Dedicated clinics in India provide specialised care to 'long Covid' patients

Many hospitals across India have opened up post-Covid clinics to provide wide-ranging and long-drawn-out care. PHOTO: REUTERS

KOLKATA - Ms Suvarna Oommen tested negative for coronavirus on Oct 19. However, the 48-year-old feels she is yet to recover from Covid-19.

Crippling fatigue, insomnia and a lingering lung injury from a bout of pneumonia brought on by the coronavirus still haunt her.

"I feel helpless because I am nowhere near as active as before, even anxious whether my lungs will heal fully," she told The Straits Times.

Ms Oommen, who lives in Trivandrum, has also been diagnosed with depression after battling the virus for more than a fortnight.

"Those moments when I was unable to breathe, I wanted to kill myself," she added.

This despair was aggravated by the deaths of other patients she saw from close quarters in the ICU and a prolonged isolation from her loved ones. "I would rather wish for death than go through it again, honestly."

In a country with the second highest caseload of Covid-19, providing dedicated aftercare for patients such as Ms Oommen has become a priority.

Many hospitals across India have opened up post-Covid clinics to provide wide-ranging and long-drawn-out care that "long Covid" patients need.

The state of West Bengal even released guidelines on Dec 16 for the treatment of long Covid patients, recommending follow-up care lasting as long as a year in some cases for what it described as a "multi-system disease".

The post-Covid clinic at Delhi's Rajiv Gandhi Super Speciality Hospital was one among the first off the block.

Launched in August and equipped with experts such as neuro specialists and respiratory consultants, it has handled more than 600 patients.

Dr Ajeet Jain, a nodal officer at the clinic, said it was set up after many patients who had recovered at the hospital complained that they were not receiving proper aftercare at other hospitals they had been referred to.

"Not only is there a fear factor of contracting the disease, there is also the fear of less knowledge. You have a fear of not knowing the pathophysiology of the disease, not knowing how to deal with its symptomatology," Dr Jain told The Straits Times.

He said that India needs to set up more post-Covid clinics with specialists who have a better understanding of the illness that continues to throw up new facets, including on the role of antibodies in causing long Covid.

A study by researchers at Yale University and published this month found that Covid-19 patients reported dramatic increases in auto-antibody reactivities that targeted organs, tissues and the immune system, rather than fighting off the invading virus.

"Because antibodies can persist for a long time, it's conceivable that they may contribute to the development of long-Covid diseases," Dr Aaron Ring, an immunobiologist at Yale and senior author of the study, told The Guardian this week.

While young patients below the age of 40 formed the majority of the clinic's initial patients, this mix is now dominated by those above 60. This means the kind of problems it has to deal with has also expanded from neuropsychiatry ones, such as fatigue or stress, to aggravated forms of chronic illnesses common among the aged such as diabetes, as well as cardiac and lung ailments.

Dr Jain, a cardiologist, said that patients with pre-existing cardiac illnesses reported aggravated symptoms even after testing negative for coronavirus.

"They started suffering more. The breathlessness or weakness they were feeling after walking for 500m or climbing two flights of steps, they started feeling the same with even 200m or 300m or with one flight of steps," he added.

A review article in Lung India last month also warned that post-Covid lung fibrosis - a condition in which the lung tissue becomes stiff and scarred - could be the "tsunami that will follow the earthquake".

It said about 10 per cent of patients globally will develop severe Covid-19 pneumonia and 5 per cent will develop acute respiratory distress syndrome. While the majority will recover without residual lung damage, it is likely that a "sizeable number" will be left with fibrosis or other severe pulmonary complications.

One of its three authors, Dr Zarir Farokh Udwadia, a consultant physician with the Hinduja and Breach Candy Hospitals in Mumbai, told The Straits Times that patients with more severe initial lung involvement and damage must be followed up "extra carefully and monitored" for the development of lung fibrosis.

"We are in the process of designing trials to see if the new anti-fibrotic drugs given to this subset of patients would prevent this dreaded complication," he said.

Dr Ravindra Mehta, a consultant pulmonologist with Apollo Hospitals in Bangalore, has come across "at least 50-70 cases" of lung fibrosis at two post-Covid clinics launched in October. But he said that while it is a problem to be acknowledged, most are getting better with follow-up care.

"Our understanding of the worst extent of this problem is currently based on western data but it looks like it will not be that bad in the Indian cohort. We, however, need concrete data (in the Indian context) to see whether nature will resolve it entirely or a small percentage will need drugs," he told The Straits Times.

Last month, a post-Covid clinic also opened at the Government Multi Speciality Hospital in Chandigarh to allow patients to bypass burdened outpatient departments and receive dedicated care. While severe cases are dealt with at another hospital, the clinic here receives around eight patients daily with concerns such as persistent cough, myalgia and stress-related disorders.

Dr Amandeep Kang, director of health services at the Chandigarh Administration, said even those with "mild to moderate" concerns are adversely affected, such as by the trauma of potentially transmitting the virus to their loved ones, or the fear of how the illness will eventually pan out in their bodies.

"All these issues are there... People need support later on," she added.

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