When Dr Suranjit Chatterjee, 55, thought of returning to work after recovering from the coronavirus disease (Covid-19), he realised that he could not walk even small distances without his heart rate increasing.He had to be readmitted in hospital for an echocardiogram to check his heart health.

Chatterjee has a family history of heart disease, but did not have a pre-existing condition. He had borderline diabetes and hypertension.

“The echo was okay, but a cardiac MRI revealed that I had developed myocarditis (inflammation of the heart muscles),” said Dr Chatterjee, who has now recovered and has gone back to Covid-19 duty. He is a senior consultant of internal medicine at Indraprastha Apollo hospital.

He says he is not alone. Some of his recovered Covid-19 patients have come back to the hospital emergency ward with complaints of variable heart rates, breathlessness and chest pain.

“After recovering from Covid-19, some of the patients come in with reduced heart function and heart attack or even stroke. This could be owing to the damage to the small vessels caused by Covid-19 that leads to excessive clotting during the course of the disease,” said Dr Yatin Mehta, critical care specialist at Medanta Hospital, .

Covid-19 is known to attack the endothelial cells that line the blood vessels, leading to clotting across the body.

“Now that the disease has been in the country for five months, we need to start looking at post-Covid rehabilitation. After the acute phase of Covid-19 is over, patients come back to hospitals with symptoms such as lethargy, body aches and itchy throats even four to six weeks later. Some even get heart attacks or strokes, although a scientific link on Covid-19 causing it is yet to be established. Patients also have psychiatric disorders like anxiety and depression,” said Dr Chatterjee.

Tiredness, lethargy, loss of weight, and psychiatric issues because of remaining in isolation at hospitals have been reported from the All India Institute of Medical Sciences (AIIMS) as well, said Dr Anjan Trikha, professor of critical care at the hospital.

Dr Chatterjee said doctors should look out for neurological symptoms such asthe guillane barre syndrome wherein the body’s immune system attacks the nerves, leading to weakness and tingling in the extremities. Reports of the syndrome being linked to Covid-119 have come from Italy, China and Austria.

Lung disease

Doctors from hospitals across the city have reported patients who have recovered from coronavirus disease (Covid-19) coming back to the hospitals with low oxygen saturation and secondary infections.

A recovered Covid-19 patient in his mid-fifties had to be rushed back with low oxygen saturation to the emergency department of Max hospital, Saket a day after his discharge. “The patient had been admitted to the hospital for almost 20 days and had been discharged after he was doing well and all his symptoms had been resolved. Yet, just a day after he had been discharged he was brought back to the hospital emergency with respiratory failure and died. Since his symptoms were the same as Covid-19, we got him tested again, but the report was negative,” said Dr Sandeep Jain, head of the department of emergency medicine at Max Super Speciality hospital.

He has seen about 1 to 2% of the Covid-19 patients treated at the hospital returning back after being discharged. “The recovered patients come back to the hospital emergency with a whole spectrum of lung diseases – from fibrosis (formation of hard fibrous tissues as the lung heals from an injury) to secondary infections and pneumonia. This is more likely in patients who have had severe symptoms of Covid-19 and needed either ventilator support or non-invasive ventilation like Bipap,” he said.

The most common sequelae – or a condition caused by another disease — that doctors have seen in patients who have recovered from severe symptoms of Covid-19 is residual lung fibrosis, wherein the lung capacity decreases as the lung tissues harden after healing from an injury.

“Residual lung fibrosis is not restricted to Covid-19 and has been seen in other viral infections as well. This is something we have found in our patients too resulting in inadequate oxygenation. Various drugs are being tried – like a longer course of steroid or anti-fibrosis drugs but nothing is definitive. There is a need for pulmonary rehabilitation in such patients. Usually the fibrosis caused by other disease improves over time but Covid-19 is a very new disease and we do not know what will happen,” said Dr Trikha.

His team is trying to analyse CT scans of patients taken six weeks after discharge to assess the extent of fibrosis.

Secondary infection

Again, a direct link hasn’t been established, but doctors have seen recovered Covid-19 patients return back with secondary infections.

“The patients with moderate to severe symptoms of Covid-19 infection are administered steroids and sometimes medicines like Tocilizumab – both of which can suppress the immune system leading to secondary infections. Sometimes patients come out of the ICU {intensive care unit} and then deteriorate because of an infection,” said Mehta.

As in the case of measles, Covid-19 may weaken immunity and result in reactivation of dormant infections such as tuberculosis, said Dr PS Narang, associate director of paediatrics at Max hospital, Shalimar Bagh.