The long road to recovery

Persisting side-effects even months after surviving Covid are taking a heavy physical and emotional toll on patients, making their return to normal life a protracted and difficult battle.

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Virus watch: A health worker collects samples for Covid test in Delhi’s Sadar Bazar

The first time Vidhushi Tripathi sensed something was wrong with her was when she couldn’t smell the garam masala her mother uses as a garnish for dal. Normally, the aroma of the spices would alert Tripathi, a 33-year-old software engineer in Bengaluru, that dinner was about to be served. But one night in June, she could smell nothing. “I tested positive for Covid. I had mild symptoms, fever and fatigue. I can never explain how frightened I was that I might have infected my mother, but she was negative. After two weeks, I tested negative too and could smell again,” says Tripathi.

Tripathi thought the worst was over. But nearly five months on, she continues to struggle with her post-Covid recovery. Debilitating fatigue was the first symptom she experienced of ‘Long Covid’, a condition where patients continue to deal with Covid-related symptoms long after their body has been rid of the virus. Some days, the fatigue was so extreme that she found it difficult to even talk while walking. The next symptom was the same old loss of smell, which would last about two days at a time. “Suddenly one day, I couldn’t smell my coffee, I couldn’t believe it. Then a few weeks later, I couldn’t smell flowers. The symptom just comes and goes in waves. Every time I feel I am getting better, I relapse,” says Tripathi. The third symptom, which persists to date, is gluten sensitivity that has forced Tripathi to give up wheat, flour and other gluten-heavy products.

In another part of India, another patient reported an entirely different experience of ‘Long Covid’. Mumbaikar Azad Khan, 40, woke up one July morning to find rashes and red marks on his fingers. He thought it might have been caused by the stress of dealing with Covid and immediately got into meditation. Ten days later, when his joints began to ache painfully, he visited Jaslok Hospital where a doctor informed him that the condition could have been caused by blood clots, an occurrence among several Covid patients. Studies in France and Netherlands suggest that 20-30 per cent of Covid patients develop thrombosis, or blood clots, which could persist even after recovery. If not treated in time with blood thinners and anticoagulants, it could be life-threatening.

Both Tripathi and Khan had jobs that could be done from home. Sreekumar, a 34-year-old courier delivery executive in Noida, in the National Capital Region, had no such luxury. Despite crippling exhaustion and muscle-ache, he continued to ride his bike to deliver packages. In October, the mental trauma of two months of battling the physiological manifestations of ‘Long Covid’ got too much. Sreekumar gave up on his dream to make a living in a big city and prepared for return to his hometown in Telangana to work at a farm.

As India inches towards the 10 million cases mark, what remains unrecorded are the ways in which Covid has changed the health and lives of patients. Even today, Covid continues to startle doctors with the variety and unpredictability of its symptoms. “Every Covid case is different and we still receive complete surprises. Sometimes an elderly person sails through while a young person remains severely ill for days,” says Dr N.N. Mathur, director, Lady Hardinge Medical College, New Delhi. Indeed, week after week, studies published show never-before-known impacts of the virus. Most recently, in a study by the UK-based Anglia Ruskin University, 40 per cent of 3,103-odd patients in 48 countries reported that Covid had worsened tinnitus for them. Tinnitus is a condition that causes the perception of noise in one’s ears. The study has been published in the journal Frontiers in Public Health.

Another study in the Journal of Clinical Immunology and Immunotherapy notes delirium and fever to be common post-Covid symptoms. “When the pandemic began, we only knew of Covid as pneumonia. Now, we have at least 50 per cent patients reporting other symptoms. Some of them are unusual and unexpected, such as amenorrhea, a condition which causes women to skip their period. We are still learning what all other symptoms one can have for Covid, though we know they exist for certain,” adds Dr Mathur. A host of post-Covid symptoms are now known, among them ‘brain fog’ or the feeling of confusion and ‘Covid toes’ or rashes on toes. But doctors say a lot is going unnoticed because of poor post-Covid follow-ups. It is one of the reasons a post-Covid care clinic was opened at the Rajiv Gandhi Super Speciality Hospital in New Delhi. Not to document the health condition of recovered patients but to provide treatment for their persisting symptoms. The clinic says about 30 per cent of Covid patients battle ill-health even after testing negative for the virus. “There is one thing as being unable to infect others. But there is quite another thing as having fully recovered,” says Dr B.L. Sherwal, director, Rajiv Gandhi Super Speciality Hospital. “Since the lingering symptoms are often minor, doctors may not recommend invasive tests to, say, review organ health. One weighs the risk benefit ratio in these cases. Yet, even if we don’t record or test each one of the 8.5 million-odd cases, we should have the medical infrastructure to support their recovery.” AIIMS in New Delhi and other hospitals in the country are in the process of setting up similar clinics.

WHO IS AT RISK?

Healthcare workers aren’t just concerned about the bewildering assortment of symptoms during and after Covid, but the fact that there is no clear way to assess who is at risk from them. Initially, those on ventilator care were seen to suffer the most in their recovery phase, but increasingly patients with mild Covid symptoms are reporting lasting impacts of the virus. Many researchers are looking for patterns to determine who are most likely to suffer from ‘Long Covid’. “We have some markers for cases that could turn severe, such as age and comorbidities. But we don’t have that for persisting symptoms of Covid yet. Age could play a role,” says Dr Randeep Guleria, director, AIIMS, New Delhi.

The Covid Symptom Study published recently in the UK says older people, women and those with at least five symptoms in the initial phase of Covid are more likely to have persisting problems. But this is still far from conclusive evidence as other studies warn of young people being at equal risk from ‘Long Covid’. In a recent study, the US-based Centers for Disease Control and Prevention said Covid could result in prolonged illness, ‘even among young adults without underlying chronic medical conditions’.

In India, Covid death rates are the lowest amongst young adults. However, lingering post-Covid symptoms like fatigue, anxiety and muscle pain can wreak havoc in young individuals’ lives. Shahana Ray from New Delhi knows this all too well. The 29-year-old artist hasn’t been able to hold a paintbrush for the past two months. Covid wrecked her economically and personally. “I had to move back in with my parents. The mental trauma is so great now that I am unable to be creative. I am stuck,” she says. When Ray got Covid, she experienced nothing more than an upset stomach, two days of fever and a few days of exhaustion. Yet, those minor symptoms have eventually led to a much more damaging outcome. “I still have days when I can’t do as much work as I used to,” adds Ray.

Without a definitive determinant as to how the virus will impact an individual, doctors continue to advocate prevention, wearing a mask and social distancing, as the best strategy. “If people say ‘Let’s just get it (Covid) and be done with it,’ it is a wrong attitude to have entirely. At the end of the day, it is a pathogen in your body. With or without symptoms, it is not good for anybody’s overall health,” says Dr Sherwal.

IMPORTANCE OF SELF - CARE

Given the onset of winter and the rising levels of pollution in several Indian cities, doctors are recommending flu shots as part of the recovery regime. While annual flu vaccines are regularly taken in Europe and the US, flu immunisation awareness remains relatively low in India. While a flu shot will not protect anyone against Covid, it can potentially help reduce its severity by protecting individuals against influenza.

The best defence against ‘Long Covid’ is self-care and maintaining a healthy lifestyle, say doctors. Diet plays an important role during both the treatment and recovery phases. “Avoid heavy food. You don’t want to stress your system with rich and oily meals,” advises nutritionist Kalpana Bhatia. “Your body needs vitamins and minerals to recover, and plenty of water. People often underestimate the role digestion and nutrition play in combating diseases and their after-effects.”

Doctors also recommend drinking hot water, steam inhalation and gargle to help the throat and lungs recover from the impact of Covid. “In traditional medicine, it is important to respect one’s body. When you have been through a disease as severe as Covid, you have to slow down and take time to heal. You should not rush back into a city schedule again,” says Dr Issac Mathai, noted holistic healer and chairman of Soukya in Bengaluru.

Many of those who have been handling post-Covid symptoms for months now say complete bed rest and home-cooked food have made a difference. “There is no shortcut. You have to suffer through the symptoms, but you can arm your body in the right manner,” says Tripathi, who has been taking homeopathic supplements in her recovery phase. She feels it has made her “mentally stronger and helped with physical recovery”.

Mental anxiety is one of the most commonly reported symptoms of ‘Long Covid’, all the more caused by the feeling that one’s life is far from returning to normal. Patients say they can no longer exercise, work or even socially interact like before. For many, the nagging fear is that the virus may infect them again. “People don’t expect to be ill for so many months. Somebody with severe Covid would feel the trauma of hospitalisation. But equally, someone with minor Covid symptoms could feel the burden of persisting symptoms. This becomes worse when you add economic and financial burdens,” says Dr B.N. Gangadhar, director, NIMHANS, Bengaluru. Even small things like not being able to walk one’s own dog or attend one’s job could potentially leave a mental scar. It is why despite a minority of cases being recorded officially with persisting symptoms, healthcare experts continue to emphasise on a careful and professionally supported recovery regime for Covid.

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