Five months after recovering from COVID-19, 72-year-old Mohammad Ashraf Andrabi still coughs profusely, his throat seems parched. There are moments when the veins in his neck tighten and a sharp pain runs through his chest and throat as he runs short of breath.
The former school teacher and his entire family had tested positive for the virus in September last year. He had mild fever, restlessness, and fatigue; but also comorbidities diabetes and hypertension — making him vulnerable to succumbing to the disease.
The family of five was admitted to the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Srinagar’s Bemina for treatment that stretched over a period of one month. During this, his oxygen saturation levels couldn’t be maintained without an oxygen concentrator machine.
Even as Andrabi has recovered from COVID-19, he still needs an oxygen concentrator to recover from the frequent bouts of painful breathlessness. “I require the machine after coming back from the washroom or even after walking a few steps in my room,” he said.
Given his dependency, he borrowed an oxygen concentrator — from Athrout, a Srinagar-based non-profit — which he keeps close to his bed for emergency use and takes along to the hospital when he goes for checkups.
Andrabi consults a doctor every week since he was discharged from SKIMS in October. He was put on medication for the deteriorating condition of his lungs. “I feel like I only have skin on my ribs and there were no organs inside of my chest,” he said. “This scared me.”
He has been on medication for about six months now. “The doctor has told me that I will be fine within a few weeks but I believe that my lungs are no longer the same,” he added.
Andrabi, however, isn’t the only patient to recover from COVID-19 but not its long-term effects, particularly on the lungs.
Studies conducted by doctors at Srinagar’s Government Chest Diseases Hospital (CDH), the largest COVID-19 care centre in Kashmir, reveal that nearly half of COVID-19 survivors monitored during research showed residual lung abnormalities three months after recovery.
Even asymptomatic patients
The doctors at the CDH have been studying x-ray images of COVID-19 infected individuals ever since March 2020, when Jammu and Kashmir reported the first case of the infection.
In July 2020, doctors began studying asymptomatic patients with an aim to formulate strategies to prevent the spread of the disease through asymptomatic patients, which could have otherwise gone unnoticed. The study was published in the British Journal of Radiology with the title “Clinico-radiological course in coronavirus disease-19 (COVID-19) patients who are asymptomatic at admission”.
The research focussed on the clinicoradiological course, correlating clinical symptoms with radiological findings, in 137 asymptomatic individuals to monitor any lung abnormalities in order to understand clinical trajectory and build an in-depth knowledge about asymptomatic patients, said Arshad Hussain Parry, consultant radiologist at Department of Radiodiagnosis, SKIMS and the study’s co-author.
Of the 85 males and 52 females, all with a history of travel to high risk zones and all the patients were asymptomatic at the time of admission, said Parry, “nearly one-half or 44 percent had abnormalities in their lungs on chest CT scan at admission and rest 56 percent had a normal or negative CT at admission.”
During the study, the specific clinical information, laboratory test results and CT scans done during the initial period as well as those done during the hospital stay of patients were studied and analyzed. The researchers found that one-fourth of the patients among the CT negative group presented clinical symptoms whereas the rest didn’t develop any symptoms at all throughout their hospital stay. “During the course of hospital stay 71 percent showed resolution of lung abnormalities in a span of one month and the rest percent still had lung abnormalities,” Parry said. He added that older individuals with underlying comorbidities like diabetes and chronic obstructive pulmonary disease took a long time to recover.
According to the study, Parry said that asymptomatic patients were found to be one of the reasons for the surge in the number of COVID-19 cases as they “act as a hidden source of infection in the community”.
When COVID-19 arrived similar measures were put in place as those used in controlling the SARS outbreak but the authorities were unsuccessful in curbing the COVID-19 pandemic, said Parry. “What went wrong this time?,” he asked, and answered his question: “The answer lies in the inherent differences between the two viruses.”
SARS virus mainly affects the lower respiratory tract and replicates there due to which most of the affected individuals were symptomatic, easily detected and isolated which led to a halt in the chain of transmission, said Parry. “Unlike SARS virus, COVID-19 virus replicates in both upper and lower respiratory tract and thus a sizable chunk of patients are asymptomatic, hence escape detection,” he added.
As per the research, the clinicoradiological course of these asymptomatic cases is variable. While some patients recover without developing symptoms, some show few mild symptoms and others deteriorate.
Cause for lung abnormalities
Another study published by the Egyptian journal of radiology and nuclear medicine studied recovered COVID-19 patients to assess the “potential predictors of persistent lung changes” was conducted in February this year. “We tried to detect what proportion of survivors had complete clearance of lung abnormalities and what percentage of patients had residual lung abnormalities after three months,” said Parry, also a co-author in this study.
During the study, RT-PCR confirmed COVID-19 patients were enrolled who had undergone chest CT during the initial or active phase of their illness and at least one follow-up CT with a gap of at least three months between the two scans. Of 81 patients studied, only 56.8 percent demonstrated complete resolution of lung findings and the remaining 43.2 percent had residual lung opacities on the follow-up CT.
“Older age, obesity, presence of preexisting comorbidity, longer duration of hospital stay, ICU admission, a higher initial CT severity score, and a lower rate of steroid administration are associated with more prevalence of residual lung abnormalities in COVID-19 survivors,” the study found.
Parry said: “The commonest symptoms reported by these patients were fatigue, chest discomfort or pain, breathlessness and joint pains.”
The preliminary findings according to the research suggest that lung damage caused by COVID-19 does not completely resolve in all the survivors of COVID-19 and in some, the initial insult to lungs progresses into lung fibrosis – permanent scarring of lungs. “Lung fibrosis is an irreversible damage to lungs. This impairs the function of lungs and can be nightmarish to these people,” he said.
The patients recovering from COVID-19 must follow with the concerned hospital in order to diagnose any residual abnormalities, said Parry. “ Patients must watch out for any residual symptoms after discharge and seek proper attention,” he said.
Parry added that a patient with severe persistent symptoms must immediately seek medical help to “keep serious consequences at bay.”
New year, new strain
The first case of COVID-19 viral infection was traced in J-K’s summer capital, Srinagar on 18 March last year when a woman from Khanyar area of Downtown tested positive with an international travel history.
As the news of the first COVID-19 case spread across Kashmir, the situation became chaotic, keeping panicked people indoors after the region was immediately placed under a lockdown. The administration ordered a shutdown of schools, colleges, offices, markets, religious places and public transport. However, the lockdown was eased in recent months.
The total number of cases recorded in J-K reached 126772 on Thursday as 79 fresh cases were detected. Out of these, 883 cases are currently active while 123930 have recovered. The death toll across J-K has reached to 1959; 725 in Jammu division and 1234 in Kashmir division.
Naveed Nazir Shah, professor and HOD Chest Medicine at Government Medical College Srinagar, recently warned that there are indications of a second wave of COVID-19 and urged people to be cautious and take vaccines, if given an opportunity as people have become more lenient toward following the Standard Operating Protocols (SOPs) since Kashmir valley is witnessing a sharp decrease in daily cases.
The vaccination process against the deadly COVID-19 virus was kickstarted on 16 January this year. The first two phases involved vaccination drive of healthcare workers and frontline workers. “70 percent healthcare workers got vaccinated during the first phase and 65 percent frontline workers got vaccinated till now,” said Qazi Haroon, State Immunization Officer.
The third phase was started from 1 March in which people above the age group of fifty and people below the age group of fifty with any comorbidities will be vaccinated.
The number of infections might be lesser in the second wave owing to the fact that some people already have attained a certain amount of protective immunity due to prior infection or vaccination, said Parry, consultant radiologist at Department of Radiodiagnosis, SKIMS and the study’s co-author.
“However, we should not be deluded into thinking that the severity or mortality among the infected people could be lesser. The only thing that can delay or perhaps prevent the onset of the second wave would be a robust mass vaccination of the community,” he said.
Parry said that the use of a mask, physical distancing, proper hand hygiene and respiratory etiquettes hold the key in preventing the spread of disease. “Additionally, mass vaccination could prove a major boon in attaining a level of herd immunity that would halt the march of this virus,” he added.