Unnerving, crushing fatigue tops post-Covid complaints, say doctors
Nearly 30% of patients complain of severe, debilitating fatigue, unable to resume their daily activities like bathing, cooking, walking or working from home, says doctor
Bhandup resident Prabhavati Nilve wakes up at 6.30am, but it takes another two hours for her to gather the energy to get out of bed. “The weakness irritates me,” said the 50-year-old who had tested positive for Covid-19 in January, but still struggles from the lingering aftereffects of the viral infection. Nilve, like hundreds of Covid-19 patients battling the long-term impact of the virus, find themselves at the post-Covid outpatient departments (OPDs) often with one question: Why is my body not feeling all right?
The second wave in Mumbai may have settled but post-Covid OPDs continue to be busy with patients. The Hindustan Times met Nilve on Thursday at the Fortis Hospital’s post-Covid-OPD in Mulund, the first such clinic that opened in the city last August. A typical day at the OPD sees patients from across the city, many who were admitted for Covid treatment at Fortis, and some like Nilve who were treated at other hospitals but require post-Covid rehabilitation.
An IT manager in a pharmaceutical firm, Nilve was admitted to Surana Hospital in Chembur for five days after she tested positive for Covid. Doctors told her that the infection had spread to her lungs and she was put on a cocktail of drugs including steroids, antibiotics and Remdesivir. After discharge, she felt better, but her sugar levels and blood pressure had shot up, for which she had to be put on medication. In May, her palpitations, weakness and shortness of breathing increased so much that she had to be admitted to a local nursing home for four days where she was put on nutritional supplements.
“My family doctor told me that the symptoms I was experiencing were all a part of the post-Covid effect,” said Nilve who was among the six patients who visited the OPD on Thursday. This was her second visit to the OPD. “I have become irritable. At times, it’s hard for me to have a conversation with people,” Nilve said, adding that she is also troubled by immense hair fall.
According to infectious disease consultant Dr Kirti Sabnis who examined Nilve, nearly 30% of patients complain of severe, debilitating fatigue, unable to resume their daily activities like bathing, cooking, walking or working from home. In some cases, the symptoms persist for two to six months. “It plays on their mind, often making them anxious,” said Sabnis, as she screened the files of a husband-wife duo who had contracted Covid-19 in July. The couple from Vikhroli was on their second post-Covid consultation. The husband had recovered, but the wife who was put on steroids during Covid-19 treatment showed a tendency of high blood sugar. “Blood sugar levels fluctuate generally after patients are put on steroids. You have to exercise and maintain a low carbohydrate diet,” Sabnis told the woman, prescribing them a two-dose pneumococcal vaccine and a single dose influenza vaccine as a precaution against other viral diseases. “After Covid, patients generally have low immunity which makes them susceptible to other viral infections. We, therefore, recommend them to take the flu and pneumonia shots,” she said.
Another patient, Sunil Kumar Bandhu, 58, who came from Kharghar, was recovering from a bout of viral infection. He had contracted Covid-19 in August last year and was on his fourth follow up at the OPD. An avid walker, Bandhu had recovered well considering that he had spent 24 days in the hospital on oxygen support battling Covid, 10 of them in the intensive care unit (ICU). “We have observed that people who have been actively exercising recover better. The lung patches also resolve,” said Sabnis, who advised Bandhu to undergo a pulmonary function test (PFT)- a test to determine how well the lungs are functioning.
Patients undergo a battery of blood tests during their first visit to the OPD. Those with persistent complaints undergo a chest X-ray, PFT, and high-resolution CT (HRCT) scan of the chest for a better understanding of the impact on their lungs. Typically, post-Covid clinics help patients to build endurance with nutritional supplements and diet planning in addition to breathing exercises for improved lung function. Some patients need bronchodilators, while some have to be eased into simple activities like taking stairs. Doctors said that at least one in 10 patients require counselling, however, most refuse to get a consultation. “Put simply, post-Covid care is like preparing a person for a marathon,” said Dr Rahul Pandit, a critical care specialist at Fortis Hospital and a member of Maharashtra’s Covid-19 task force.
Just five months into the pandemic, the Fortis Hospital had started receiving patients with severe myalgia, chronic fatigue, unknown fear, disturbed bowels habits, insomnia and some cases of thrombosis after Covid. “By then, we had realised that there were post-Covid impacts. The medical fraternity across the country had started sharing observations on internal groups, social media, and other platforms,” recalled Sabnis.
The KEM Hospital in Parel, Apollo Hospital in Navi Mumbai and some jumbo centres also opened post-Covid care setups due to the increased demand. In the first wave, the Fortis OPD received eight to 10 patients every day. During the second wave, their daily footfall hovered between 10 to 12 patients. The numbers highlight the need for more robust post-Covid setups as we anticipate the third wave amidst widespread Delta variants.