Coronavirus Outbreak Explained: What Are The Long-Term Impacts Of COVID-19 On Human Body And The Recovery Process?

New Delhi: From the time the first reported cases of COVID-19 emerged towards the end of December, the new strain of the coronavirus now called SARS-CoV-2 was thought to affect the lungs, like its predecessor the SARS-CoV-1 which was responsible for the outbreak in 2003. But after close to seven months of the pandemic one of the globally emerging trends is that this virus can impact multiple body systems. Experts say that the disease can have some long-term effects on the body and it can take at a minimum of three months for the patients to fully recover from the after-effects of the disease. According to Dr. David Nabarro, special envoy of the Director General of WHO there are a proportion of people, maybe as much as 5 per cent, who developed long term central nervous system challenges, tiredness and loss of memory in other cases. NDTV reached out to doctors who have been treating COVID-19 patients for the past six months to learn about the long term impacts of the coronavirus infection on the body and how does a patient recover from it.

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In his message to people who have fought the virus but still experience some symptoms, Dr. Nabarro said,

If you are still feeling the symptoms even after being tested negative, I want to tell you that you are not alone. Many recovered people are feeling the same because there seems to be some long-term impact of COVID-19 on the human body. Please keep a watch over your symptoms and keep your doctors informed about how you are feeling.

Padma Shri Awardee, Dr KK Aggarwal, President, Confederation of Medical Associations in Asia and Oceania (CMAAO) and Medtalks, Heart Care Foundation of India who has been involved in the treatment of over 2,000 COVID-19 patients in Delhi said,

These are called as persistent symptoms. Nine days from the first day on which COVID-19 presented symptoms is called the COVID period. After nine days we have a post COVID phase during which the patient tests negative which implies that the virus has gone, but it has caused damage to the body which is persistent. These post-viral symptoms can persist FOR up to three months.

According to Dr. Aggarwal, the most common post COVID symptoms are as follows:

1. Post COVID Immunological Reactions: When COVID-19 antigens, which are substances that cause the immune system to produce antibodies against the virus continue to be in the body even after infection has subsided, then the body may continue to go through immunological reactions. This means that the person may continue to get a fever which is less than 100 degrees Fahrenheit.

We have seen some fever lasting up to 42 days in some patients, says Dr. Aggarwal.

2. Post COVID Persistent Inflammation: This is the condition in which fever is persistent along with high inflammation measured by Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) level. This means that along with fever the patient also experiences pain in the joints, muscle, discs, ligaments, tendons, fascia, among other parts, says Dr. Aggarwal.

Dr. Ramana Dhara, Professor at Indian Institute of Public Health (IIPH), Hyderabad explains that while it is yet to be concluded as studies are still going on but it is being considered that the inflammation caused by the COVID-19 is causing multi-systemic effects even outside the lungs, on the brain, heart, liver, endocrine system, skin, stomach and intestines and kidneys. He said,

While not all patients will get all of these effects, however, those who do the treatment of COVID-19 for them will be enormously complicated and expensive. This is because each organ effect will have to be evaluated and treated separately. The treatment protocols for these effects are still being developed because every day some new effect is emerging. The treatment of COVID-19 and its effects will going to be a combination of trial and error.

3. Post COVID Diarrhea: According to Dr. Aggarwal, some patients suffer post COVID Diarrhea. He said that it occurs due to either an inflammatory reaction or allergic reaction.

4. Post COVID Persistent Hyper Coagulation: Dr. Aggarwal said that some patients may develop thickening of blood that can cause post COVID heart attack and paralysis. He said that some patient suffer a sudden clotting of blood mostly in cases where the patient stops taking blood-thinning medicines. The blood-clotting complications may sometimes lead to the death of the coronavirus patient. Dr. Nabarro also highlighted about this condition while speaking with NDTV and said that SARS-CoV-2 is a really dangerous virus and has the capacity to develop blood clots which can cause lots of complications besides complications in the lungs.

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Dr. Aggarwal asserted that most of the post COVID symptoms persist until three months of being tested COVID-19 negative. However, there are some conditions that COVID-19 patients may have to deal with for an even longer period. One of such conditions is the loss of myelin which is a material that insulates nerves that send and receive messages from every part of the body and help the brain process these messages. When myelin wears away or is damaged, nerves can deteriorate, causing problems in the brain and the patient may suffer problems in speaking, feeling, moving and even thinking. This, according to Dr. Aggarwal may come and go even after three months post COVID-19.

He also said that sometimes, patients may also develop redness in the left eye which can go away in a few hours but may come back again after a few days. He said that this is very common and can happen while recovering from any kind of allergic disease. Similarly, most patients may even feel soreness in the throat for 2-3 months post COVID. Some patients may also develop acute bronchitis and can recover from this within three months.

Dr Aviral Roy, Consultant Critical Care, Medica Superspecialty Hospital in Kolkata said that among the COVID-19 patients he has been treating, loss of smell and a prolonged state confusion and tiredness have been the most common post COVID symptom. He said,

We have been noticing a lot of cases where symptoms continue to persist post COVID. The major organs which continue to be impacted by COVID-19 even after the patients has recovered are nose and brain. Some people lose the sense of smell and some suffer prolonged confusion and disorientation. Some people also experience a chronic feeling of tiredness and fatigue. But this is not uncommon or restricted to only COVID-19. People recovering from other severe diseases also face similar symptoms for a certain period of time.

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Talking about the sense of smell, Dr. Roy said that it is not unique to COVID-19 and happens in all kinds of allergic diseases like common cold and sinus infection. He said that the sense of smell comes back within 2-3 weeks but in the worst case scenario in which the olfactory nerves are completely damaged, it may take upto one to two years as the brain usually takes that much time to rebuild the completely damaged nerves.

While explaining further, Dr. Roy said whenever the body suffers an illness, there is always some change in appetite and most of the time people stop eating properly. So the body uses protein from the muscles because the body needs a lot of protein to fight the infection. This, according to Dr. Roy, causes muscle loss which is the reason for a prolonged weakness that patients suffer post-illness because the body takes time in redeveloping the lost muscles. He said,

If the patient does not have any underlying situation like hypertension, cardiac complications, obesity and others then the likelihood and the intensity of the person suffering muscle-loss will be less. But if the person has any underlying conditions and their ability to tolerate infections is low, then they will experience weakness over a long period of time. The rule of thumb here is: every one day you spend in an ICU, you need 3-5 days of rehabilitation in order to make up for the functional loss that the person suffers due to the illness.

According to experts, it is too early to say if COVID-19 patients will suffer any of the post COVID impacts for years or for their whole life because the disease is only eight months old as it was discovered in December 2019. Some anecdotal information, according to experts shows that patients who are suffering a relapse of COVID-19 are getting worse post disease impacts. However, in the absence of larger numbers of patients to study, this is difficult to say definitively. They suggest that to have a sense of the impact of COVID-19, the data should be extrapolated from the previous diseases caused by other coronaviruses- SARS (Severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Experience from the previous coronavirus induced diseases can provide information on what can be expected from COVID-19 in the long term. The experts suggest that once the patients become COVID-19 negative, they should get back to a normal diet and should start exercising gradually in order to build up the immunity.

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NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.