Covid-19: Not just an acute infection
The world is facing the biggest pandemic of the 21st century as the second wave of the coronavirus disease (Covid-19) continues to infect almost 170 million people across the globe, with numbers still counting. As the second wave of the deadly virus is beginning to recede, new post Covid-19 sequelae are coming into play.
The post-Covid complications are proving as detrimental to the population as the acute Covid-19 illness does. The post-Covid sequelae may occur as a result of the side effect of the medications used during Covid-19 infection or due to severe immunity compromise and lung damage occurring as a result of the infection. Even the patients with asymptomatic acute Covid-19 illness can have highly complicated post-Covid repercussions. However, no strict risk factors have been defined for post covid sequelae so far as this condition is still very new and under investigation.
In the previous wave of Covid-19, children presented with a Kawasaki-like illness (high-grade fever, rash, conjunctivitis, swelling, lymph node enlargement) within four weeks of Covid-19 infection with multi-systemic complications, that came to be known as post-Covid multi systemic inflammatory syndrome (MIS-C). A similar presentation is seen in adults during the second wave with varied presentations still under research.
Even after 14 days of illness, many patients are experiencing severe lethargy, joint pains, chest heaviness, breathing difficulty. These are caused by serious damage to the immunity and lungs during the acute illness and need good nutrition, breathing exercises, chest physiotherapy etc., for relief and recovery. These symptoms are very common and can take upto three months for complete remission.
Post-Covid illness needing medical attention presents itself as generalised fatigue not improving with rest, continuous cough, dyspnea, palpitations, maculopapularrashes, arthralgia, high grade fever upto 4-12 weeks post acute Covid-19 illness. The condition can also present as a highly fatal illness causing pulmonary embolism, myocardial infarction,viral myocarditis, acute respiratory distress syndrome, deep vein thrombosis, stroke, pancreatitis, hepatitis,etc. Such patients need to see a doctor immediately if they are experiencing any of the above symptoms. Any delay in treatment can cause severe complications and even death.
Mucormycosis, more commonly known as black fungus, is one of the recent complications encountered in the patients recovering or recovered from Covid-19. It is a non-communicable fungal infection seen predominantly in patients taking high dose ill regulated steroids, using industrial oxygen for inhalation and having poorly controlled diabetes. Other risk factors are still under research as we are encountering almost 100 patients of mucormycosis everyday at AIIMS, New Delhi. Early signs of the infection include facial swelling, dental pain, blurring of vision/ double vision,discoloration of nose. Early identification of symptoms is very crucial for early diagnosis and initiation of treatment. If left untreated it can spread to vital organs like lungs and brain leading to increased complications that are very difficult to treat.
Apart from all these varied symptoms, patients are also presenting side effects of high dose corticosteroids like hyperglycemia, severe bradycardia, gastritis and superadded bacterial infections. These signs need corticosteroid tapering and can not be regarded as post covid sequelae.
Henceforth, early recognition of the signs and symptoms is extremely important to unfold this mysterious illness that is still under investigation.
(Dr. Anupam Kumar Ranjan is a senior resident, emergency medicine at AIIMS New Delhi)