Post COVID Syndrome

By Dr Saswat Subhankar & Dr A.K. Mohapatra Dept. of Respiratory Medicine, KIMS

1.      What do we mean by post-COVID syndrome?

Post-COVID syndrome includes a wide range of new, returning, or ongoing health problems that people experience after first being infected with SARS CoV-2 virus.

2.      How long can post COVID symptoms last?

Around 10% of patients who have tested positive for SARS-CoV-2 virus have been found to have symptoms beyond three weeks. A still smaller group may have symptoms for months.

3.      Why are some people affected and not all?

It is not known why some people’s recovery is prolonged. Persistent viraemia due to weak or absent antibody response, relapse or reinfection, inflammatory and other immune reactions, and mental factors such as post-traumatic stress have been proposed to contribute to these symptoms. Patients who did not have any symptoms during infection may also develop post-COVID symptoms.

4.      What are the common post-COVID symptoms?

Post-COVID symptoms are diverse. These include:

• Tiredness or fatigue
• Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
• Headache
• Loss of smell or taste
• Dizziness on standing
• Fast-beating or pounding heart (also known as heart palpitations)
• Chest pain
• Difficulty breathing or shortness of breath.
• Cough
• Joint or muscle pain
• Depression or anxiety
• Fever

The symptoms may become worse after physical activity.

5.      Can post COVID affect other organs as well or it is just limited to lungs?

Multiple organs including heart, kidney, skin, and brain may be involved in post-COVID syndrome. Multi-organ involvement may also occur due to conditions that occur after COVID-19, like multisystem inflammatory syndrome(MIS) and autoimmune conditions.

6.      How do we manage a case of post COVID?

The management of post-COVID illness involves a holistic approach and is symptomatic.

a.  Management of cough and breathlessness: These are the most common symptoms reported. The cough in post-COVID responds well to breathing exercises and drugs like inhaled bronchodilators.

Patients with dyspnea also respond well to breathing exercises like belly breathing, huff-cough technique etc. A pulse-oximetry is highly recommended for all patients.

b.  Management of fatigue: There is no medical management for fatigue. It is seen to improve with a graded increase in activity, diet and physiotherapy.

c.  Mental health and well-being: Symptoms of anxiety and depression are common during post-COVID illness. Social connection, self-care (including diet and hydration), peer support, and symptom control have been found to be helpful in overcoming these symptoms.

d. Cardio-vascular complications: Nearly 20% of patients admitted with COVID-19 have clinically significant cardiac involvement including myocarditis, pericarditis, myocardial infarction, dysrhythmias, and pulmonary embolism; they may present several weeks after acute COVID-19. They are commoner in patients with pre-existing cardiovascular disease.

Left ventricular systolic dysfunction and heart failure can be managed according to standard guidelines. Intense cardiovascular exercise must be avoided for three months in all patients after myocarditis or pericarditis.

e. Neurological complications: Symptoms like headache, dizziness respond well to symptomatic treatment. However, complications like ischaemic stroke, seizures, encephalitis, and cranial neuropathies should be referred to a neurologist.

7.      A couple of questions beyond the topic of discussion: everyone has been talking about delta and delta plus variants. Please throw some light on these variants of COVID-19.

The delta variant was declared a “variant of concern” by the World Health Organization in May, 2021. This means that there is increased evidence that this variant is more transmissible, causes more severe illness or reduces the effectiveness of vaccines or treatments. Studies in the UK have shown that the variant could be 40 to60 percent more transmissible than the alpha variant, though studies are ongoing.

The Ministry of Health and Family Welfare announced delta plus was a variant of concern noting this form of the virus was more contagious, could bind more readily to lung cells, and potentially could evade some antibody response.

8.      What about the lambda variant?

This variant is said to have originated in Peru and is thought to be more transmissible than the rest. It has been regarded as a “variant of interest”.