Amid studies hinting at long-term impacts of COVID-19 infection, the world, including India, has started monitoring people who recovered from the disease
It’s been four months since Jugal Kishor Sharma, 39, officially recovered from the novel coronavirus disease (COVID-19). His struggle, however, seems far from over. He has undergone four X-Ray tests in the time — each of which showed infection in the lungs.
He says he starts gasping for breath on a short walk. And a fear of asthma daunts him.
Jugal joined the faceless list of 1.2 million who recovered from the infection in India in the last five months. But the pandemic has shown no signs of stopping — at the time of writing this, India continued to record more than 40,000 cases a day through the first week of August.
Even as the Union government and daily newspaper headlines shine the spotlight on the number of recoveries than active cases, the truth can be a little twisted. After all, the nature and evolution of SARS-CoV-2 virus is still being studied. And facts have been elusive.
Amid studies hinting at long-term impacts of the infection on recovered patients, the world, including India, has started monitoring this set of population.
As a part of formulating a treatment code and feeding observations into vaccine development, monitoring health of recovered patients has become more crucial. Down to Earth caught up with people who defeated the virus. But did they?
Health issue persist
Sushila, 38, a teacher at a Delhi school, tested positive for SARS-CoV-2 on June 10. Ideally, she ought to have been tested again in two weeks to confirm if she had the virus, but doctors allegedly told her not to do so. As her symptoms receded, she simply assumed that she recovered.
Two months on, however, continuous bouts of panic attacks keep her up. “My heart beats fast. Sometimes I feel it would burst,” she says.
What condition is it? Her heart pulse, on instrument, is normal. “It is a new condition,” she says.
Avnish Chaudhury, a journalist with a television channel, has accepted that he would never breathe normally again. Fatigue has not left him, two months after he recovered from the disease. He also experiences irregular heartbeats and a strange sense of not being able to attend to regular chores.
Chandan Kumar, a 34-year-old resident of Pandav Nagar in Delhi, shares Avnish’s experience of the post-recovery phase. On July 25, he was medically declared to have recovered from the infection. But he continues to experience writhing pain in his head.
“The pain is severe and it changes spots,” he says, adding that even flight of stairs has become daunting and painful.
“The pain is so acute that I feel like dropping dead,” he says.
Neither of them visited any doctor after they were discharged. There has been no official follow-up on their health status either.
In the last week of July, the Union Ministry of Health and Family Welfare asked its Joint Monitoring Group to evolve guidelines on managing long-term complications arising out of COVID-19. This group advises the ministry on responses to various health events.
The government follows a protocol on how, and at what stage, to discharge a COVID-19-positive person, and when to recommend treatment at home or in hospitals.
India follows the World Health Organization (WHO) protocol on this. But there is no established protocol to mount health surveillance on recovered people.
“It has been reported that a section of recovered patients may experience respiratory or heart-related issues, renal or liver complications, or even ophthalmological (eye-related) side-effects. Our experts are working on putting a document together to guide people on what kind of long-term care they would require, and what are the issues they may face,” Rajesh Bhushan, officer on special duty to the Union health ministry, told the media in Delhi.
Back in April, the WHO clarified that an infection is neither a ‘passport’ of immunity, nor an end to a person’s health worries.
“Some governments have suggested that the detection of antibodies to the SARS-CoV-2 could serve as the basis for an “immunity passport” or “risk-free certificate” that would enable individuals to travel or to return to work. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection,” WHO had said.
A recent research study on recovered patients supported by Union government’s Science and Engineering Research Board flagged the criticality of following up on recovered patients in an organised way.
According to a research carried out by scientists from multiple universities and medical institutions:
It needs to be figured out if the virus-mediated organ damage completely improves on recovery. In order to determine the actual consequences of the condition, it is essential to maintain follow-up studies on patients. It will help to determine diseases at initial stages and allowing medical intervention in a timely manner.
Follow-up studies have been carried out for major outbreaks in the past. Several studies were done for the Severe Acute Respiratory Syndrome (SARS) 2002-2003 outbreak, to check whether re-infection was possible for recovered patients.
Similar studies were carried out for recovered patients of the Middle East respiratory syndrome (MERS); many were found to have lesions in the periphery of lungs even a year after recovery.
A study by the University Hospital Frankfurt offered some insight into post-recovery health complications. The study found that around 80 of the 100 patients whose cardiovascular MRIs were examined after they recovered from COVID-19 had some structural changes to their heart.
It found that the disease inflicted damage on the organ long after the patient had recovered and in cases where the infection was not even severe to begin with. The MRIs of the 100 infected patients were compared with those who did not carry the infection, two months after the first group recovered from the disease.
Another study, published during the same time, analysed autopsy results from 39 people who died of COVID-19 and whose average age was 85. It found high levels of the virus in the hearts of 24 patients.
“An unanswered question is the extent to which the virus can hide in seemingly recovered individuals. If it does, could this explain some of the lingering symptoms of COVID-19 or pose a risk for transmission of infection to others even after recovery?” asked William Petri, a physician-scientist of infectious diseases at the University of Virginia and who conducts research on COVID-19.
Some studies indicate that the coronavirus causing COVID-19 could be found in organs earlier considered immune to the virus. For instance, the new coronavirus could infect foetus via the placenta. It has also been found in the blood and the nasal cavity and palate for up to a month or more after infection.
“The mounting evidence suggests that SARS-CoV-2 can infect immune privileged sites and, from there, result in chronic persistent — but not latent — infections,” said Petri.
K Srinath Reddy, president of the Public Health Foundation of India, stressed on the need to understand the health status of recovered persons: “We do not yet know how those who recover behave. The recent German study published in JAMA talks about heart infection post recovery, that too in young people. And this is just the beginning of our understanding.”
He added to assume all recovered COVID-19 patients, including asymptomatic ones, gain full recovery is not correct.
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