Dealing With Post Covid Syndrome
Covid-19 (Corona Virus Disease 19) is a respiratory tract infection with a newly recognised corona virus, SARS-CoV2. It seems to have originated as a zoonotic virus that has mutated or otherwise adapted in ways that allow human pathogencity. Covid-19 was provisionally called 2019-nCoV infection at start of outbreak (2019 novel corona virus infection). This outbreak began in China but has since spread globally and it was officially declared by WHO to be a pandemic on March 11, 2020. This new virus is a beta corona virus similar to the agents of SARS (Severe Acute respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) detected few years back.
Illness ranges in severity from asymptomatic to symptomatic, mild or severe form. A small proportion of patients with clinically evident infection develop severe disease, which may be complicated by pneumonia and shock.
Most common complaints are fever (more than 80%) and cough with or without sputum, upper respiratory tract symptoms like running nose, sneezing and sore throat may be present. Headache, myalgia and fatigue are common and fatigue may be profound. Alteration in smell and/or taste is widely reported, often as an early symptom, and is highly suggestive. Chest pain and gastrointestinal symptoms like nausea, vomiting and diarrhoea are uncommon but may occur. Patients with moderate to severe disease often complain of dyspnea due to severe hypoxemia, but it is not a criteria. Mortality rate among diagnosed case is generally 3% globally, but varies by country. Most reported case are in adults of middle age or older and risk of severe disease increase with age.
Transmission of disease by person to person is through close contact probably via respiratory droplets and perhaps in some cases by aerosolization.
Various diseases like Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease, Cancers, Obesity and heart condition worsens Covid 19 and puts the patient in high risk. Also conditions like Asthma, Chronic Liver Disease, Pregnancy, Hypertension… etc may influence disease progression and complications.
(i) Polymerase chain reaction (PCR) tests have been accepted as the gold standard investigation for diagnosis. Positive identification of SARS-CoV-2 by polymerase chain reaction test is considered confirmative of diagnosis. False negative results have been reported and may be due to a variety of factors, including inadequate sensitivity, poor sample collection, or time course of disease. However repeated sampling should be considered if suspicion for Covid-19 is high and initial result is negative.
(ii) Antigen tests are also useful for diagnosis of Covid-19, and they have the advantage for rapid turn-around. In general, these results are less sensitive than polymerase chain reaction, although specificity may be as high as 100%. Blood test, urine test or culture of blood or body fluid is not recommended for diagnosis.
Whom to be tested?
Acute onset of fever and cough or acute onset of symptoms like general weakness, myalgia, headache, sore throat, anorexia, nausea vomiting are to be tested if one of the following is present:
(a) Living or working in a place with high risk of transmission of SARS-CoV- 2.
(b) History of travel to or residence in an area reporting local transmission.
(c) Working in any healthcare setting.
Specimens (swab) from upper respiratory tract (Nasopharyngeal, deep nasal or Oropharyngeal) or lower respiratory tract (Bronchoalveolar lavage or tracheal aspirate) are recommended for viral testing.
No specific drug has been found against Covid-19, but a few antiviral drugs are recommended. Various guidelines provide recommendations for corticosteroid in the treatment of Covid-19. But, excellent supportive care is the only treatment to date that appears to be consistently helpful in Covid-19. Close monitoring by critical care team for severely ill patients in Intensive Care Unit has best outcome. Supplemental oxygen therapy is needed when oxygen saturation falls below 92%. Mechanical ventilation is of utmost importance for those in whom oxygen targets could not achieve with oxygen administration. Other medical conditions and co-morbidities are to be addressed simultaneously and rigorously.
Prevention and vaccination
Covid-19 can be prevented by proper wearing of good quality face mask , frequent usage of hand sanitizer and observance of social distancing when ever and where ever possible.
As there is no definite drug to control Covid-19 pandemic, vaccination is the needed solution to address the problem. Numerous vaccines against SARS CoV- 2 are in development or are entering use. Leading countries in the world are on placebo - controlled trails and looking into safety and efficacy of vaccines. Overall efficacy of all vaccines is about 95%. In India we are hoping that vaccines would be available in January 2021 on priority basis.
Covid 19 patients, after recovery continue to face a range of health issues depending on the severity of the disease they underwent. It poses risk for people across all age groups, in different degrees and affects some more gravely than the others. Recent report suggests that patients who tested positive for Covid-19 have persistent symptoms with a reduced quality of life 2 to 3 weeks after initial testing. The most common symptoms are fatigue, cough, dyspnoea, head ache, joint pain, sleeplessness etc.. Impairment of cardiovascular functions, renal functions, depression, myalgia and other persistent physical and psychological effects are also noted in post Covid period. For many, COVID Antigen test may turn negative but some typical symptoms may continue to persist for weeks after combating the illness.
Addressing post Covid symptoms or sequela of Covid-19 is crucial because it could be either a post Covid Syndrome or a different illness, patient can develop during the same period. In order to address the problem one has to attend a hospital or a designated post Covid Clinic where patient will be investigated in detail. Specialist services are needed to meet his requirements of heart, lung, mental distress and much more. Rehabilitation care for Covid-19 survivors must be focused, addressed by a specialist and planned for longer term to meet the needs of the individuals.