Things You Should Know About Post Covid Complications

It has been days or even weeks that you tested negative for covid but you still don’t feel fully well. Or you just had mild covid infection and your condition is persistent for weeks even after testing negative post covid. Do you still get aches and pains, persistent low grade fever, persistent cough, sleepless nights, loss of taste and smell, anxiety or even forgetfulness?

All these are real complaints people are reporting many days or weeks after recovering from covid infection. Post covid complications can occur in anyone irrespective of their covid severity. We have seen people fighting chronic fatigue or persistent low grade fever after returning from ICU or people developing anxiety disorders post covid. Even patients recovering from mild symptoms and treated in home isolation can develop cardiac complications in the following weeks. So here are a few common Post covid complications or complaints that should never be ignored.

Chronic fatigue:

Chronic fatigue post covid is the most common complaint after recovering from covid. People feel unwell even after testing negative. They don’t feel like going to work or want some more rest and don’t feel fresh or motivated. Chronic fatigue syndrome has long been a known syndrome but its prevalence in post covid patients has got it to the frontseat.
Those recovering from covid will tell you how difficult they feel to perform their routine work. Chronic fatigue occurs post many viral infections and its same for covid as well. People go on thinking it to be prolonged covid or reinfection. Some keep on continuing with antibiotics, and some continue to undergo repeat investigations to find out cause for their ailment, but in vain. Lab reports are generally within limits. Even cases with mild covid symptoms initially, may have lingering fatigue. And all this can take a toll on their’s and their family’s mental health status.

What is chronic fatigue syndrome?

Chronic fatigue syndrome, also called myalgic encephalomyelitis, medically defined as unexplained, persistent or relapsing fatigue of definite onset, and not as a result of any ongoing exertion.

• Symptoms that persist or recur during six or more consecutive months of illness.
• Not alleviated by rest.
• Resulting in substantial level of reduction of previous levels of occupational, educational, social, or personal activities.

The spectrum of complaints in chronic fatigue may be

• Muscle pain
• Joint pain
• Headache
• Unrefreshing sleep
• Sore Throat
• Low grade fever
• Impairment of concentration
• Memory impairment of short term
• Prolonged exhaustion after minor physical exertion.
• Frustration, depression, and loss of physical fitness are common.

For long there have been studies about the cause and management of chronic fatigue. It is seen that chronic fatigue is common post many viral infections like Epstein barr virus, retrovirus or HIV, and of last post covid infection. So it is also termed as post viral fatigue and lately post covid fatigue.

There are many studies presently going on all through the world to find out residual effects of covid after recovery. In one such study done in Wuhan, China, probably the place of origin of covid, it was seen that most common post covid symptom was fatigue or muscle weakness seen in almost 63% of cases.
Chronic fatigue is a diagnosis of exclusion, there are no specific tests to diagnose it. Experts believe that due to its association with depression or anxiety in a large number of cases, it should be considered as a psychiatric ailment and should be treated under the guidance of psychiatrist. It usually don’t progress beyond a certain point and many patients show gradual improvement with proper care and management.

Management includes

Self motivation is the best management therapy.

• Acknowledging the reality and disability associated.
• Symptomatic medication like pain killers for aches and pains.
• Paracetamol may help with low grade fever.
• Antihistamines like cetrizine and steam inhalation helps with cough and chest congestion.
• Depression and anxiety disorders should be acknowledged and psychiatric help may be essential.
• Gradual return to normal functioning should be encouraged by overcoming avoidance and regaining physical capacity.

Behavioral change:

Change in behaviour by

• correction of misconceptions
• addressing the issue
• relaxation therapies
• motivating self by listening to soothing music or positive talks
• pursuing some hobby may play a vital role in long term outcome.

Sleep management:

A good sleep is important part of fatigue management. Few tips to improve your sleep pattern includes:

• Having a sleep pattern, like sleeping and waking up daily at the same time.
• Avoiding caffeinated drinks before bedtime.
• Avoiding heavy meals before bedtime.
• Don’t indulge in gadgets before going to sleep.
• Dim lighting, some essential oil fragrance at bedside may be helpful.

Physical exercise:

A light yoga may be good to start with. Don’t push yourself, go slow initially. Exercise threshold should be improved gradually. Later on, you may have to push your limits but initially give time to your body. Doing this with the help of a trained person, or a helpful friend will keep you motivated.

Complications in other organs:

Post covid some people may get severe damage to their major organs, days to weeks after testing negative. Same as in fatigue, these damages are also independent of covid severity. Manifestations may present as sudden cardiac arrest, severe lung damage, chronic renal failure or even amnesia, also called Brain fog. These damages may either be directly due to covid infection or may be due to the chronic inflammation caused by covid all through the body. Our body response that fights covid, may in later stage can also be a reason for cytokine storm that causes some serious covid and post covid complications, as our immune system gets confused between infected cells and healthy cells.

Cardiac complications:

Studies going on all through the world have shown cases where people with mild covid infection experienced sudden cardiac arrest few weeks after testing negative. Few patients may have underlying cardiac condition or other comorbidities like hypertension, diabetes which is diagnosed only at the time of covid treatment but large number of cases were healthy. People may develop myocarditis, ischemia or sudden cardiac arrest. It is seen that people returning to strenuous exercise soon after recovering from covid have greater chance to land in cardiac complications. Its generally advised to go slow while returning to physical activities. Even after testing negative, body may have dormant viral effects. So body still needs rest and slow return to precovid exercise schedule.

Alert:

• Go slow while returning to exercise.
• Don’t ignore signs of breathlessness, chest pain, syncope, palpatation, limb swelling or weakness etc.
• Keep a watch on your blood pressure, sugar levels, and get baseline cardiac investigations done.

Lung damage:

Lung parenchyma can be damaged during the course of covid infection, leading to fibrosis, commonly called patch in lungs. In recovery phase, sometimes it may take weeks or months for these patches to get healed and many times our lungs can’t get back to their normal status. People may feel breathless even after minor daily chores, they may also need intermittent oxygen therapy at home.
As with other complications, even lungs need time to heal. So,

• Go slow while returning back to normalcy.
• You can get back your lung capacity to a great extent even after fibrosis, if you go in a phased way.
• Continue any medication prescribed by your treating doctors.
• Simple breathing exercises at home like pranayam, pursed lip breathing, blowing a simple balloon repeatedly at home can be really helpful.
• Lying on your stomach for atleast half an hour 2-3 times a day can help increase your lung capacity.
• Deep breaths during the infection period and in recovery period can prove effective in improving lung capacity.
• Steam inhalation twice or thrice daily gives soothing effect, to be done till symptoms persist.

Brain fog:

Of late, people are coming forward with complains of forgetfulness, short term amnesia, or confusing state of mind. There may be just 1-2 episodes or it can continue for longer term.
People usually can’t correlate it to covid. Though reasons still being researched, it may be due to the damage caused to the brain either due to oxygen level fluctuations or as a result of overall inflammation that body goes through during covid and postcovid phase. If you experience any such thing

• Always report it to your doctor.
• Avoid getting panicked, as it may worsen the overall recovery.
• Simple mind games like solving a riddle, sudoku, chess may help during isolation phase as well as in recovery phase.
• Engage your mind in activities which involves light thinking and mental work.
• Indulge in positive thinking, plan your future.
• A simple book reading can keep you engaged.
• Video chats with friends and family will help you remain positive, but mind overexerting yourself talking.

Black Fungus:

 

As more and more people are recovering from covid, cases with delayed complications or super added infections are also rising. This new entity,  black fungus, medically called mucormycosis, is all over the news. Actually this fungus has been present in our atmosphere since ages but lately post covid, its cases are coming to light. This fungus is all over our atmosphere and it affects our body only when our defense mechanism to ward off these infections fails to check it. Its an opportunistic infection which flourish in low immunity. Though this infection can prove fatal but its generally rare. There are many other fungi which can fourish in low immunity. Covid itself hamper our immunity as our body gets tired fighting the infection and those who already have compromised immunity due to uncontrolled diabetes, cancer, HIV infection, and others are more susceptible to super added infections. And self medicated steroids can play havoc with the immune system preparing a fertile ground for the fungus. Fungus may affect nose, sinuses, eyes, lungs and brain. It invades our blood vessels and nerves and can form clots or erode the near by tissue. It may present as stuffy nose, headache, pain around eye orbits, facial pain, vision disturbance, black nasal discharge or redness/ discoloration of skin or rashes.

Alert:

• Every rash or every pain is not mucormycosis.
• Always keep your blood pressure, diabetes in control. Many studies show that people who enter covid with normal HbA1C have better outcome overall.
• Use distilled/ boiled water for oxygen cylinder or oxygen concentrator’s humidifiers.
• Use steam  inhalation judiciously, longterm steam inhalation can cause scalding/ burning and may produce raw areas for pathogens to grow.
• Never self medicate over the counter steroids. If given judiciously they are life saving in covid in both diabetics and nondiabetics.
• Consult your doctor if you experience any of the signs like persistent headache, periorbital pain, black nasal discharge, skin discoloration around eyes or nose or anything unexplained not resolving.

Renal complications:

People may land up in deranged renal functions or chronic renal failure post covid. As for other organs the damage may be due to the virus itself or due to our immune response. Thickening of blood in covid may also be a reason. Change in amount or color of urine, or pain in renal angles can be alarming.

• A baseline kidney test can help you relieve some anxiety.
• Check your fluid intake during and post infection.
• Avoid alcoholic, aerated and packed drinks for liquid supplementation.
• Nothing is refreshing that a glass of plain water. You can add lemon, mint,honey or fresh fruits for flavors.
• Avoid excessive use of salt and sugar.

There are many other organs that may get affected postcovid like pancreas, appendix, liver and others being researched. With the invent of vaccine, world may be able to curb the covid infection in coming months or years. But there will be a whole pool of people with physical, mental and emotional issues post covid that will take a toll on health system. So if you feel any of the postcovid complications, its better to be aware and act accordingly rather than worsening the condition and increasing the burden of already crumbled health infrastructure.