What the doctors learnt while fighting the pandemic

82-Dr-Anuroop-Balagopal Ace team: (From left) Dr Anuroop Balagopal, Dr T.R. John, Dr Suresh G. Nair, Dr Geetha Philips, Dr Praveen Valsalan K., Dr Arun Wilson and Dr Johnson K. Varghese at Aster Medcity, Kochi | Josekutty Panackal

On December 7, 2020, Dr Johnson K. Varghese, consultant at the department of emergency medicine at Aster Medcity, Kochi, got a distress call to shift a pregnant, Covid-positive patient with severe hypoxia and respiratory distress. She was at a peripheral hospital that was not equipped to handle the case. This was her first pregnancy, and the 31-year-old was into her 31st week of gestation.

Varghese, who was overseeing high-risk Covid cases, acted swiftly. “We dispatched our ambulance to bring her to Aster,” he says. “The patient was on a BiPAP machine [a semi-ventilator machine], with her oxygen saturation levels wavering between 72 and 78 per cent. She also had gestational diabetes.” Transferring a patient hooked up to a BiPAP machine is a risky affair, but the team rose to the challenge. “We intubated the patient and then shifted her to our hospital,” says Varghese. “Two lives were at stake here, and our immediate concern was the baby. So, the patient was immediately moved to the operation theatre for C-section.”

As the baby was floppy and blue, she was immediately put on a ventilator in the neonatal intensive care unit. Meanwhile, the mother was put on a V-V ECMO—a machine that primarliy supports lung function. “The chances of saving both mother and child were very less,” says Varghese. However, medical science and the dedication of the staff carried the day. On December 31, after testing negative for Covid, the mother finally got her chance to hold her firstborn.

“We have many such success stories to share as we were well-equipped and ready for Covid-19 from the start,” says Dr T.R. John, director of medical affairs, Aster Medcity. “Over the pandemic period, Aster became the last refuge for many; we admitted and saved several critically-ill Covid patients who had spent even 30 to 40 days in the ICUs of other hospitals.”

Covid-19 patients with severe comorbidities, like those with respiratory diseases—chronic obstructive pulmonary disease, for instance—chronic kidney or liver diseases and those taking immunosuppressants were found to be in the top-risk category, says Dr Praveen Valsalan K., consultant pulmonologist at Aster Medcity. “Cardiac cause of death is also widely observed among serious Covid patients.”

The doctors testify they have seen many people with post-Covid complications. “Anybody can go into post-Covid complications,” says Dr Geetha Philips, senior consultant, internal medicine, Aster Medcity. “In those affected by Covid-19, there is a chance that the symptoms persist even after they test negative. In some other patients, new symptoms may arise once they turn negative.” Doctors point out that acute Covid-19 usually lasts for four weeks from the onset of symptoms. “Then, there is a group called Covid long-haulers; there are two sections in this group,” says Philips. “First come those who experience Covid symptoms for four to 12 weeks. The second set comprises groups whose symptoms persist for more than 12 weeks. They are said to have a chronic long haul.”

Extreme fatigue is one of the most common symptoms observed in long-haulers, according to Philips. “Other symptoms include headache, body pain, difficulty to concentrate or a condition called brain fog,” she adds. “Then there is a group that comes with chest pain and palpitation that developed in the post-Covid phase. There is also the risk of major complications—like those affecting the brain, neuromuscular disorders and stroke. In some rare cases, people had developed Guillain-Barré syndrome [a condition that affects nerves, and causes numbness, weakness and pain], too.” Another observation from Philips is that Covid-positive cardiac patients saw their condition worsening. “They became more vulnerable,” she says. “Some of them exhibited elevated troponin levels (which is a sign of heart problems), some others experienced [heart] failure or change in the heart rhythm. Also, they exhibited increased chances for a thromboembolic phenomenon.”

According to doctors, a major lung condition observed among long-haulers is pulmonary fibrosis, which causes lung scarring and difficulty in breathing. “I observed another phenomenon in young people, of late,” says Philips. “These patients, who were asymptomatic when they were infected, are now—after two months of Covid exposure—coming in with pneumonia.” Even after being vaccinated, patients who are elderly, diabetic or with kidney problems are at high risk for acute Covid, the doctors say. They say that a range of other issues like sleeplessness to hair fall also has been observed in the post-Covid phase.

John says the pandemic has triggered “caveman’s syndrome” in many—a condition where people are afraid to resume their public routines. “Also, existing psychiatric disorders flared up because ambient stress (stress caused from fears about job security, social security, debts etc) increased,” he says. “Several people have plunged into depression, anxiety disorders or have become paranoid about illnesses.”

Aster had opened a post-Covid clinic as early as September 2020 for the rehabilitation of long-haulers. “As part of rehabilitation, first we will do a heart, lung and neuromuscular assessment of the patient,” says Dr Valsalan. “Then we have a set of exercises to deal with everything starting from breathing. There are also exercises targeting different muscles. Along with them, we will also do nutrition assessment and psychosocial assessment. This [rehabilitation] process would take anywhere from one to three months.”

Dr Suresh G. Nair, senior consultant in anaesthesiology & critical care at Aster Medcity, notes that compared with the initial phase, there is greater knowledge about virus spread now, and that has brought more relaxation in protocols for clinical management of Covid-19. There is also more confidence in the medical community on how to handle even the most critical case of infection. But the doctors caution that the war is still not over and that we should continue safe-distancing and masking to keep the virus at bay.