Coronavirus Asia

Indian hospitals set up dedicated clinics for 'long Covid' patients

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

Ms Suvarna Oommen tested negative for Covid-19 on Oct 19 after a bout with the disease. But the 48-year-old feels she is yet to recover. Crippling fatigue, insomnia and a lingering lung injury from a bout of pneumonia brought on by the coronavirus still haunt her.

"I feel helpless as 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. This despair was aggravated by the deaths of other patients she saw in the intensive care unit and prolonged isolation from her loved ones.

In a country with the second-highest caseload of Covid-19, providing dedicated aftercare has become a priority. Many hospitals across India have set up post-Covid clinics to offer wide-ranging and long-drawn-out care that "long Covid" patients need. West Bengal state even released guidelines last Wednesday, 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, launched in August and equipped with experts such as neuro-specialists and respiratory consultants, has handled more than 600 patients.

Dr Ajeet Jain, a cardiologist and nodal officer at the clinic, said it was set up after many patients who had recovered at the hospital complained of inadequate aftercare at other hospitals where they were referred to. He said India needs to set up more of such clinics with specialists who have a better understanding of the illness, including on the role of antibodies in causing "long Covid".

A recent Yale University study said 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 the study's senior author, told The Guardian.

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 problems it faces have expanded from neuropsychiatry ones, such as fatigue or stress, to aggravated forms of chronic illnesses common among the aged such as diabetes, and cardiac and lung ailments.

Dr Jain said patients with pre-existing cardiac illnesses reported aggravated symptoms even after testing negative for Covid-19. They feel breathless or weak walking 200m or 300m, or climbing one flight of steps, compared with 500m or two flights of steps previously.

A review article in Lung India last month also warned that post-Covid lung fibrosis - where 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 most will recover without residual lung damage, it is likely 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 Hinduja Hospital and Breach Candy Hospital in Mumbai, said patients with more severe initial lung involvement and damage must be followed up "extra carefully and monitored".

Dr Ravindra Mehta, a consultant pulmonologist with Apollo Hospitals in Bangalore, has seen "at least 50 to 70 cases" of lung fibrosis at two post-Covid clinics launched in October. But he said 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 said.

Last month, a post-Covid clinic opened at the Government Multi Speciality Hospital in Chandigarh. It 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. "All these issues are there... People need support later on," she added.

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A version of this article appeared in the print edition of The Straits Times on December 21, 2020, with the headline Indian hospitals set up dedicated clinics for 'long Covid' patients. Subscribe