16 October,2020 07:03 AM IST | Mumbai | Vinod Kumar Menon
Newly started Out Patient Department for recovered COVID patients at the BKC centre
The death of a doctor after recovering from COVID has raised fresh concerns over post-COVID-19 complications. Dr Ratneesh Saah from Jalore, Rajasthan, died on Wednesday of cardiac arrest. He had resumed work a few weeks ago.
Dr Wiqar Shaikh, senior allergy and asthma specialist said, "Given the incidence of post-COVID-19 complications, it is essential for all public hospitals to start stringent screening of recovered patients by multi-disciplinary specialists. The virus affects several other organs and psyche. It can also lead to blood clots. It is now a multi-organ disease."
Dr Ratneesh Saah (left) from Rajasthan died after recovery
He added, "The WHO has estimated that between 20 to 40 per cent of recovered COVID-19 patients could develop complications. However, there is no data on such patients in India yet."
Dr Subhash Hira, Professor of Global Health at University of Washington-Seattle, USA and health advisor to several UN, Indian and African health agencies, "During Phase I Of the COVID patients from abroad from January-March 2 per cent progressed to vascular clots and auto-inflammatory syndrome. During the pandemic in India from April-June, the pandemic was in Phase II (local human transmission). COVID-19 patients were being discharged by day 10 of the onset of symptoms. Soon, over 20 per cent of such discharged patients started returning to hospitals with 'ground glass opacities in lungs', cardiomyopathies, kidney shutdowns, and vessel and brain clots causing multiple paralyses."
Dr Hira added, "The intensely debated Phase III (community transmission) started in June-July. The clinical features attributed to COVID-19 now include dermatological swellings on tips of fingers/toes, neural deafness, transient blindness with retinal clots, etc, mostly attributed to hypercoagulation of blood in circulation due to auto-inflammatory syndrome attributed to 'cytokine storm' released from COVID-infected human cells on-or-after 12 to 15 days of onset of early symptoms."
Dr. Hira added, "Soon, ICMR suggested postponing discharge in suspect cases to the 16th day since the onset of early symptoms. All complications are preventable provided the patient is counselled appropriately and gets a weekly follow-up for four to six weeks."
With winter around the corner, common cold and influenza are likely to add on to the caseload. The following are the differences seen between these and COVID-19: "COVID-19 starts with low-grade fever and gradually adds on more illnesses; common cold begins with a sore throat and gradually adds on watery eyes, sneezing and running nose; influenzas start with a cough, and abruptly add high-fever, headache, sore throat and running nose, body pains, etc," said Dr Hira.
Dr Ketan Vagholkar, Professor of surgery at DY Patil Medical college has started getting cases of post-COVID complications in the past few weeks.
A middle-aged female patient Navi Mumbai had to be rushed to the emergency room a week after her discharge as she developed severe abdominal symptoms of distension and vomiting, a classic gastrointestinal complication. Luckily, her CT did not show any thrombosis of the intestine.
Dr Vagholkar said, "Though the recovery rate of COVID has improved, late complications after recovery are increasing too. There is an urgent need for meticulous follow-ups. Increased incidents of blood clot formation is serious. It can cause sudden heart failure, stroke and various gastrointestinal complications."
"Comorbid patients are at a high risk of late complications. Follow up visits should be spread over eight weeks. There has to be assessment of heart, lung, liver and kidney function. Patients suffering from neurological problems should be assessed by a neurologist," said Dr Vagholkar. He concluded saying, "Recovered patients should first be tested for thrombotic complications across all organs. All COVID hospitals and centres should immediately start follow-up OPDs."
Head Constable Deepak Hate died a few hours after being discharged
On May 28, 53-year-old Mumbai police Head Constable Deepak Hate died four hours after returning home from the COVID-19 at Jumbo Centre at Worli. In another case, K Raja Subramanian, from Madurai, Tamil Nadu, was discharged from a local government hospital, after he was treated for fever for three days. He was comorbid and after returning home, he again developed complications and was shifted to a medical college, where he died on September 10, due to severe acute respiratory infection.
The BMC's Jumbo COVID centre at BKC has started a post-COVID-19 OPD. "It is for the sole purpose of serving patients discharged from this Jumbo facility. It started on October 3," said Dr Rajesh Dhere, dean of the facility.
MP Supriya Sule and Dr Rajesh Dhere, dean of BKC's Jumbo COVID centre at the OPD for recovered patients
Dr Dhere added, "The OPD has three pillars - clinical assessment to tackle the residual impact, psychological intervention and rehabilitative care to assess the impact on mobility, exercise tolerance and muscle weakness. Patients will also be assessed for lung fibrosis and pulmonary fibrosis, especially among those with complicated recoveries."
The OPD has two chest physicians, two diabetologists, a cardiologist, a psychiatrist, two psychological counsellors, three physiotherapists, four junior doctors and two nurses. There will be telephonic follow-ups and those needing a physical examination will be called to the OPD on day 14, 28, in the second, fourth and sixth month after recovery.
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