Devyaani, 42, had her first Covid-19 infection in Oct 2020. Fever was mild and stayed only for 2-3 days but she suffered from extreme fatigue. Two weeks later, she felt that her grip weakened, and was unable to hold heavy objects. Post covid, along with some breathing issues, she also faced general pain and aches in the bones and the muscles, which though became mild with time, continued for months.
She caught Covid the second time in April 2021. This time, the fever was high and it affected her lungs. Devyaani had to remain on steroids for about a month. Post covid, along with general weakness, her muscle aches increased. So did her skin and respiratory allergies, inflammation in the bones, and rotating pain in different parts of the body. “I had this severe pain in one part of the arm one day, which will move to one of legs the next day and then will affect my back. Doctors were blaming it on the covid but there was no specific treatment they were prescribing. I also gained about 10 kilograms of weight post covid,” says Devyaani.
Devyani’s medical reports suggested a mild auto-immune response. Her doctor told her that a lot of her patients are showing minor changes in titters ( amount of antibodies in blood) post Covid. Along with a brief course of anti-inflammatory drugs, her doctor asked her to remain happy and calm and eat well for a year. She advised her not to take stress, include mild daily exercise in her daily routine, and take nutritious meals without thinking too much about her increased body weight.
The prescription helped Devyaani immensely. Almost two years later, Devyani is much better. Her allergies have calmed down. Though she has gained weight, she has built stamina. The inflammation in muscles and bones have subsided to a great extent. “My symptoms have not been eliminated, but I am feeling quite better now, and that too without any medication,” she says.
It has been about two years since the country witnessed a severe Covid wave in April-May 2021, but the virus continues to impact health of people in several ways. “Some people continue to have clinical symptoms. These are the people who had severe infection of lungs. The inflammation in lungs and muscles around the heart are causing breathlessness in many patients. Though most of my patients have recovered to a great extent in the last two years, a few continue to be on oxygen support,” says Dr Randeep Guleria, a noted pulmonologist and former director, AIIMS Delhi. He is now director, Medical Education at Medanta, Gurugram.
Apart from the lungs, the virus has deeply impacted the immune system in many cases. Dr Uma Kumar, Head of the Department, Rheumatology says that the virus has caused changes at the cellular level.
Sjogren's syndrome is a disorder of the immune system identified by its two most common symptoms — dry eyes and a dry mouth. In many patients, antinuclear antibodies were found in their blood, which could be an indication of systemic lupus or other rheumatic illness. Few patients has soft tissue inflammation, a condition called Tenosynovitis which is inflammation of the protective sheath (the synovial membrane) that surrounds your tendons.
“We still get patients with extreme fatigue, myositis, which is weakness and pain in the muscles of the hips and shoulders,” says Dr Kumar. “In some patients we need to prescribe medications we do to the patients of auto-immune disorders.”
Though how the virus exactly affects the cells is not known, there are several hypothesis. One is when the virus enters a cell, it replicates and causes inflammation. The cell ruptures, throwing out its content. The immune system recognises the cell content as foreign material, triggering an immune response against its own cells. Another hypothesis is the inflammation in one cell affects and inflames the surrounding cells.
Dr Anurag Agrawal, former director CSIR IGIB, and now Dean of Biosciences and Health Research, Ashoka University, Sonipat, says that though in India there is a very little research on long-term covid because there were not many high-quality large cohorts or good digital medical records at a national level, there is plenty of international data that shows that Covid has some severe and serious long-term health consequences.
Various researches on the impact of Covid between early 2020 and early 2021 before vaccines were developed suggest a great increase in stroke, heart attacks, arrhythmia, says Dr Agrawal. There have been studies that point to a doubling in deaths among people who caught and recovered from covid. “There have been a large amount of data collected in UK that also indicates a significant increase in arrhythmias, clotting in the lungs and the heart of patients who had Covid,” he adds.
“Then there was some long-term impact of covid-19 vaccines. For example, mRNA vaccines can cause arrhythmia and heart inflammation. Vectored virus vaccine such as Covishield is associated with thrombosis, especially in young women. Studies show one in 30,000 young women were affected by thrombosis,” says Dr Agrawal. “Though in the case of vaccines, we didn’t have much choice. The pandemic was an emergency and we could not have waited to see rare effect of vaccines. Overall vaccines saved lives.”
What Covid-19 has brought to the fore is that India needs to digitalize its health records and strengthen research. “In India vectored vaccines were used the most, but because we don’t have digital health records, we could not identify the increase in cases of the thrombotic event the vaccine was causing in young women recipients of vaccine,” says Dr Agrawal.
There is a need for further research in India to fully understand and prevent the long- term impact of Covid.