I was diagnosed with COVID-19…

Yes, doctors are commonly encountered with the above statement nowadays. This has happened due to a deadly pandemic which had soared all over the world in 2019 and continues till date. There have been mutated variants which have come in waves, showing peaks of disease and deaths. There have been mass campaigns, detailed education, study material, tips, hints and precautionary measures at every healthcare center mat, wall, door, slip etc. Awareness about it has been very well delivered to remote parts of the human population via media or health care personnel. People all over the world have tried their level best to prevent, fight, and break the transmission but still it has taken large numbers to fill its hunger. There have been reportedly 6.3 million deaths and increasing. All this life lost for a simple semi-living thing called Coronavirus.

Well, death toll portrays a small fraction of the disease burden. The infected and suffered number is more by 200 fold. It appears as if almost every person on earth has been exposed and infected. It is just that a big fraction of the population showed signs and were tested positive while the rest didn’t.

There were many trial treatments which failed horribly, some which worked but not sure whether they will continue to work. It’s all been a dream with uncertainty being the only understandable reality.  It appears that whoever is left healthy now have won over the pandemic, but that is not it. There is more to come and there is more we have missed.

“I was diagnosed with COVID-19…”, this doesn’t end with a pat of sympathy. A detailed history into the condition must be recorded to provide any treatment for the presenting health situation. Why would that be necessary? What happens if one was diagnosed with COVID-19? Everyone needs to ask a doctor about the connection with their present health status and previous Coronavirus status.

The acute phase of infection is well studied as there was no scarcity of cases around the world. The virus gains entry into our system through the nose or mouth either via saliva droplets or via touch. It then colonizes in the upper respiratory tract parts like the nasal lining and the throat. It is at this point when most of the infected show symptoms like runny nose, cough, sore throat, fever etc. Most do recover from here, however, there are a few unfortunate people in whom the virus progresses into the lower respiratory tract, worsening their health via many mechanisms. Inflammation, congestion, consolidation, and reduction of local immunity makes one prone to usual fatal bacterial infections, clots, infarcts etc. All these immediate complications lead to respiratory failure, and decreased oxygenation needing ventilation. Only a few survive this stage, the rest 6.3 million souls were lost.

There is another face of COVID-19 and that is the later complications which we can expect patients who have recovered to have. These have to be well searched for and managed before they become fatal or hamper one’s well-being. There are always infections and health problems when patients visit their doctor. It has be a mandate to enquire about one’s Coronavirus history and assess the present clinical status, to connect the dots and to help manage present ailments. 

Complications of COVID-19 post recovery:

1.     New Onset Diabetes – In patients who had severe forms of the disease, there was liberal use of high dose steroids to suppress the immunity which was over active and damaging in itself. Though it helps well to combat the indirect viral damage, the bill comes due. A short course of high dose steroids does meddle with the insulin working mechanism. This leads to insulin resistance diabetes. People who had risk factors for developing diabetes were the ones who easily sailed into overt diabetes. The number is not known but there are several ongoing studies  which will surely give an alarming number of de-novo diabetes due to COVID-19 treatment.

2.     Poor Immunity – This again is a side effect of heavy dose steroids. Steroid drugs are immune suppressants, the character of which was employed in the management of Coronavirus related hyper immune activation and resultant lung damage. In some people, this effect can last long, making them prone to infections for a long time. They can be recurrent bacterial infections in the form of upper respiratory infections, urinary tract infections, skin infections etc. These may not be fatal but can take more than the usual time to get cured. Though there are numerous immune boosters to be used, none of them have promising results in reversing the COVID-19 treatment suppression. Immunity will recover but will take time. Till then, every infection is a challenge to be treated.

3.     Lung Fibrosis – The main pathology which made COVID-19 deadly was lower respiratory tract damage. Both the airways and lungs get affected equally. Active damage in the lungs and bronchioles is in the form of wounds secreting enormous amounts of sputum, further reducing gas exchange, and leading to death.  These wound over time heal with fibrous tissue, covering the damages, resulting in the scarring of the airways and gas exchange membrane. This fibrosis leads to decreased lung reserve that is needed for oxygenation; the person will continue to be hypoxic. There are a few cases which need oxygen support for life with positive pressure ventilation or a simple oxygen concentrator. Then there are some who have non-debilitating scarring which makes them breathless upon exertion. A part of the affected population develop a hyper-responsive lung lining which responds with reflex contraction of the airways to simple dust and pollen, resembling allergic bronchitis or asthma. This is one of the most dreaded and direct complication seen in patients who have recovered from COVID-19.

4.     Chronic Respiratory Infections – In patients who were ventilated mechanically for a long duration and those who were on oxygen supplements do encounter side effects of the treatment. Poor ventilatory hygiene results in hospital acquired infections which most of times are resistant to many antibiotics. These infections can run their course for longer duration even when the COVID-19 phase has passed. It becomes a challenge to treat these infections while we have used steroids to manage the Coronavirus damage. A few may even contract infections like tuberculosis, cryptococcal pneumonias etc. A good fraction of the patients who were on oxygen therapy ended up having black fungus (Mucormycosis). The treatment of which is expensive and the condition itself is very severe in its presentation. By the time black fungus is diagnosed, a major part of the affected area is damaged and is far from recovery.

5.     Depression – It is very obvious that it is hell for a person to be tied up to a bed for a long duration with shortness of breath taking its toll. This is apart from an environment involving all masks, gowns worn, unseen faces, the hospital ceiling, the nurses, repeated blood withdrawal, countless injections and the most troubling, non-access to family members and loved ones with no visits or communication. This for sure makes one hell of an experience, pushing the patient into a state of psychological sensitivity, prone to post-traumatic stress disorder and many more.

6.     Market made Immunity Supplements – There was this trend of unproven, irrational, unethical use of many supplements which were promised to prevent COVID-19. Vitamin C, vitamin D, zinc, lemon juice etc., and a long list of unstudied products were used to prevent the infection. There is no record of any of them being really useful. The fear of the pandemic pushed many to use them, inadvertently leading to toxicity, side effects and vague symptoms. The main dilemma is that most of the unexplained symptoms that are presented nowadays can still be connected to those unprescribed self-medication steps that were previously followed, but one cannot pinpoint which supplement caused the symptom as many were being used together.

The list doesn’t end here. Time is the only factor which can show more evident effects of the Coronavirus treatment and the COVID-19 virus itself. It is always advisable to seek medical attention even for a minor ailment as it could be connected to the past COVID-19 status or treatment. This phase is not over. The pandemic is still not over. Taking individual responsibility and precautionary measures to protect oneself is the best protection one can practice.