetes, hypertension, any other chronic illness. Patient who are having a high CRP, a Higher CT severity score of 4/5 out of 5 or 15 should be in touch with their treating physician or any Pulmonologist to reduce the severity of complications. Last but not the least is a impact on mental status of patients. Almost all patients develops some or more amount of mental stress in some or other form leading to anxiety, Post traumatic stress disorder, depression and others. These also needs a proper counseling and sometimes a long term psychiatric treatment. As researches are getting concluded, day to day modifications are being made in the treatment protocol. What we have learned till this time is that early the intervention better will be the result. This could be reality only if patients presents early to the hospitals, and testing each possible contact or possible patient so a active and early intervention could be started at earliest.

Author: Dr. Amrut Kumar Mohapatra, Nodal Officer KIMS COVID Hospital, BBSR Assistant Professor, Department of Pulmonary medicine, KIMS,BBSR