COVID-19 is different and even more difficult to treat
The unprecedented deadly second wave of COVID-19 is reaching its crest and I am glad that patients, who consulted me, have recovered or are on the path of recovery. Undoubtedly, those who suffered from this disease had gone through a strenuous time, treating COVID patients has been equally taxing. Getting distress calls in the middle of night, young people needing ICU care and some of them going critical within a short span, was tough and demanding for me as a doctor.
Treating pneumonia and its complications is a routine scenario in medicine wards however COVID associated pneumonia is a different ball game altogether. The uncertainty of complications in individuals makes it even more perplexing for the doctors. Graph of recovery has never been so unpredictable before.
Covid infection has its own disparities as compared to other infectious diseases which makes it even more difficult to treat than other viruses. Let me take you through various challenges that I have faced during this pandemic.
Happy hypoxia / Silent Hypoxia- This term may sound alien to a common man but has been very popular among doctors lately. Usually any patient, whose oxygen saturation falls, shows signs of hypoxia such as breathlessness, increased heart rate, sweating and distress. But this hasn’t been the case with COVID-19 pneumonia.
Here a patient looks fine based on physical appearance, but her oxygen saturation might be alarmingly low if checked. Happy Hypoxia has been the major reason why so many patients were late in getting urgent hospital care. In many cases the caretakers were under the false impression that their patients were doing fine until they became critically ill or actually collapsed at home.
This phenomenon has been a nightmare because we can’t take any patient for granted and have to keep monitoring them more vigilantly. We have to teach the caretaker about the importance of not being casual about the same.
Permanent lung fibrosis- Another major concern which I have to address regularly, is dealing with patients requiring oxygen support at home after discharge. Lot of patients who recovered from Covid-19 of moderate to severe pneumonia were showing signs of persistent scarring in the lungs (lung fibrosis).
Because of this sequel to disease, patients’ lungs are not recovering to 100% capacity. Simple activities like taking a flight of stairs or walking at a pace has become a herculean task for many due to decreased exercise capacity and compromised lung conditions.
Most of these patients were young healthy individuals and never had any respiratory ailment before.
A country’s young generation needing long term oxygen support, nebulizer or inhaler therapy to sustain is difficult for both doctors and the society.
COVID-19 and Diabetes- SARS-CoV 2 virus not only has damaging effects on the respiratory system but also has a collateral effect on pancreas.
India is the diabetic capital of the world and emergence of COVID-19 infection has pushed pre-diabetics and non diabetics into overt diabetes. Diabetes is a complicated metabolic disease, with its own bunch of side effects and twining it with COVID-19 has worsened the treatment outcome and prognosis. As physicians, it has made us scratch our heads to calculate the benefit risk ratio of using steroids and other immunosuppressants without harming the patient whose immunity is already compromised due to diabetes.
Dealing with COVID-19 and diabetes together has been like playing with a double edged sword.
Long term COVID- Some people, even after relatively mild symptoms of COVID-19 infection, showed delayed resolution of symptoms. Few had persistent non-specific symptoms like breathlessness, joint pain, generalized fatigue or brain fog while some had serious sequelae like clotting in major vessels of blood.
It is very difficult to predict who will have a normal recovery curve or who could go into Chronic COVID or long acute COVID-19.
I want to share a few examples here.
A young healthy individual had mild symptoms and completed 14 days of home isolation. Everything looked perfect. A few days later he presented with symptoms of persistent nausea, vomiting and giddiness. After Initial symptomatic treatment he didn’t show signs of recovery, so a brain scan was done and the cause of symptoms was brain swelling. It came out as a shock both for the patient and us. Such an uncertain diagnosis has made me think twice about every symptom with a different perspective because SARS- CoV2 is notorious for presenting in surprising ways.
In another case, a normal recovering gentleman from Covid-19 later complained of uneasiness and vague chest discomfort. On evaluation it was found that there was heart soreness(Myocarditis) with slowing of pulse.
Thus as a physician I started taking every patient seriously no matter how mild the symptoms are.
Counselling and building the right attitude- With so many casualties around, it’s only fair to have anxiety or panic attacks. People became super cautious of any new symptom, whether it was a slight rise in temperature, fatigue or weakness. They related it with grave diagnosis. To handle these scenarios, counselling and assurance became an integral part of patient management along with medical treatment.
Being aware of disease and its complications is the need of an hour but to overthink, stress and panic is not the solution.
Situation we are going through is arduous and depressing. But the only way out is to think positive and tell yourself everything is going to be fine. Perhaps, it sounds too good to be true, but realism can be bad for your health.
High ‘self enhancers’ — people who see themselves in a more positive light than others see them — have low cardiovascular response to stress and recover faster.
It is an interesting fact that 9% of the human genome is viral in origin and it’s virus-like entities called Retrotransposons account for 34% of the genome. It makes us think about how it even got there. We appear to be the survivors of a brutal yet creative succession of viral epidemics.
For us modern people, emerging viruses such as SARS, MERS, Ebola, Zika will continue to cause tragedies but for our descendants, it could turn out to be vital. Therefore, dealing with problems with correct behavior and hope for the best future is the way forward.
