Dear Friends,
I am a Sports Specialist with a vast experience in treating ALL types of patients. Moreover, I have been infected by Covid, and I am now in the post-Covid recovery stage.
Here is my analysis of post-Covid recovery based on my professional and personal experience. For my analysis of my personal Covid journey, please read my blog titled ["https://drbshow.blogspot.com/2020/10/walking-out-of-doors-of-death-story-of.html"]
1. Introduction
After symptomatic Coronavirus infection, the effects of viral damage result in a stage of long-term inflammation in the body and in one or more organs i.e. lungs, heart, liver, gall bladder and kidneys. This condition may continue for next 3-6 months. In this period, people are vulnerable to serious infections with bacteria, virus and fungus. Another severe infection soon after Covid can aggravate the existing autoimmune/other disorders like diabetes.
Everybody who got Covid must pay attention for next 6 months and watch for these Post-Covid effects. In most people, virus becomes inactive and not infectious to others (cannot spread) after 3 weeks. Some people may test positive even after 21 days. This is because RT-PCR is a very sensitive test and can detect the residual viral proteins and RNA bits for many days after infection. One should not worry about it and go ahead with normal life.
To know whether we are immune to virus or not, we must check SARS-CoV-2 antibodies after every 3-4 months for a couple of years. This will tell us how long we are going to have immunity against coronavirus.
There are two stages of damage to humans with coronavirus infection.
- Damage during Acute stage of infection (within 10 days; many people died in this stage all over the world)
- Damage to different organs of the body after 10 days (Post-Covid effects)
- What are the effects on the body after Covid-19 infection?
Lung damage: There are three popular groups of viruses that normally cause respiratory diseases like the common cold and complications like pneumonia (infection of the lung tissue).
- Influenza viruses
- Adenoviruses
- Coronaviruses
Now, there are more than 11 genotypes of Novel coronavirus and some of them are known to be very lethal to humans. Coronavirus causes severe damage to lung tissue and other organs also. It's damage to lung tissue is detected in a High-resolution CT scan (HRCT). Grading begins from ground-glass appearance to severe lung tissue damage.
2. What happens to the lungs and its function after corona infection?
Damaged lung tissue is repaired automatically by the body with fibrous tissue that is not elastic like original lung tissue. It cannot function (conduct gaseous exchange) properly. This will lead to permanent scarring in the lung, thus compromising lung function. This is a serious complication (Ex- 2 percent of my all lobes of lungs are damaged, as seen in HRCT)
Vo2 max (the ability of a person to extract maximum oxygen during work) is drastically diminished (40%)
Forced expiratory volume (FEV-measures how much air a person can exhale during a forced breath). Forced vital capacity (FVC - the total amount of air exhaled during whole breath). Both are reduced drastically during acute infection. These will recover very slowly. This is the reason why people feel fatigued very quickly.
Chronic cough: People may have a cough for many weeks. This is because of two reasons; firstly, the body thinks that there are viral products leftover in the lung and the body tries to throw out by coughing. Secondly, there are secretions for the same purpose, and these have to be expelled through cough. Cough can make people tired, exhausted, and sometimes interfere in gaseous exchange, thus reducing Oxygen saturation.
Fatigue and Post-viral Myalgia, Arthralgia: This is quite annoying with pain, stiffness in the joints, muscles, and weakness. It can remain for at least 4-6 weeks after Covid infection. Elderly and seriously ill people may find it very difficult to cope.
Indigestion is often observed in more than 65% of people. There are many medicines consumed by the person that hurt the gut; and the virus itself causes severe gastritis (infection of the stomach) and enteritis (infection of the intestines). With good dietary regime and discipline, one can recover faster.
Psychosomatic changes: Going through Covid (symptomatic) is quite traumatic. Some people may continue with anxiety, brain fog, sleep disturbances and unexplained behavioural changes for many weeks to months. Good recovery depends on good emotional status with happiness.
Secondary Infection: Post-Covid increases risk of infections. The aged, chronically ill, uncontrolled diabetics and people on long time steroids are likely to get secondary infection from common bacteria /fungus. They may require serious long term medical management.
Prolonged inflammation: It is a common observation that 90% of patients continue to have high CRP (C- Reactive protein), hs-CRP (specific C-Reactive protein), IL 6 (Sign of inflammation) and many of them have tested positive for typhoid. This is due to Covid infection. The table given below shows a person who recovered from serious Covid infection. Still, his values are raised so high, even after three months. This shows how one can open the doors for infection after complete recovery from Covid-19.
Test ESR CRP hs-CRP IL 6
First month 56 46 3 200
Second month 38 20 3 112
Third month. 21 8 2 20
3. How to cope with this situation?
Lung care
- Breathing Exercises: Breathing exercises have a tremendous role in lung recovery. Proper and regular breathing exercises help in good recovery and improve Vo2Max, FEV and FVC. Pranayama, Taichi, Yoga, Qigong and Shuang yang are fantastic breathing techniques where lungs and diaphragm are utilized in different formats. Good breathing exercises can reduce the irritation, cough, and can mobilise the secretions from lungs easily. They can be done at home, but better to do outdoors (on your terrace/balcony). These should never be done outdoors during rains. These should be continued for a long time after complete recovery also because the repairing process is an ongoing process in post Covid lungs.
- Vapour & Gargling: Vapour therapy that is steam inhalation is number two in the list. One must continue steam inhalation even after recovering completely, for at least for 8-12 weeks. This will help to prevent scarring and adhesions and allow for better expansion of the lungs. Warm water Gargling helps to shed the viral and bacterial residues in the throat.
Activity & Rest
- Rest & Sleep: People do not sleep adequately. Less than 7 hours of sleep can increase inflammatory chances and drastically interfere in recovery. Including mildly symptomatic people, everyone must sleep more than 7 hours a day for the next three months.
- Avoid Undue Exertion: This is a very important factor which people often neglect and land-up in trouble. After Covid, there is a drop of muscle strength, neuro-muscular coordination (in Elderly), and shortness of breath. All these reduce fitness and they need a couple of weeks to months to regain their original strength. I am experiencing similar things one month after getting infected. I am getting tired of moderate activities in my garden within a couple of minutes. Sudden undue exertion can cause metabolic acidosis because lungs are not able to pump Co2 effectively out of lungs. Young people may ignore this, and may land in serious trouble.
- Smoking and Alcohol and Emotional distress are equally dangerous and seriously jeopardize the recovery.
4. How to resume Activity and Sports?
One may gradually start activities, begin with low-intensity domestic work, short walks and gentle exercises. Do not indulge in sudden high-intensity exercises. These may cause sudden death irrespective of their age. Many fit players suffered serious heart problems in post-Covid period. There are guidelines for post-Covid professional players to get their cardiovascular system thoroughly checked. A very fit professional player can have sudden death during high intense activity after Covid infection. It is well documented that heart problems are not uncommon during sudden undue physical exertion, during Post Covid recovery period.
Active young people who want to participate in serious sports and exercise programmes must undergo thorough cardiac screening such as TMT, 2 echocardiogram and other biochemical tests advised by your doctor.
• People with Medical Diseases (Comorbidities). These are the high-risk group of people who can have serious complications after apparent recovery from Covid. Vascular & Respiratory damages that happened during active viral infection may last for a very long time. They must keep their blood sugars under strict control, get their BP under control, and they should be under proper medical supervision.
5. Dietary Habits & Immuno-Nutrition
The human body has two connections with the outside world, breathing and eating. There are some dietary habits and problems which are common among patients all over the world.
• Untimely food
• Non-staple food
• Wrong sources of food
• Wrong quantities of food
There is enough published literature to substantiate the importance of untimely food, resulting in obesity, acidity, and digestion problems. These untimely food habits lead to malabsorption and micronutrient deficiency in the long-run. Doctors somehow are more involved in finding the disease and treating them, but they could not influence the people with the right nutrition.
People blindly believe in quacks, personal opinions on google, Whatsapp, YouTube and other media on nutritional advises and make drastic changes in their food habits resulting in serious toll on their health.
We developed our food habits because of their availability and family habits over many decades. Eating food just because they are good for health and somebody told its good for us can be very dangerous. A regional and reasonable quantity of food is essential to maintain adequate immunity in the body.
In my experience, many people who became critical and succumbed to Covid-19 are either vegetarians (poor eaters with less protein) or people who changed their habits from non-vegetarian to vegans.
Wrong food sources like completely refined, marketing-hyped food (in India) such as Kenova (Quinoa), Chia seeds, Oats, excess poultry, and many more new things confuse the body's metabolism and lead to malabsorption.
Excess or poor quantities of food can disturb the body function. One must remember, any problem in nutrition will interfere in digestion, absorption and assimilation. Final outcome is micronutrient deficiency, which means diminished immunity. Eat your own native staple food.
• If you belong to South India, coastal areas, North-Eastern states, your basic cereal is Rice and Rice based products.
• If you belong to Northern and Western part of India, your cereal is Wheat, Jawar, other millets.
• Similarly, if you eat your own locally grown nuts, they do not interfere in your body chemistry.
• Eat on time, correct quantities, variety and taste of your choice. During post-Covid recovery time, pay attention to protein content, especially vegetarians. If you have a non-vegetarian habit, eat regularly & happily.
• Eat seasonal fruits in 2-3 servings and consume large quantities of well-cooked vegetables.
• Hydration: Drink adequate water and check your urine, whether pale yellow (normal) or crystal clear (Overhydration). Excess water can cause loss of sodium and more weakness—increase fluids in the form of buttermilk, coconut water and Orange juice.
6. Medical Supplements
After Covid infection, recovery and regeneration needs Vitamins and mineral supplements to boost the metabolism and restoration of bodily functions. You may take your personal doctor's help because you may already be on these. Don't buy from online stores, it's better to buy good pharmaceutical products.
My personal advice is to consume the following but with caution, if you have serious disorders like kidney and liver disorders.
• Vitamin D3 2000 IU daily for 2-3 months
• Vitamin B - complex with Zinc
• Cod-liver oil capsules 250 mg once or twice a day
I don't advise too much of vitamin C because it can cause acid reflux in many people. Ideally, you must have these after a good meal.
7. Getting Immunity to Coronavirus (Post-Covid status)
The novel coronavirus is completing 07 months (first case reported in Kerala in March) in India. The world is not clear whether one can get immunity forever after getting infected with the coronavirus like any other viruses. There are few controversial cases with recurrence of infection without clear evidence.
A vaccine is unknown, and I feel it will take a long time to reach the common man. After just 7 months, we cannot say whether we get immunity or not. Best thing is to get yourself checked for SARS-coV-2 antibody test every three months. This will help everyone assess the body's ability to get antibodies against the coronavirus and how long they last.
It is sure that very soon all of us are going to get infected. We may attain herd-immunity (80% of community gets infected; automatically others also get immunity.) But the problem is that many lives (aged, diseased, untreated) have to be sacrificed. Let's wait and watch.
There are a lot of problems in diagnosing Covid. Test like RT-PCR is accurate only in 70-80 %, which means a positive result is positive for disease, a negative result is not negative. Other tests are of no use. CT scans of the chest are ok to understand the severity. Hospitalization is a nightmare and VIPs like S P Balasubramaniam could not be saved.
8. Post-Covid Period
Your chances of getting other infections are high due to lowered immunity. You may think you are a free person, no need to wear mask because you have immunity. But you are forgetting that you can still get virus from others on your hands, body parts and things you carry like phone, keys etc. Your chances of getting coronavirus infection are low, but you can transmit from one person to another person by other means.
0 -12 weeks require serious attention (irrespective of age)
12 - 24 weeks require. Good lifestyle routine to get back to full action
Post Covid status is as serious as Active Covid disease. I have gone through this nightmare and hope this will benefit many people who are recovering from the disease.
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