It was on the eighteenth day after he was first diagnosed with Covid-19 that Dr S. Chatterjee resumed work. But later that day, he rushed home; he felt giddy, very weak and had a variable pulse rate. A battery of tests revealed that he had myocarditis—an inflammation of the heart muscle. The Covid-19 literature has been peppered with reports about myocarditis accompanying the disease. “It took a slightly longer time for me to recover,” says Chatterjee, internal medicine specialist at Indraprastha Apollo Hospitals in Delhi. “This virus kind of pulls you down.” He is back on his feet now, with his PPE suit on for seven hours straight and handling patients inside the Covid-19 ward.
Being infected with the novel coronavirus is akin to facing a boxer’s punch, say experts. The pugilist walks away, but the victim is left reeling from the bout for months on end. “It takes time for the body to come back to the baseline after testing negative, and whether it will bounce back to its original self at all remains debatable,” says Dr Rahul Pandit, an intensivist at Fortis hospital in Mulund, Mumbai.
Medically, a patient is said to have recovered from Covid-19 once he or she tests negative. But the actual recovery may take days, months and even years, say doctors. “The signs and symptoms we see in patients in the recovery phase, which is long after they first tested positive, is what we term as the post-Covid syndrome,” says Pandit.
Acute weakness, fatigue, low-grade fever and changes in blood pressure are a few common symptoms observed in patients four to six weeks after they test negative. There are also reports of symptoms like diarrhoea and vomiting that continue for days after the patient tests negative. “Covid-19 continues to impact the heart, lungs, nerves, kidneys and the psyche for weeks after the patient has tested negative,” says Chatterjee. “Right now, we have a Covid-19 patient who showed symptoms of Guillain-Barre syndrome (rare disorder in which one’s immune system attacks nerves) after almost three to four weeks.”
Ganesh Shah, 53, spent 33 days at Bhatia Hospital in Mumbai; he had pneumonia and later tested positive for Covid-19. But even now, his lungs are inflamed and any strenuous activity leaves him gasping for breath. “The doctors have said it will take at least another two months for recovery. I exercise a little every day and have stopped going to work altogether,” says Shah, who works at a jewellery firm in downtown Mumbai. “I hope to recover completely, but I am not sure if it is possible.”
Patients with acute respiratory distress syndrome are advised to continue with oxygen therapy once back home from hospital, says Dr Samrat Shah from Bhatia Hospital. Those with ARDS, he says, are on oxygen support inside the hospital, as their respiratory muscles have gone into fatigue because of overwork and the lungs undergo certain fibrotic changes. “So, after a prolonged stay of 45-60 days inside the hospital, patients are asked to continue oxygen therapy at home for at least one or two weeks until the lungs get their capacity back to help the patient perform day-to-day tasks,” he says.
Recovery, however, differs from person to person. Satish Katke’s recovery has been speedy, “without any leftover signs”. Katke and his family of six had tested positive for Covid-19 in April. Today, Katke feels “fit as ever”. A resident of Dharavi, he recently donated his plasma at a drive organised by an NGO.
A majority of Covid-19 patients also show a tendency to develop blood clots. “We are now putting these patients on at least three to four weeks of blood thinners,” says Pandit. “Even at discharge, the blood tests done suggest that there could be a tendency to clot.”
In patients with pre-existing comorbidities, the dosage of drugs for those conditions may change. For instance, a patient whose sugar levels could be controlled through tablets earlier might have to take insulin owing to the rise in blood sugar levels during Covid-19 treatment. Blood sugar levels could rise because of the use of steroids in Covid-19 treatment, say doctors.
Hospitals are now planning to start post-Covid outpatient departments, offering medical and psychological counselling and support. “I know how depressing it was to stay inside the isolation ward of the hospital for 14 days,” recalls a 33-year-old woman. “I was all by myself and had frequent bouts of anxiety, depression and a constant fear of what will happen next.” Issues related to stress and depression are being reported increasingly now, especially with patients who have long recovered from Covid-19. Pandit, who, too, had tested positive for Covid-19, says that the trick is to never let one’s guard down.
Yet, with the disease being relatively new and the knowledge about it being limited, doctors say it is too early to estimate the long-term impact of Covid-19 on a patient’s health. Most doctors recommend complete rest even after being discharged from hospital. “Rushing back to work is just not possible and it takes at least three weeks to recover well,” says Dr Harshad Limaye, senior consultant, internal medicine, Nanavati hospital. “We have had incidents (less than one per cent) where patients have gone home with negative reports and come back with positive report after a couple of months. Whether this was re-infection or persistence of the virus remains open for debate.”