Since the spike in June, patients requiring post-Covid treatment are regularly being referred to the department of pulmonary medicine at the Goa Medical College (GMC). Head of department Dr Durga Lawande said that recoveries in these cases may often take two or more months.
In such cases, she said, CT scams reveal residual changes in the lungs, which will likely clear in 2-3 months. “It is still early to say with certaintly the exact period required for recovery, since Goa’s Covid-19 spike occurred later than other states,” she said.
Lawande said that if patients come with severe cases like post-Covid fibrosis, doctors commence treatment if there are chances of its persisting.
Some patients, even after being discharged from hospital, suffer from residual breathlessness.
Simple tasks such as walking to the washroom or going from one room to another become difficult due to the patient’s dropping oxygen level.
“These patients require post-Covid treatment. They are referred to us after their discharge from (the Covid) hospital,” she said, adding that they are given additional treatment of steroids, but tapered over two months. “Most patients have responded well to the treatment,” she said.
With the virus being new, Lawande said it is unclear whether patients who had pneumonia will heal in due course or with residual fibrosis in the lungs — scarring in the lungs — which interferes with oxygen exchange in the system. “To avoid the development of fibrosis, patients are given doses of steroids for two months. What happens to the fibrosis after three months is yet to be seen,” she said.
However, she said that the few patients who have completed their two months (of steroid course) have done very well, though some may be required to be given oxygen for an additional month at home.
She said that as compared to interstitial lung fibrosis due to other diseases, she said there is a better prognosis in Covid cases. “With Covid lung fibrosis, we don’t expect (it) to progress further, and it will likely clear. That’s what we are learning from the cases seen elsewhere,” she said.
Certain drugs have been advocated for treatment of lung fibrosis that persists beyond three months, Lawande said, but they are still in the experimental stage. “Studies are still underway to determine the efficacy of those drugs,” she said.
Lawande expects that around 20% of cured Covid-19 cases may have gone into fibrosis. It will be difficult to say which age group is more vulnerable to the risk of post-Covid health issues in the absence of a study, she said. “It would likely depend more on the extent of the infection of the virus the patient suffered. Other factors such as age and comorbid conditions may come into the picture, but we can’t say more without a study.”
Some peculiar cases — patients who didn’t have active infection and were asymptomatic — developed breathlessness at a later stage, she said. Depending on the outcome of the investigation, treatment is initiated in them, she added.
In some cases, she said the hyper-inflammatory state gets extended, raising the risk of strokes or myocardial infarctions (heart attacks) during post-Covid period.
“Those patients need to be followed for three months post-Covid recovery,” she said. “They are informed about this at the time of their discharge. If there is a sudden increase in breathlessness, they shouldn’t ignore it.”