3rd July 2021

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 Musings.......


Long Covid 


The unpredictability of Covid symptoms is a matter of concern for patients as well as the medical community alike. The general symptoms include body ache, fatigue, headache, fever, loss of smell, taste and breathlessness. 

It is being now increasingly seen that many patients now experience extended symptoms even after 14 days - the average time it takes for body to fight off the virus. 


Patients may develop symptoms even 6months to 1 year after recovery. This is known as Long Covid. 


According to ICMR, if a person has symptoms 4-12 weeks after testing negative for Covid, it should be treated as post-Covid Syndrome ( PCS). 

If after 12 weeks symptoms continue to reappear, patient should do an RT-PCR test. 

If positive then they are reinfected with Covid. 

If negative, then it should be treated as Long Covid. 


Two important pathogenic mechanisms of Covid are - 

- [ ] Inflammation - 

Inflammation is a natural

Process by which the body reacts to or fights off infection or injury. 

The Covid virus entering any organ of the body can cause inflammation to the organ. 


- [ ] Thrombosis - 

Blood clot in layman language refers to tendency of blood to clot in presence of foreign body. 

If not treated these clots can lead to life- threatening complications in organs like cardiac events, pulmonary thromboembolism, stroke or kidney damage. 

With Covid there are reports of even clots in hands and legs ( thromboembolism ) 

Patients more prone to blood clots are bed-ridden, cancer patients, elderly or with past history of blood clot. 


Organs at risk - 


Lungs- 

During Covid patients can develop pneumonia and hypoxia ( decrease in blood oxygen level ). 

After Covid patients can get permanent fibrosis of lungs, clots in lung tissue ( pulmonary embolism ) and long term breathlessness. 

Scarring and fibrosis of lungs can lead to normal breathing space being converted to dead tissue, causing breathlessness and loss of function. 


People above 60 years, smokers, alcoholics and those with prolonged ICU stay or ventilator stay are at higher risk to develop lung fibrosis. 


Heart - 

Inflammation of Cardiac muscle is a major post Covid complication which is being seen even weeks after recovery from Covid. 

The heart too possess the ACE2 receptors, the protein the virus hooks on to gain entry into the body, and causing inflammatory reaction. 

Many people may live a normal lifestyle even with small plaque formation. Symptoms only appear when the plaque blocking vessel is around 50-70%. 

With Covid, these plaques can rupture because of inflammation in the heart muscles. 

This can increase chances of thrombosis and trigger heart attacks. 


Kidneys- 


Patients with Chronic Kidney Disease (CKD) are at higher risk for Long Covid. Covid compromises immune system and inturn the risk is higher for kidney transplant patients. 

Poor fluid intake during Covid can cause acute Kidney injury - (due to cytokine storm leading to tubular necrosis or kidney injury). Recovery here can take weeks to months. 

Few will develop tubulointerstitial nephritis or inflammation in tubules or kidney secondary to drugs given for Covid. 

If the drugs are stopped in time, patient recovers fully. 


Brain - 


Clots travelling to brain can lead to stroke, and neurological disorders. 

Brain fog is a very common condition seen during long Covid especially in children. People find it difficult to think clearly for a long period of time, but it is temporary and cured in weeks. 


There are simple blood tests that can give us evidence of impending danger. These tests can be done based on severity of Covid and has to be interpreted by a Medical Professional. 


- [ ] CRP- C- Reactive Protein - if elevated can mean internal inflammation 

- [ ] D-DIMER-  Indicate possibility of blood clot or thrombosis if elevated 

- [ ] CBC - Complete Blood Count - to look for secondary infection

- [ ] Routine LFT, RFT - look for liver and renal function. 


So many ask what is the ideal diet post Covid - 

Basic idea is to have food that improves and gives a boost to natural immunity as well as ensure basic nutrition. 


- [ ] Protein- with an added addendum that too much protein can stress out Kidneys especially in people with CKD. 

- [ ] Fluid Intake - soup, fresh juice and water to ensure hydration 

- [ ] Iron- seasonal fruits daily 

- [ ] Calcium- dairy products 

- [ ] Dry fruits 


Avoiding excessive sugar and processed foods will be helpful. 

Those suffering from Long Covid are advised to take it slow. Not to engage in vigorous physical activity initially, but gradually over a period of 3-4 months. 


We live in uncertain times and this demands extraordinary measures. In this fight for survival, only the “ slow and steady” wins the race. 


Food for Thought.......


RC 


rohitchennithala.blogspot.com 

rohitchennithala.home.blog

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