Recovered from COVID-19 but still reeling with fatigue, exertion, loss of smell and taste, and even unexplained anxiety? Experts believe that many recovered people are exhibiting 'Long COVID-19' symptoms.
Be it mucormycosis affecting vision, or post COVID-19 memory loss, loss of concentration, people who have recovered from COVID-19 have reported different symptoms post infection, some even lasting after several months. This experience of exhibiting COVID-19 like symptoms and illnesses even after being treated is known as Long COVID-19 in medical terminology.
While Mumbai's Hinduja Hospital reported cases of steroid-induced cell death in the thigh bone in recovered COVID-19 patients adding to the list of post COVID-19 complications, according to Delhi's Max Hospital's recent study on 1,000 recovered patients, close to 40 per cent of them suffered from Long COVID-19 in North India.
The US Centers for Disease Control and Prevention have stated that post COVID-19 complications lasting more than four weeks are even seen among people who were asymptomatic but did not know that they had long COVID-19.
Doctors BOOM spoke to said that the only way to avoid long COVID-19 symptoms is to ensure that people do not get infected by the virus in the first place. As COVID-19 is a new disease, research on it is still evolving and developing. For the doctors, it has been difficult to club and classify post COVID-19 complications, as every new patient presents different effects.
A compilation of studies by researchers from Brazil has listed all the different adverse events as well as long-term events. They even concluded that the post COVID-19 effects are not localised in the human body. They have grouped them on the basis of the area they affect.
1. Complications with the immune system (e.g., Guillain–Barré syndrome, rheumatoid arthritis, pediatric inflammatory multisystem syndromes such as Kawasaki disease)
2. Complications with the blood/ hematological system (vascular hemostasis, blood coagulation)
3. Complications with the pulmonary system (respiratory failure, pulmonary thromboembolism, pulmonary embolism, pneumonia, pulmonary vascular damage, pulmonary fibrosis)
4. Complications with the cardiovascular system (myocardial hypertrophy, coronary artery atherosclerosis, focal myocardial fibrosis, acute myocardial infarction, cardiac hypertrophy),
5. Complications with the gastrointestinal, hepatic, and renal systems (diarrhea, nausea/vomiting, abdominal pain, anorexia, acid reflux, gastrointestinal hemorrhage, lack of appetite/constipation)
6. Complications with the skeletomuscular system (immune-mediated skin diseases, psoriasis, lupus)
7. Complications with the nervous system (loss of taste/smell/hearing, headaches, spasms, convulsions, confusion, visual impairment, nerve pain, dizziness, impaired consciousness, nausea/vomiting, hemiplegia, ataxia, stroke, cerebral hemorrhage)
8. Effect on mental health (stress, depression and anxiety).
The Brazilian study has not highlighted fungal infections as well as avascular necrosis as seen in India.
What Long COVID Effects Are Doctors Seeing In India?
BOOM spoke to two doctors- Dr. Tanu Singhal, Kokilaben Dhirubhai Ambani Hospital, Mumbai, and Dr. Pooja Khosla, Sir Ganga Ram Hospital, Delhi to understand the complaints they have witnessed from patients who have recovered from COVID-19. Both doctors shared that apart from the adverse effects that are reported in the media, many of their patients are facing difficulties in performing activities they could do easily before the pandemic.
"International studies share that only 10-30 per cent recovered patients are reporting long COVID-19 effects, but in reality, many people are considering exhaustion, anxiety as normal instances and not referring to their doctors," Dr. Singhal observed.
When asked as to what are the common ailments that patients are coming forward with, Dr. Khosla said that she encountered patients with complaints of fatigue, sleeping issues, less concentration, not being able to effectively work, and facing issues with memory. "It has become really common to see five to eight people who have recovered complaining about the post COVID lethargy and fatigue," she shared.
Dr. Singhal concurred and said that there were some patients who were still facing issues with taste and smell as well as anxiety. "Several patients complained that they never had issues with anxiety earlier, but now it was becoming increasingly difficult for them to not be extensively worried all the time," Dr. Singhal added.
A study by Massachusetts Institute of Technology suggested that people who have recovered from COVID-19 are witnessing signs of autoimmune diseases- diseases where the body's immunity system starts attacking itself.
"We had a patient who reported severe joint pain and on tests we realised that its a case of an autoimmune disorder, but we could not classify as to which one it was specifically," Dr. Singhal explained.
We also asked if there were any ways to avoid these post COVID complications to the doctors. "Judicious use of COVID-19 medicines for adverse effects, but you cannot really avoid the other complications. The best way is to prevent oneself from contracting COVID-19," Dr. Khosla answered.
Adverse Effects: Mucormycosis, Avascular Necrosis
India reported the first cases of Mucormycosis in December 2020 and since then this fungal infection has infected many patients who were treated with steroids which led to an increase in blood sugar levels. Due to this fungal disease, several patients even lost their eyesight as the fungus infects different areas of the nervous systems.
This is not the only steroid-induced post COVID-19 effect that is being witnessed in India. While other fungal infections such as candida, aspergillus were also observed in India, Mumbai's Hinduja hospital's paper on avascular necrosis was only recently published.
At the time of submitting the paper, only three people were being treated for the loss of blood to the cells of the thigh bone, but orthopedics at the hospital told BOOM that they have now treated over 23 patients.
Dr. Mayank Vijayvargiya, orthopedic consultant, Hinduja Hospital told BOOM that the treated patients are now getting back to their regular lifestyles after reporting of sudden intense pain in the hip and thighs.
"Not everybody can come to Mumbai for treatment, therefore people should know to consult a doctor when they face sudden pangs, and ask their doctors if their symptoms clinically match those of AVN and should get appropriate care for the same. There is not enough evidence to find how AVN occurs in the body after COVID but we have seen it in close to 20 patients who had recovered from COVID-19 and complained of severe exhaustion and body pain.," explained the doctor.
While bone grafting- a part of the bone removed from one part of the body and transplanted to the area of the decayed bone- is a definite method to treat AVN, Dr.Vijayvargiya shared that the hospital uses medical therapy devised by a senior doctor, Dr. Sanjay Agarwala to help treat these patients.
The cause of concern with AVN, Dr.Vijayvargiya concluded was that most of their patients were between the ages of 25-50. Even the other doctors shared that long COVID-19 effects were witnessed more among people in the younger age groups.
