Does a Covid-19 patient recover fully? Long-term health effects loom large

The novel coronavirus is still raging in India and many parts of the world. The good news, however, is that the recovery rate is over 50 per cent in India as well as globally. The direct fatality rate is comparatively low for Covid-19 than some of the previous pandemics.

However, there is a big catch. Are Covid-19 survivors really fully recovered patients?

The disease is new and there is no clear answer to this question. Even the earliest patients who recovered in China got re-infected only a few months ago. There are not enough data to analyse the long-term effects of Covid-19. This is where it becomes scarier.

On June 14, a nurse working in Atlanta, US, posted a tweet saying, "When they say 'recovered' they don't tell you that that means you may need a lung transplant. Or that you may come back later with a massive heart attack or stroke bc COVID makes."

Simply, the nurse red-flagged the long-term effects of Covid-19 on patients going home with a discharge slip from a hospital, feeling relieved but without an inkling how her health condition may unfold in coming weeks and months due to the coronavirus infection she just survived.

Standard Covid-19 protocol says an average patient recovers in two weeks and can be discharged. 

The WHO says critical cases can take up to six weeks for recovery. All recovered patients are advised home isolation for some time and report any new health condition immediately.

There is not enough verifiable data to know what percentage of Covid-19 patients come back to hospitals with serious health conditions after recovery. But studies in China and elsewhere give enough of a glimpse of what may be the long-term effects of Covid-19.

REDUCED LUNG CAPACITY

Studies have pointed to CT (computerised tomography) scans showing distinct changes in lungs of Covid-19 patients. Lungs of a healthy person appear black in CT scans, those of Covid-19 patients show grey patches, called ground-glass opacities.

These damages to lungs could be permanent, researchers suspect. Researchers in China found ground-glass opacities in over 70 per cent of Covid-19 patients.

Another study in China established that such lung scarring is not limited to critically ill Covid-19 patients but is seen even in asymptomatic patients. Those with mild symptoms also reported the same patches on their lungs.

Asymptomatic patients form the majority of all Covid-19 victims. Next come Covid-19 patients with mild symptoms. Direct critical conditions are reported in less than 15 per cent of all Covid-19 patients.

These ground-glass opacities are actually debris and pus. They form due to a strong immune response to the novel coronavirus, SARS-CoV-2. The debris makes lungs less pliable.

These patches are similar to those found in cases of SARS of 2002-03, caused by another coronavirus. A study mapping effect of SARS on patients over 15-year-period showed that more than one-third patients still had reduced lung capacity.

What makes Covid-19 more serious than SARS is that the novel coronavirus infection has been found to impact both lungs. In SARS and MERS, usually only one of the lungs was impacted by the coronavirus infection.

WEAKENED HEART

Covid-19 essentially being a respiratory illness reduces oxygen levels in the body of serious patients. Low oxygen levels in the body increase pressure on heart. This study concluded: "Coronavirus disease 2019 is associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias."

The Covid-19-causing coronavirus is understood to induce inflammation of heart muscles. The virus gets access to heart muscle cells as they have abundant number of ACE2 receptors, which have been found to be the entry gates for SARS-CoV-2.

That a weakened heart is associated with Covid-19 had been seen even in patients in Wuhan, the early epicentre of coronavirus pandemic. About 20 per cent of Covid-19 patients in Wuhan reported damage to heart.

But, as said earlier, there is still no clarity about the long-term damage of heart muscles. The question whether the damage is reversible or irreversible cannot be answered with authority at this point.

DAMAGE TO BRAIN, KIDNEYS

The brain is overly dependent on an uninhibited supply of oxygen by blood vessels. What doctors have found in Covid-19 patients is that many develop blood clots, which can cause brain stroke. Stroke was not diagnosed only among the elderly Covid-19 patients but also in young adults.

The clotting of blood can cause severe damage to other organs as well, such as lungs, heart and kidneys. During dialysis of some Covid-19 patients, doctors have found blood clots making their way up to the dialysis machines and clogging them.

Among other possible long-term effects of Covid-19 on recovering patients include impact on neurocognitive ability, increased level of anxiety and other psychological and mental health disorders.

Some other studies have indicated infertility as post-Covid health condition and recommended urogenital tract monitoring among men having recovered from Covid-19.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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COVID-19: Government issues revised guidelines for discharge of patients

Following the easing of restrictions of the nation-wide COVID-19 lockdown in India, there have been a sharp and alarming spike in positive cases. Considering the fact that there is no cure or vaccine for this disease as yet, we may have to live with it for some time to come. So, we need to fall back on preventive measures and social distancing rules. The government is also doing its best to contain the spread of the disease. But COVID-19 has a way of defying all efforts to subdue it. In light of all these developments, the government of India has come out with revised guideline for the discharge of patients from health care facilities across the country. 

REVISED DISCHARGE POLICY FOR COVID-19
These guidelines are different from the previous rules. According to the earlier guidelines, a positive case had to be tested on day 14 once and then again in a span of 24 hours. If both the results are negative, only then is the patient fit to be discharged from the health care facility.


For mild/very mild/pre-symptomatic cases

Such cases admitted to a COVID Care Facility will undergo regular temperature and pulse oximetry monitoring. The patient can be discharged after 10 days of onset of symtoms and provided that he ahs no fever for 3 days. There will be no need for testing prior to discharge. At the time of discharge, the patient will be advised to follow home isolation for further 7 days. If at any point of time, prior to discharge, the patient’s oxygen saturation dips below 95 per cent, he or she will be moved to a dedicated COVID health centre. After discharge from the facility, if the patient develops any symptoms like fever, cough or breathing difficulty, he will have to contact the COVID care centre or state helpline or 1075. Healthcare professionals will then follow the patient’s health via tele-conference on 14th day. 

For moderate cases

This includes patients whose symptoms resolve within 3 days and who maintains oxygen saturation above 95 per cent for the next 4 days. Such patients will undergo monitoring of body temperature and oxygen saturation. If the fever goes down within 3 days and the patient maintains saturation above 95 per cent for the next 4 days without oxygen support, he or she will be discharged after 10 days of symptom onset in case of absence of fever without antipyretics, resolution of breathlessness and no oxygen requirement. There will be no need for testing prior to discharge. At the time of discharge, the patient will be advised to follow the home isolation for 7 days.

On the other hand, patients on oxygenation whose fever does not resolve within 3 days and whose demand of oxygen therapy continues will be discharged only after resolution of clinical symptoms and when they display the ability to maintain oxygen saturation for 3 consecutive days.

For severe cases including immunocompromised (HIV patients, transplant recipients, malignancy)

Discharge criteria for severe cases will be based on clinical recovery and only if the patient tests negative once by RT-PCR after resolution of all symptoms.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

https://gscrochetdesigns.blogspot.com. one can see my crochet creations  
https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes    
https://kneereplacement-stickclub.blogspot.com. for info on knee replacement