The Health Department is in the process of drawing up a protocol for following up an ever increasing pool – which has already crossed three lakh now – of persons who have recovered from COVID-19 but who might be experiencing “long COVID” or the post-COVID syndrome, which could in some cases be life-threatening or just debilitating.
“It is a long road to recovery after COVID-19 and even those who had asymptomatic or mild disease could be experiencing a range of multisystemic manifestations such as chronic fatigue, sleep disorders, short-term memory loss or brain fog. We have been following up a cohort of some 400 health-care workers who had contracted the infection. Our estimation is that while about 10% of the patients experience “long COVID”, which lasts typically for about three weeks, about 2% will go on to experience chronic post-COVID syndrome lasting over three months,” R. Aravind, Head of Infectious Diseases, Government Medical College, Thiruvananthapuram, says.
However, screening and management of the unmanageable number of recovered patients is posing a major challenge for the Health Department . It is exploring all possibilities from telemedicine to self-monitoring and reporting, so that the focus remains on picking up those patients who might experience life-threatening or chronic post-COVID syndrome. “Most of the extra-pulmonary complications of COVID manifest after day 10, when the patient would have been discharged. Clinicians should ensure that a patient has been clinically stable for the past two days and not just antigen negative when he is discharged,’’ Dr. Aravind says.
The priority of post-COVID clinics should be in the early identification of patients who experience palpitation or dyspnoea, and getting them into pulmonary rehabilitation, with anti-fibrotic drugs if needed.
“The last thing we want is for those with mild post-COVID issues to crowd at these clinics, which could then turn out to be another hub of virus transmission,” a senior health official says.
Algorithmic approach
The Health Department is drawing up an algorithmic approach to manage these issues in primary care clinics, from where patients can be screened and referred to specialists.
“All patients at the time of discharge itself should be educated about post-COVID syndrome and taught self-monitoring and report back to doctors. They should be trained in breathing exercise to increase the efficiency of respiratory muscles which have been weakened by COVID-19,” Dr. Aravind says.