We are slowly but surely making progress in the battle against Covid-19. While the number of cases is increasing, the rate of increase of new cases is on the decline, and of the over 2.1 million cases, almost 1.5 million cases have been discharged.
The mortality at around 2 per cent is among the lowest in the world and, if we are to bring that down, we must address the fact that more than 70 per cent of these are due to co-morbidities. If the co-morbidities are targeted and controlled with proper management of non-communicable diseases (NCDs), patients with Covid will be better able to fight against the infection with a better chance of making a recovery without any complications. As the number of patients recovering from Covid increases, another consequence of pre-existing co-morbidities is now coming to light and that is the post-Covid complications that are making their appearances, especially in patients with NCDs.
There have been numerous reported cases of post-Covid complications causing extended health issues ranging from lasting heart complications, kidney and liver injury, pancreatic issues, respiratory failure, and problems affecting different systems. Even the Government has taken cognisance of this and begun a project to follow-up and document clinical details of cured Covid-19 patients for assessing the presence or development of long-term complications. The emergence of these is of particular significance in patients with existing health issues as many COVID survivors look ahead to months or years of complications.
Long-term consequences
India is home to a large population with diabetes and hypertension. Diabetes has a prevalence rate of 7.3 per cent with a pre-diabetes prevalence that is 1.4 times higher, while hypertension has a prevalence of 28.9 per cent.
The SARS-CoV-2 virus that causes Covid enters the cells through ACE-2 receptors that have the highest presence in the human body in the lungs and the heart. A German study of 100 patients who had recovered from Covid showed that 78 per cent had some kind of cardiac abnormality, and 60 per cent had signs consistent with myocarditis.
With pre-existing heart disease, this can increase the risk of mortality in the long term with complications like arrhythmia, cardiac arrest and death that can occur if a person performs some rigorous exercise without being aware of the underlying condition. These findings indicate the need for an ongoing investigation of the long-term cardiovascular consequences of Covid-19.
Lungs are another organ where the long-term effects of Covid are showing. While the acute phase of the disease may lead to lung complications such as pneumonia, acute respiratory distress syndrome or ARDS, and even sepsis leading to lasting harm to the lungs, the resulting injury may lead to difficulty in breathing in the months that follow after recovery. In the months after discharge, patients who have recovered from severe acute respiratory syndrome may display symptoms that include restrictive pulmonary dysfunction, palpitations, hand tremors, and exertional dyspnea that harms the quality of their life. There is a need for setting up a pulmonary rehabilitation programme for patients who have recovered from Covid but have residual symptoms related to lungs.
There have been reports of mild pancreatic injury in 17 per cent of Covid patients. This makes it important for individuals who have diabetes who have recovered from Covid take care to ensure good glucose control by timely proper medical management. Improvement in glycaemia also boosts the immune response.
Coming to the kidneys, the overall incidence of acute kidney injury in patients with Covid-19 is around 10 per cent with a higher incidence in patients with chronic kidney disease. This may lead to post-discharge complications due to nephritis and needs proper management with dialysis.
Target NCDs
Therefore, it is critical that while we target NCDs through the promotion of healthy lifestyles, early diagnosis and management of diabetes, hypertension, cardiovascular diseases and cancers, our strategy to tackle the NCD burden should consider including the aspect of post-Covid complications. It is only then we can be successful in reducing the long-term morbidity and mortality from NCDs.
It must also be noted that the Covid-19 pandemic has had an adverse impact on the financials of the private healthcare sector across India, which constitutes more than 60 per cent of hospital beds and almost 80 per cent of doctors. On account of the nature of the virus, hospitals and nursing homes, which have been caring for Covid-19 patients, have invested heavily on special equipment for safety and additional infection-control systems, PPEs for their manpower, created dedicated facilities and so on.
Furthermore, across hospitals on account of widespread anxiety of being infected, patients have stayed away from hospitals, and footfalls have dropped by more than 75 per cent and revenues have halved, all the while there has been no special support from the government with regard to the reduction of bank interest rates, etc.
Across many smaller cities and towns, hundreds of small nursing homes, hospitals run by doctors and many such medical centres have been shutting down on account of them being unable to cope with the financial pressure.
Alongside caring for patients, it is important that we are mindful of the health of the private health sector, too.
The writer is Vice-Chairperson, Apollo Hospitals Group and Senior Vice President, NATHEALTH