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Hospitals grapple with post-COVID admissions, plan to add dedicated ICUs

Eighteen-year-old Abdullah from New Delhi’s Chandni Chowk was suffering from breathlessness. He was rushed to Sir Gangaram Hospital after he became unconscious. While the reverse transcription-polymerase chain reaction (RT-PCR) test for Covid came negative, he was found to have unusually high antibodies. Doctors suspected post-Covid cardiac complication — myocarditis — and found his heart had started to pack up.

Long Covid has been described as a range of symptoms such as fatigue, headache, loss of smell, dizziness, chest pain, fever, depression that Covid-19 pat­ients may experience up to 12 weeks after recovery. Doctors also say symptoms such as palpitations and exercise intolerance can persist after an acute case of Covid in 35-87 per cent of patients. Many may complain of a quicker heartbeat or low blood pressure, but heart failure is rare.

“It is rare that a Covid infection can also directly affect the heart, causing inflammation of the cardiac tissues. It is a life-threatening complication that needs urgent attention,” says Ashwani Mehta, senior consultant, cardiology, Sir Gangaram Hospital.

While Abdullah, after receiving a few days of treatment, is now recovering at home, doctors say post-Covid patients — especially younger people —have been more acutely ill during the second wave, compared to the first.

Hospitals across the country say a bulk of the admissions now are patients suffering from post-Covid complications. There are two categories of patients – some who are already hospitalised with severe Covid and then go on to test negative on RT-PCR but develop other complications, and there are many who have been managed at home or in smaller nursing homes and are now seeking admissions in tertiary-care hospitals with post-Covid complications.

“I am getting referrals daily from smaller hospitals,” says the administrator of a leading hospital in Mumbai.

He says smaller medical establishments are not able to manage post-Covid complications. Thus, the demand for admission in tertiary-care is on the rise.

Covid occupancies are steadily on the decline. Hinduja Hospital in Mumbai says its Covid-dedicated beds have 30 per cent occupancy, while non-Covid beds have 72 per cent occupancy.

Harish Chafle, consultant intensivist and chest physician, Global Hospitals, Mumbai, says, “We have more post-Covid cases now than positive ones. Around 50 per cent admissions are patients with post-Covid complications.”

Hospitals are planning to have dedicated intensive care units (ICUs) for post-Covid patients now.

Rahul Pandit, director, critical care, Fortis Hospitals, Mulund in Mumbai, says he is considering starting a separate ICU, with at least 10-12 beds for such patients where monitoring can be standardised.

Are post-Covid complications more in the second wave?

Doctors concur. A higher number of Covid cases would naturally lead to a higher number of post-Covid complications. Chetan Rao Vaddepally, consultant pulmonologist, Yashoda Hospitals, Hyderabad, explains: “Due to shortage of beds, many patients were treated at home. At home, the infection management protocols are not stringent.” Moreover, many patients were put on immunomodulating medication this time around – like steroids, monoclonal antibodies etc – which eventually led to secondary infections in some.

A Max Healthcare spokesperson says while every patient needs to be evaluated independently, many were following one-size-fits-all prescription for the entire household. “People were not following the doctor’s advice and were self-medicating. That worsened the post-Covid complications.”

In mild cases, weakness, fatigue, headache, loss of taste, depression, and anxiety are common. Those who were on external support for long have residual lung infection, often leading to breathlessness. Many with mild disease complain of persistent low-grade fever, recurrent chest infection, and urinary tract infection.

Doctors are also seeing cardiac events, pulmonary embolism, besides a surge in other serious fungal infections like mucormycosis and uncontrolled diabetes.

Vaddepally says he has seen some cases of tuberculosis in patients who have recovered from Covid.

“It can affect any organ. This wave has been devastating. Almost 70 per cent of outpatients are those with post-Covid symptoms,” says Dr Manoj Goel, director, pulmonology, Fortis Memorial Research Institute.

Many patients who did not receive hospital care are also among those facing lung or tissue damage.

“The Delta variant also seems more virulent, showing a much more severe immune response,” adds Goel.

While post-Covid patients are contributing to the footfall, there is also a pick-up in non-Covid treatment. Though it is yet to reach pre-Covid levels, hospitals such as Max Healthcare are seeing foreign patients from Africa and West Asian countries coming to India to treat cancer, and cardiac, neuro, and spine ailments, as well as organ transplants.

Non-Covid demand is picking up more in places where the Covid cases are down.

“Patients have delayed their surgeries, but the situation is better than it was during the first wave. We have increased medical ICU beds to take care of the needs of a large number of post-Covid and non-Covid patients,” says Anil Vinayak, group chief operating officer, Fortis Healthcare. Business Standard