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LETTER TO EDITOR
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 1797-1798  

Recovery from Covid-19 may be prolonged


1 Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India
2 Department of CFAR (Cytogenetics Unit), KG's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission04-Oct-2020
Date of Acceptance02-Dec-2020
Date of Web Publication29-Apr-2021

Correspondence Address:
Dr. Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_2052_20

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How to cite this article:
Gupta H, Kumar A, Gautam M, Nigam N. Recovery from Covid-19 may be prolonged. J Family Med Prim Care 2021;10:1797-8

How to cite this URL:
Gupta H, Kumar A, Gautam M, Nigam N. Recovery from Covid-19 may be prolonged. J Family Med Prim Care [serial online] 2021 [cited 2021 May 18];10:1797-8. Available from: https://www.jfmpc.com/text.asp?2021/10/4/1797/314916



Dear Editor,

Kumar et al. draw their inference from nationwide lockdown up to phase 2 as a response towards novel Coronavirus -2 epidemic in India in Sep 2020 issue of the Journal. They analyse various data of first 68 days of the pandemic related to number of (investigation confirmed) cases, doubling time, number of deaths & notifications issued by Government of India.[1] In Figure 5 the investigators depict that how much fraction of cases recovered at various points of time.

However now we're realising that a certain percentage of cases may have recovered virologically from the disease but they continue to remain symptomatic. Researchers from Israel emphasise that there is a need to conduct a study of long-term consequences of Covid-19.[2] Now we know that among various clinical features of the disease, some are caused by direct virological cell invasion & others are due to immunological responses mounted by patient's body. Hence when these patients are discharged, how many after-effects are there individually due to which mechanism/s, need to be assessed. Also when patients develop this highly infectious disease, they are separated from their family -members & cared by strangers (healthcare-workers in PPEs) in unfamiliar setting of isolation- rooms. Hence mental healthcare issues are arising for this group. Therefore whether it leads to psychiatric features requiring expert support, will be known only in times to come.

Recently British Medical Association sent a warning to its members that impact of long-term symptoms of Covid-19 may be profound on patients.[3] Researchers in Italy – which became an epicenter of the disease in early stages of the pandemic- followed up their patients who were hospitalized after discharge & directed them to fill a questionnaire defining their symptoms. What they discovered is that more than half (55%) of the patients continued to experience 3 or more symptoms, most frequently being fatigue, dyspnea, joint pain & chest pain.[4] Although Italian cohort was not matched for a control group & patients discharged after a bout of pneumonia are known to have some symptoms afterwards, there is a need to conduct a bigger study to know its any disproportionate increase in Covid-19 cases.

Also various clinicians are reporting cases of cardiac inflammation in covid-19 patients.[5] Patients with pre-existing illness (comorbidities) are likely to get destabilized soon. Follow-up cases of Hypertension, coronary heart disease & congestive heart failure are likely to deteriorate fast once they develop novel coronavirus infection as compared to general population. When cardiac cells die, enzymes contained in those cells are released –known as cardiac markers of injury & include high sensitivity Cardiac Troponin T. When patients are discharged on becoming asymptomatic, they are shown to be having inflammation in myocardium. What is its prognosis, we'll know only in future. Even asymptomatic patients are having this malady on cardiac MRI. As a few cases of sudden deaths are known during this pandemic in young adults, what is the contribution of cardiac inflammation there; is a dilemma, we are forced to face & seek answers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kumar D, Raina SK, Chauhan R, Kumar P, Sharma S. Drawing inference from nationwide lockdown as a response towards novel Coronavirus-19 (CoVID-19) epidemic in India. J Family Med Prim Care 2020;9:4507-11.  Back to cited text no. 1
  [Full text]  
2.
Yelin D, Wirtheim E, Vetter P, Kalil AC, Bruchfeld J, Runold M, et al. Long –term consequences of Covid-19: Researh needs. Lancet 2020;20:1115-7.  Back to cited text no. 2
    
3.
Rimmer A. Covid-19: Impact of long term symptoms will be profounds, warns BMA. BMJ 2020;370:m3218.  Back to cited text no. 3
    
4.
Carfi A, Bernabei R, Landi F. Persistent symptoms in patients after acute Covid-19. JAMA 2020;324:603-5.  Back to cited text no. 4
    
5.
Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: From basic mechanisms to clinical perspectives. Nat Rev Cardiol 2020;17:543-58.  Back to cited text no. 5
    




 

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