Hospitals should gear up for post-Covid phase

A marked decline in the number of daily infected persons and consequent decrease in the number of deaths are redeeming, but should these developments lull the healthcare personnel and the population into complacency? For prevention of a second wave, measures like avoiding crowded places, social distancing, mask-wearing and hand hygiene should continue. Regular exercise, sunshine, good sleep and nutrition, besides shunning smoking and alcohol, could be added to the list to prevent long-term complications in the post-Covid phase.

A vaccine may also help in the prevention of infection, but its long-term efficacy is yet to be established. In any case, it has no role in the prevention of post-Covid complications. In fact, mild adverse symptoms and occasional death have been reported after vaccination. Whether the vaccinated person can be a super-spreader or himself develop complications like long-haulers in the long run is not known at present.

Those who appear to have recovered also need extended supervision by the hospitals. They can develop clinical signs and symptoms weeks and months later — extreme fatigue, brain fog, sleep deprivation, heart palpitations, shortness of breath, chest pain, dizziness, pins and needles in hands or feet, nausea, diarrhoea, abdominal pain, loss of appetite, fever, dry cough, headaches, sore throat, loss of sense of smell, taste or vision, skin rashes, joint pain, depression and anxiety. While serious cases will need hospitalisation, the mild ones can be treated at home under supervision. If the hospital cannot extend such services, the family physician should be treated as an extension of the hospital. The need for setting up multi-specialty post-Covid clinics in every hospital is paramount.

Besides Covid-19, the pent-up demand of non-Covid patients of communicable as well as non-communicable diseases is bound to explode as normal hospital services remain suspended. How long can these chronic and co-morbid patients who needed ongoing health maintenance wait? The euphoria of dealing with the coronavirus or its vaccines while neglecting childhood vaccinations and maternal services of millions, besides obesity, diabetes, hypertension, heart diseases, asthma, tuberculosis, nutritional and environmental ailments cannot usher in a healthy society.

According to a study in The Lancet, more than 75% of the people hospitalised for Covid still had at least one symptom six months after recovering. The distressing symptoms may come suddenly even among those who had mild signs at the time of primary infection. In addition, there were asymptomatic patients, who never came on record, but had definite virus infection.

That makes a huge number of vulnerable persons who may require medical attention or hospitalisation in the coming months on account of post-Covid complications. Why the relapse of symptoms? Persistent viraemia due to weak antibody response, relapse or re-infection, inflammatory and other immune reactions, de-conditioning, and mental factors such as post-traumatic stress may all contribute. Some cases of kidney damage, brain fungal and spinal infections also came to notice in those sick for months.

Complications related to heart and blood vessels due to clots can result in sudden deaths. While large clots can cause heart attacks and strokes, much of the heart damage caused by Covid-19 is believed to stem from very small clots that block tiny blood vessels in the heart muscle. Imaging tests, months after recovery, showed lasting damage to the heart muscle, even in people who experienced only mild Covid symptoms. This may increase the risk of heart failure.

Similarly, the pneumonia often associated with Covid can cause long-standing damage to the lungs and consequent breathing problems. Brain involvement, even in young people, can cause strokes, seizures and a temporary paralysis. Many people who had recovered can continue to suffer chronic fatigue syndrome, a complex disorder characterised by extreme fatigue that worsens with physical or mental activity, but doesn’t improve with rest. Obesity and Covid make a deadly cocktail.

The novel coronavirus makes the body vulnerable to stress and the use of antibiotics and other medicines can likewise debilitate the immune system. Try to have a well-organised eating regimen loaded with organic products, vegetables and safe poultry items to compensate for the lost appetite. The immune system and vitamin D blood level have a close relationship. If you want a strong immune system, vitamin-D level of 50 to 80 ng/ml is recommended. However, there are other vitamins and minerals necessary for a strong immune system: Vitamins A, B5, B12, C, E, minerals iron, selenium, magnesium, zinc, copper, probiotics and Omega-3 fatty acids. Don’t hope to resume your normal exercise routine right after you get back home or test negative for the virus. Keep in mind that you have quite recently battled an illness that severely attacked your immune system.

Some guidelines on exercises for convalescing patients are: Mild symptoms — limit activity to walking or equivalent; increase rest periods if symptoms worsen; for persistent symptoms like fatigue, cough, breathlessness and fever, limit activity to slow walk or breathing exercises until two to three weeks after symptoms resolve; patients who had lymphopenia or required oxygen need respiratory assessment before resuming; patients who had cardiac involvement need cardiac assessment.

There is a need to have pulse oximeters handy. If the oxygen level is less than 90%, report to the hospital. If there are symptoms like breathlessness, palpitations and blue lips, call your doctor. If many of such recovered patients require services, it can overwhelm the already stressed and financially strapped healthcare system, full of burned-out providers.