World Health Day . A look at the changing profile of disease, post Covid-19

At the turn of the year, social media was gung-ho heralding the end of Covid-19. New cases had fallen dramatically across the country since the highs of mid-September.

In March 2021 came the second wave. Not everyone who had Covid in the first wave will have immunity to Covid reinfection as immunity develops in only 83 per cent of patients and lasts probably for six months. We are contending with patients with residual damage already induced by the first wave, suffering from Covid again. In medical terms we call residual damage sequelae; a condition that develops as a consequence of something, or a medical condition that results from a prior disease.

People with serious sequelae are the most likely to be impacted, but even young, otherwise healthy people can feel unwell for weeks to months, if they get infected due to carelessness. The most common signs and symptoms that linger over time include fatigue, shortness of breath, cough, joint pain and chest pain.

In terms of disease profile, India is a country where diabetes, blood pressure and obesity will continue to be problems. It’s not just the geriatric, but also a section of the younger population, many of whom suffer from obesity as well as undiagnosed diabetes and high blood pressure, who could contract a severe form of Covid because most are undiagnosed and untreated for pre-existing illnesses. There is also evidence that neurological complications are on the rise. All of these could result in a newer disease profile for India.

There will also be a marked change in the heart-health profile of the country, the long-term problems are likely to manifest in organs such as

1. LUNGS: The type of pneumonia that is normally seen in Covid-19 may cause irreparable damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to long-term breathing problems. In the case of smokers, the negative impact of smoking will be felt even more.

2. HEART: Those who have recovered from Covid-19 may continue to show lasting damage to the heart muscle, even if they experienced only mild symptoms. This may increase the risk of heart failure or other heart complications in the future. On a population level, on the one hand, there will be higher cardiac incidences. On the other hand, the severity of the cases itself will be greater.

3. CLOTTING: Covid-19 can make blood cells more likely to form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by Covid-19 is believed to stem from very small clots that block tiny blood vessels (capillaries) in the heart muscle. This may have an impact on a higher percentage of sudden deaths at home, especially among those with undiagnosed pre-existing blocks.

4. KIDNEY: Covid-19 may weaken the blood vessels and cause them to leak, this could lead to long lasting issues with the kidney.

5. PANCREAS: Empirical evidence suggests that Covid leads to inflammation of the pancreas. Incidence of abdominal pain and temporary or permanent diabetes will increase due to the same. Diabetes, in turn, is a risk factor for cardiac disease.

6. MENTAL HEALTH: People who have severe symptoms of Covid-19 often have to be treated in a hospital's intensive care unit, with mechanical assistance such as ventilators. Simply surviving this experience can make a person more likely to later develop post-traumatic stress syndrome, depression and anxiety. There will be a sharp increase in the need for mental health management post Covid.

The resurgent strain of March 2021- a virus that has mutated to a more rapidly spreading strain (not a more fatal one) - has hit us at a time when we are Covid fatigued and have become complacent about prevention behaviour such as wearing a mask and maintaining physical distance. And this is what we must guard against.

A more rapidly spreading strain is bad news more so when we are casual and do not follow precautions. Even after vaccination , there is no protection for a week and partial protection for 4-8 weeks (depending on the type of vaccine). People have to follow the same precautions.

As mentioned earlier, being infected once gives protection only to 83 per cent of those getting infected and most likely only for six months after. Which means that one can get reinfected. Now this re-infection may be more dangerous, especially for those who have already compromised immunity.

(The writer is Vice Chairman and Managing Director , Asian Heart Institute, Mumbai. Views are personal)

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