Doctors say that many people are suffering from unrecognised long COVID. Patients who have had a serious infection often think that they are alright once they are discharged from the hospital. However, their lungs need ongoing monitoring and care.
The second wave of COVID-19 brought home the devastating effects of the viral infection on our lungs, as thousands struggled to get access to oxygen and ventilators. Months later, doctors say some patients with moderate or severe lung involvement continue to experience profound and long-term impacts even after they have left the hospital.
“Most people think that the risk has passed once they are discharged from hospital following an acute COVID-19 infection,” explains Dr Srinivas Rajagopal, Director of the Transplant Pulmonology and Lung Failure Unit at the Kauvery Group of Hospitals. However, some patients have shown significant deterioration in lung function months after getting out of the hospital, even needing a lung transplant.
“We still don’t have enough predictors to know exactly who will have problems after discharge,” explains Dr Srinivas. In general, he says, there is enough evidence to show that patients who are older, have a history of smoking, have prior lung diseases, or have had extensive lung involvement during acute Covid requiring BiPAP or ventilator support are likely to have persistent problems after discharge.
Beyond this general understanding, however, there are three possibilities for patients under the long COVID umbrella. “The vast majority will slowly improve over the next 3-6 months,” says Dr Srinivas. In CT scans after six months, 70% of such patients show abnormalities in the lungs, but they can largely take care of themselves and go on with their lives. “We still don’t know all of the long-term effects for these patients, however, and advise them to do annual lung function tests, vaccinations, avoid smoking, eat well and exercise,” he cautions.
For the second broad group of patients, oxygen support is needed even after six months since hospitalisation. “Some people may need a little, while some may need 4-5 litres per day. If this does not improve, then a lung transplant may become necessary at some point,” says Dr Srinivas.
In the third group of patients, symptoms worsen after discharge. “Many such patients may have had a milder infection initially, but it worsens later. In most cases, this is because of a secondary infection such as TB or fungal infections like black fungus. In less than 10% of cases, the COVID-19 related initial lung damage may trigger pulmonary fibrosis,” says Dr Srinivas. Such patients are at the highest risk and may require an early lung transplant.
Doctors are facing an uphill task with lung health because patients sometimes take too lightly the need for post-hospitalisation follow-up. But this stems from a misconception that leaving the hospital means the danger has passed.
Dr Srinivas explains that hospital discharge only means the acute phase has been completed. “If patients are stable, if acute COVID-19 phase has passed and there is no infection, if patients can eat and walk, we discharge them,” he says.
This is because it is neither logistically possible for hospitals nor financially viable for patients to remain in hospital till the long COVID symptoms have passed. “We have lung tissue of about 250 sq metres – equivalent in area to two tennis courts – inside our chest. For that much tissue to recover from damage takes a very long time,” says Dr Srinivas.
At discharge, it isn’t always apparent to doctors if lung problems are going to worsen over time.
With COVID-19, says Dr Srinivas, it’s always better to be safe than sorry as we are still learning the full impact of the infection. Some of the key signs to watch out for include continuing cough, sputum, more breathing trouble, new fevers, poor appetite and weight loss, leg swelling, and increases in oxygen requirement. “People tend to think that a cough means phlegm in the chest or a sinus infection, and so on. But it is important to get these symptoms checked,” says Dr Srinivas.
Further, says Dr Srinivas, it is also important for patients to get their lung function tested periodically, particularly if they had a severe acute COVID-19 function with poor pulmonary function tests.
Besides these, Dr Srinivas also advises pneumonia/flu vaccinations, avoiding active or passive smoking, protective gear when exposed to pollution, a balanced diet with plenty of fruits and vegetables, sufficient water consumption, and a daily exercise pattern with sufficient cardio workout. COVID-19 precautions are also important to prevent re-infection.
“Finally, while we have very few cases of vaccinated patients who develop significant lung infection, this number is not zero. So, even if people are vaccinated, they should continue to mask up and maintain hand hygiene and physical distancing,” says Dr Srinivas.
At the end of the day, the need for care following a severe COVID-19 infection doesn’t end with hospitalisation. Follow-up and continued attention are needed to make sure things don’t take a turn for the worse weeks or months later rather than diagnosing things at a very late stage.
This article has been published in association with Kauvery Hospital, Chennai.