11 July,2021 04:38 AM IST | Mumbai | Jane Borges
Mumbai-based media professional and singer Suryasarathi Bhattacharya tested negative for COVID-19 two months ago, but doctors haven’t been able to accurately diagnose the reason for his partial hearing loss. Pic/Shadab Khan
As the wife of a doctor, the C word has, for a better part of the last one-and-a-half years, occupied Mumbai resident Khushnooma Kapadia's headspace. Despite the paranoia surrounding the pandemic, especially with her husband being in the thick of the COVID-19 fight, Kapadia had assumed that the worst had passed when cases started to drop earlier this year. But, the second wave hit the family like a storm.
On April 15, around 3 am, Kapadia remembers her 16-year-old daughter coming into her room, saying she was unwell. "Cold and shivery" already, she lost her sense of taste and smell by 8 that morning. The COVID-19 test, says Kapadia, was just a formality. Her health had only just started improving, when on April 23, their son Nivaan, 11, complained of uneasiness. By the following day, he started running a temperature, bordering on 102-103 F. The assumption was that he had caught the virus as well. "COVID fever has a cycle break after three to four days, so we presumed that it would start ebbing."
When it didn't, the Kapadias did a battery of blood tests, along with the RT-PCR. To everyone's surprise, he was found to be negative. By the fourth day, Nivaan woke up with no fever, except that now, he had a huge swelling on his neck. What made it worse was that he had developed a rash all over his body. "He was throwing up persistently and could not retain anything that he was consuming," remembers his mother. Another blood report to check his immunoglobulin g (IgG) levels revealed that his counts were 20 times higher than what was the acceptable range. "That's when everything took a volcanic turn. The doctors asked us to admit him to the hospital immediately."
Nivaan had developed multisystem inflammatory syndrome in children (MIS-C), a serious condition linked with COVID-19, where different parts of the body can get inflamed, including the heart, lungs, kidneys, brain, skin, eyes, and even gastrointestinal organs. "But, all the reports had been consistently showing him to be negative for the virus," recalls Kapadia, senior area director of marketing, South Asia, Marriott International. The family later learned that Nivaan had been affected by COVID-19 four weeks earlier, which had gone unnoticed since he had been asymptomatic. "It's quite likely that his sister contracted the infection from him," she adds.
He was hospitalised for nearly seven days at SRCC Children's Hospital in Worli, and administered intravenous immunoglobulin, a series of injections, blood thinners, steroids, and IV drip. Now back home, he is doing better than he was two months ago, his mum says.
Nivaan is among the many patients, who have had to seek medical attention for serious post-COVID-related health problems that they had not been diagnosed with, until getting infected with the virus.
A recent large-scale study by independent nonprofit FAIR Health, which tracked the health insurance records of nearly two million people in the United States, found that a month or more after getting COVID-19, almost 23 per cent patients had sought treatment for new conditions.
The most common conditions seen were pain, breathing difficulties, hyperlipidemia, malaise and fatigue, and hypertension. The other issues included intestinal symptoms, migraine, skin problems, heart abnormalities, sleep disorder, anxiety and depression. Incidentally, it wasn't just severely symptomatic patients who developed these complications. According to the study, around 19 per cent of those who were asymptomatic also suffered from what doctors are now describing as the post-COVID syndrome (PCS).
Closer home, health workers have been seeing a slew of such cases, where the complications are both perplexing and concern-worthy. Among the more devastating is mucormycosis, a rare fungal infection, which not only manifests in the lungs, but also the nose, from where it spreads to the eyes, causing potential blindness, or the brain, causing seizures.
Dr Khusrav Bajan, intensivist at PD Hinduja Hospital and member of the State Task Force, says that PCS is overarching. The symptoms can be divided into cardiac, pulmonary, neurological, musculoskeletal, and psychiatric disturbances. "These usually emerge after the active illness is over - so about 28 days after the patient tests
negative. Till date, we have no idea of how long these complications can last. Earlier, we said two or three months, but we have seen cases, where it has stretched for over a year as well."
In May, Dr Paritosh Baghel, consultant for internal medicine, SL Raheja Hospital, Fortis Associate, says one of the resident doctors he works with, developed postural orthostatic tachycardia syndrome (POTS), soon after recovering from COVID-19. Usually triggered by a slight change in posture, patients with this condition often experience abnormal or rapid increase in heartbeat of 120-130 per minutes [the normal heart beat rate is 60-100 per minute], drop in blood pressure, and dizziness, along with fatigue. "Many a times, this goes undetected in tests, which is why it is often misdiagnosed," says Dr Baghel, adding that POTS is commonly seen in people who have experienced moderate or severe COVID-19 symptoms. "The condition can linger for months, and can make it impossible for the person to go about his or her daily activities. It can also make the individual very nervous, as there's always this fear about the blood pressure dropping suddenly," he says. "My patient [the doctor] was utterly demoralised because of her symptoms. Everyone would tell her that she was imagining this [the symptoms], as all her reports were normal."
An overlapping yet different symptom was seen in State Task Force member and Director-Critical Care, Fortis Hospitals, Dr Rahul Pandit's patient Amol Puranik, who was diagnosed with chronic fatigue syndrome. Puranik, an architect, who was diagnosed with COVID-19 in April, was hospitalised for nearly a month, which included five days on ventilator. "Even after discharge, I was using an oxygen concentrator at home for a month. In the beginning, if I'd attempt to walk or even go to the washroom, my oxygen saturation levels would instantly drop to as low as 79. I was struggling with concentration too," he says. Puranik returned to work on July 1, but his recovery continues to be slow. He has been advised to take it one day at a time, with just basic daily exercise for now.
These cases, says Dr Baghel, were common in the first wave as well, but at the time, the awareness was low. With the doctors finally being able to put a finger on the problem, at least the treatment is heading in the right direction.
Like Kapadia's son Nivaan, 37-year-old PR professional Deepika Kolhi was also diagnosed with MIS.
Kohli contracted COVID-19 on April 13. "Though I was quarantining at home, I was briefly put on a very low dose of steroids, as my fever continued right into the tenth day." Soon after testing negative, she developed a fungal infection in her lungs that led to severe bouts of coughing. The initial anti-fungal medicines had reduced her ability to distinguish between certain colours, especially blue. Despite the change in medicines, she continued to have severe joint pain, which would randomly shift from one joint to another. "My doctor suspected it to be MIS, but also wanted to rule out arthritis, and suggested I see a rheumatologist," she says, adding that around the same time, she had redness in the eyes. Following a series of tests, the doctor confirmed the diagnosis. Kohli says that it's been about two weeks since she has been off medication. It took nearly two months for the condition to subside.
Dr Farah Ingale, director internal medicine, Fortis Hiranandani Hospital, says that MIS has become a common PCS in the second wave. "In the first wave we mostly saw the elderly getting affected. Even if younger people contracted it, the symptoms weren't persistent. But, in the second wave, a lot of middle-aged individuals contracted the disease, with many requiring extended hospitalisation and oxygenation, because of their deranged blood barometers and poor CT scan score," she says,
adding that the virulent strains could be the reason for the severity of the disease.
Incidentally, in the previous wave, MIS was mostly seen in children, says Dr Ingale. "Now, we are even seeing it in adults, and it's become a common feature of long COVID." She says that 70 per cent of COVID-19 patients are usually asymptomatic, but that doesn't mean, they should be ignoring any kind of symptom. "Often, the complications can emerge later. Today, you cannot take any symptom lightly. If you have fever, or are experiencing deliriousness, chest pain or palpitations [that can happen due to inflammation of heart or lungs], you should immediately visit a doctor," she adds.
For the last three months, Panjim-based Dr Jonathan Gouveia has been suffering from a rather, uncommon PCS. Dr Gouveia had mild COVID-19 symptoms in April. "I was home isolating, and didn't have fever, breathlessness or anything problematic. But towards the end of my COVID recovery period, I started to develop a burning sensation in my legs and feet. That continued to increase to the point that I wasn't able to put my feet on the ground, without it becoming unbearable. This was sometimes accompanied by a lightning pain that would shoot up my legs."
After contacting his neurologist and doing his own research, the physician was able to diagnose his condition as COVID-induced inflammatory neuropathy. "The inflammation, which COVID causes to the blood vessels that feed the nerve, stops the flow of blood, resulting in the condition."
Dr Gouveia has been taking medications for his neuropathy, but at least initially, it didn't have the "greatest effect". The condition would get severe in the evenings, and for the first month, he wasn't able to catch sleep at night. "Now, finally after three months, I am feeling much better. I still have the pain, but I can move around and get by the day."
Mumbai-based media professional and singer Suryasarathi Bhattacharya tested negative for COVID-19 two months ago, but doctors haven't yet been able to accurately diagnose the reason for his partial hearing loss.
Bhattacharya had briefly moved to Kolkata to be with his parents last year. In April, the entire family contracted the virus. While his father and mother recovered well, Bhattacharya, 31, who was the only caregiver at home, had been attending to them, despite being symptomatic. "At some point, I started experiencing slight disorientation and nausea, but I didn't pay much heed to it." It was only weeks later that he realised he couldn't hear clearly from his right ear. "Inadvertently, when someone would call me up, I'd place the phone on my left ear."
Bhattacharya visited an ENT specialist, and according to him, there wasn't a single audiometry test he didn't do. "Doctors couldn't find anything wrong, apart
from the fact that the hearing capacity in my right ear had marginally reduced."
Bhattacharya says the doctors have asked him to chew gum, and have given him relaxants for his nerves. They haven't yet ruled out the possibility of it being an after-effect of COVID. Because Bhattacharya is a singer, he says, the hearing loss has proved to be an impediment. "When it comes to picking up high scales, I am not sure, if it's coming out right. Music is such an integral part of my life, and nobody can assure me yet that this won't be permanent."
Dr Milind Navalakhe, ENT Consultant, Global Hospitals, Parel, admits to have received cases of hearing loss related to COVID-19. Unfortunately, they haven't
been able to figure out exactly why this happens.
One of his patients, Chandrakant Patil, who hails from a village in Jalgaon, was diagnosed with mucormycosis a few weeks after returning home from a local hospital, where he had received treatment, which included steroids, for COVID-19. "Within a few weeks, I started coughing up blood. Even as doctors, were figuring what had gone wrong, I couldn't see from my left eye." Patil was advised to go to Mumbai, where he was hospitalised for nearly a month. He was discharged on May 4. "Mucormycosis is quite an unpredictable disease," says Dr Navalakhe. "In Patil's case, the disease quickly escalated, and his pituitary gland also became involved, due to which he developed a thyroid issue," adds Dr Navlakhe, who managed to save his vision.
For the longest time, it was assumed that the unscrupulous use of steroids and distilled water used in the oxygen given to patients, were the main reasons for the sudden spike in cases of mucormycosis. Dr Bajan says that while it is one of the reasons, "good medical literature has proven that mucormycosis does not only happen because of steroid use alone." This makes it a legit PCS. "A recent study showed that 30 per cent people who developed the condition had not been given steroids. So, it can happen from COVID-19 alone too," he says. On the other hand, the recently reported cases of bone death or avascular necrosis, a condition that leads to death of the bone tissue due to lack of blood supply, says Dr Bajan, was caused mainly because of steroid use, alcoholism, or in children who have Sickle cell anemia. "It has nothing to do with COVID," he clarifies.
Erratic blood sugar levels post COVID-19 has also been a cause for concern for doctors. In April, Dr Manzer Altamash Shaikh, consultant obstetrician, gynaecologist and fertility specialist, Masina Hospital, witnessed a pernicious form of gestational diabetes in one of her patients.
Tanvi Patel had contracted COVID-19 in her seventh month of pregnancy. A few days into picking up the infection, her oxygen saturation levels dropped drastically. "On admission, we found that her sugar levels had unexpectedly shot up. This was strange, because she had been tested for gestational diabetes between the 24th and 28th week, and all her reports were normal. Her diabetes was induced by COVID. Her blood parameters were also showing some abnormality." Patel had to be put on insulin and blood thinners. "COVID-19 usually causes clotting inside the vessels, and in pregnancy, in particular, there's a risk of clotting in the placenta. We had to avoid all complications." Patel was hospitalised for over two weeks. Subsequent tests after returning home revealed that though negative, her blood parameters once again were showing abnormality. "At some point, we were able to take her off insulin and put her on a diabetic diet, but she continued to be thinners till she delivered her baby," says Dr Shaikh.
Patel says that the last two months of her pregnancy were quite stressful. "I didn't have any family history of diabetes, so it was worrisome. But, I was monitored at least three or four times for sugar, and it helped." After discharge too, she continued to take the sugar test at home, pricking herself twice a day. She is due for another test three weeks from now, and is hoping that all her parameters are back to normal.
Dr Bajan says that in PCS, people can develop diabetes, thyroid, or experience arthralgia (pain in joints) all of a sudden. "But the biggest concerns for us now are the lung complications, thrombotic episodes and embolisms [involving blood clots], and any intercurrent infection [a disease that intervenes during the course of another disease]. We are seeing patients who have recovered, but develop lung fibrosis within one or two months, and have to be hospitalised again. In many cases, it can be life-threatening and the patient can die."
He thinks what's needed is for doctors to follow a multi-pronged approach. "They need to have regular follow-ups every week or 15 days, depending on their condition. We can't forget the patient once discharged. We wouldn't want to lose a patient after they have fought such a long and tough battle."
23
Percentage of people in the US who sought treatment for new conditions a few months after catching COVID, according to a recent study by FAIR Health done via two million people's insurance records
