New Delhi: Samad Haroon is 25, and before he caught Covid-19, he used to go to the gym, had a big appetite, and never had a major mental health issue.

Now, a little over two months after his recovery from the coronavirus, he worries that the after-effects of the disease — which have left him with bouts of crippling anxiety and, more recently, an inability to keep his food down — won’t ever go away.

“I first started developing the anxiety after I was diagnosed on 15 June. I didn’t really know what was happening, my body was heating up and I felt like I couldn’t breathe, but my oxygen levels were fine,” Haroon told ThePrint.

“This would happen on and off while I was ill. After I tested negative on 28 June, I felt fine, until it happened again last month. My body just doesn’t feel normal,” he said.

Priyanka Goyal (29) and her husband Anil Julka (32) caught Covid at around the same time as Haroon. Both were admitted to hospital, and Goyal, who is also asthmatic, spent 24 days in the ICU. Now, her asthma attacks have become more frequent, while Julka finds it hard to sleep at night, kept up by a sharp pain in the chest that doesn’t seem to subside.

“I’m mostly distracted at work, but the pain becomes most acute at night, when I’m trying to fall asleep and there are no distractions,” Julka, who doesn’t have any underlying conditions, said.

Haroon, Goyal and Julka are now consulting the city’s first post-Covid clinic at the Rajiv Gandhi Super Specialty Hospital (RGSSH), to better understand and treat their prolonged illness.

The clinic, opened on 20 August, is designed specifically to document and manage the myriad symptoms that make up ‘long-haul Covid’, and has seen a little over 60 patients so far.

“Before the clinic officially launched, we must have treated over 50 recovered patients. My phone rings non-stop. I get calls from people across the country asking what to do about their persistent coughs and fatigue,” said Dr Ajit Jain, head of cardiology and nodal officer for Covid at RGSSH. “The numbers are going to climb, I’m sure of it.”

The aim, Jain said, is to build a repository of data that will give doctors and researchers a clue about what causes ‘long Covid’, and whether treatment during active infections can prevent long-term illness.

Segregating post-Covid symptoms

An analysis by the British Medical Journal said approximately 10 per cent of recovered Covid-19 patients are afflicted by long-term illness (three weeks or more). The central government is reportedly putting together a study to monitor post-recovery complications in Covid patients.

India has seen 33,85,700 infections as on 28 August, of which 25,83,948 have been discharged and 61,529 have died. Going by the BMJ’s 10 per cent figure — modest, by its own admission — could mean lakhs of patients will suffer long-term complications.

It’s still not known what factors drive the symptoms of the coronavirus to linger in some people and spare others, but the BMJ anticipates “that many patients whose Covid-19 illness is prolonged will recover without specialist input through a holistic and paced approach”.

At RGSSH, however, Jain said medical specialists can better treat symptoms particular to their respective fields. “Patients with post-Covid symptoms should be segregated based on their symptomatology, just like we do it for active infections,” he said.

Doctors at RGSSH feel collaborative investigations between various departments, combined with close surveillance of symptoms, could lead to significant findings on the coronavirus’s behaviour.

For patients feeling breathless and complaining of chest pain, cardiologists run ECG tests or recommend an X-ray or CT scan. For patients with recurring headaches or a persistent loss of smell, the hospital’s neurologists conduct their own investigations. The clinic also houses a room for physiotherapy, yoga, and counselling for patients who need it.

The clinic’s rudimentary findings are in line with what several other studies from the world have shown: Patients suffering from a pre-existing lung problem, like Goyal, are likely to suffer longer in the virus’s aftermath. Patients suffering breathlessness also show signs of inflammation around the heart.

“By working backwards, we can see what treatment can prevent these long-term problems. Right now, we’re working through trial-and-error to see what can help alleviate the symptoms,” Jain said.

Mental health

More recently, Jain and RGSSH director Dr B.L. Sherwal noticed an uptick in recovered patients complaining of fatigue, anxiety, loneliness, sleeplessness and depression.

“A lot of patients are showing symptoms parallel to PTSD. There are behavioural complaints about hyperventilating, sleeplessness — we call this neurosis,” Dr Anubhav Dua, a neuro-psychiatrist consulting with RGSSH, told ThePrint. “A patient’s usual biological rhythms are disturbed by this, and it seems to be a reaction to stress.”

But patients aren’t always actively conscious of the stress bringing on these symptoms.

“I would watch TV and be totally relaxed one day, and then would suddenly slip into anxiety the next. I don’t know what’s behind it,” Haroon said. He was prescribed medication to ease his anxiety.

Studies from China to Italy have found that over 40 per cent of recovered patients they studied self-reported a psychopathological symptom.

“We don’t fully understand what’s causing this, but it also leads to a neurochemical imbalance in the brain,” Dua said.

Post-Covid recovery beyond RGSSH

The novel coronavirus isn’t the first to cause prolonged illness in those infected — the original Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) viruses also did.

“What is unusual, however, is that it’s difficult to predict who will get these symptoms post recovery and who won’t. Most people are doing okay, and their lab parameters are coming back to normal,” said Dr Sai Haranath, pulmonologist with Apollo Hospital in Hyderabad, which is providing remote consultations for recovered Covid patients.

“What may be causing it is an inflammatory response to the original infection,” Pai said.

More clinics and institutions are considering opening up post-Covid centres. The All India Institute of Medical Sciences is also reportedly due to open one.

Jain said patients who are either turned away or dissatisfied with the medical attention they’ve received from other hospitals are coming to the RGSSH post-Covid clinic, so their symptoms are seen in accordance with their history.

“Facilities like this are important because they put the illness in context. We have guidelines on how to handle active illnesses, but with enough research, we could have better guidelines for recovery, too,” he said.

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