For recovered coronavirus patients, pain and anxiety are constant partners; doctors grapple with long-term impacts of disease

One recovered coronavirus patient, requesting anonymity, described it as being stuck in a humourless game of Snakes and Ladders.

Anu Prabhakar April 25, 2020 10:15:14 IST
For recovered coronavirus patients, pain and anxiety are constant partners; doctors grapple with long-term impacts of disease

Anand* has been unable to sit ever since he was discharged from a Delhi hospital last month after testing positive for coronavirus . The body pain is so bad that he has trouble sitting for more than a few minutes at a stretch. “I prefer walking around the house or lying down in bed. That's how I complete my college assignments,” said Anand, who is in the middle of finishing a MA programme at a university abroad.

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Representational image. Image by Andrés Dávila from Pixabay.

The second time we speak, however, he wonders whether the pain is psychological. “I don’t know but my friend, who also tested positive, said that he is feeling breathless. My doctor told me that the body will heal on its own but what if he’s saying that just to pacify me?”

This time round, Anand also appears to be a bit on edge. He has to turn in an assignment, which is making him ‘restless’. At one point, the 24-year-old despairingly talks about how his life was poised to take off when the crisis changed his life. “I was about to start my career,” he said. “But now everything has changed.”

Everything, including friendships. Anand recalls a conversation he had with a friend from university who also tested positive. “Before travelling to India, he’d borrowed a mask from me and I’d given him a fresh mask from the packet. When he tested positive, he asked me whether I had actually given him a used mask. Why would I do that?”

Understanding the long-term effects of coronavirus

‘Uncertainty’ is a word that crops up often in conversations with recovered patients. Uncertainty about life, the economy, jobs, yes, but also about the virus itself which healthcare workers all over the world are trying to decode and defeat. And now with reports of relapses, one patient, requesting anonymity, described it as being stuck in a humourless game of Snakes and Ladders.

Currently, only very limited data on the long-term effects of the virus on patients is available. “This is a brand new virus which we have known for less than four months so it would be presumptuous of anyone to say ‘I know what’s happening exactly,” said Dr Om Shrivastav, director, Infectious Diseases, Jaslok Hospital and Research Centre. “But you observe the patterns, devise a strategy and decide what you want to do in the case of COVID-19 patients.”

He explained that a few patients from around the world, post recovery, have complained of mild skin changes, a compromised sense of taste and smell, a burning sensation in the hands and feet and sometimes, something more severe like a headache.

“The infection involves every organ. Even mild diarrhea could linger for several weeks after they have been discharged.” It finally boils down to the patient’s immune response to a particular infection.

“If you have a balanced immune system, you will recover quickly…  by and large as long as you have the patients’ metabolism sorted out, most of their parameters will return to normal,” he added.

Dr Kirti Sabnis, Infectious Disease Specialist and HIV physician, Fortis Hospital, Mulund, added that she has noticed complaints of a persistent cough and muscle pain only among recovered patients who were once in a critical stage.

“Older patients with co-morbidities who were in a serious critical state could continue to experience tiredness, breathing difficulties or some lung damage which will stay up to 15 to 20 days after discharge. But after that, they will fully recover. Everyone else with strong immunity should make a full recovery,” she added.

Days and nights of anxiety

Akhil Ennamsetty, 24, is in the thick of things. He was recently in the news for co-founding an initiative to help students with questions about COVID-19 among other things and had also formed a WhatsApp group for COVID-19 patients while under isolation at the hospital.

He described how he struck up friendships with other patients as they all stood by their respective doors whenever their rooms were cleaned. “We spoke to each other through our hazmat suits,” he remembered.

Ennamsetty, who also studies abroad but is now in Warangal, said he opted to get tested at Gandhi Medical College and Hospital straight from the airport and later checked himself in when he tested positive for coronavirus .

“At the hospital, patients who were fine in the morning died at night right in front of me. It’s spine-chilling to think that they died from the same virus that you are trying to recover from,” he said.

Now, with new relapse cases, Ennamsetty said a few recovered patients have completely stopped taking calls. Anand, who has been inundated with concerned relatives’ calls, agreed that it gets irritating after a point. “They ask me how I am feeling, when I am not sure myself. A friend’s home quarantine period ended yesterday but he asked me whether he should stay in in case there is a relapse. My parents are extremely anxious too. They avoid the news, but a WhatsApp message is enough to leave them worried,” he added.

Anand also has some trouble sleeping well. “I don’t know whether it’s because I am yet to get used to Indian time, but I sleep at 3 am and wake up by 8 am. I am unable to sleep for more than five hours.”

Harish Kanjani, 55, faces a similar issue: “Just two days ago I woke up at 3 am and started feeling anxious. I felt breathless and wondered whether I have symptoms. I felt apprehensive about my health and how much damage the virus has done to my body. I chanted, walked around the house and thought of waking up my wife. But then I convinced myself that I am being ridiculous and went back to sleep. I called my doctor the next day and he assured me that since I have no symptoms I need not worry.”

The Mumbai-based real estate consultant recalls panicking for half an hour after receiving an email from the testing centre which confirmed that he tested positive for coronavirus . “My wife was right next to me, so I asked her to leave the room immediately and then spoke to her via phone about what to do next,” he said. Kanjani checked into SL Raheja Hospital soon after.

Kanjani was finally able to step out of his room last week but the crisis continues with his 86-year-old mother testing positive as well. “She is finally back home and is still under quarantine. She cannot bend because of knee issues so I can’t leave the food on a table outside,” he said. So as the only one cleared by doctors to enter her room (due to his antibodies), Kanjani enters her room, mask and gloves firmly in place, and helps her. “Then I dispose of the mask and gloves and take a wash. She is weak now as she was in the ICU for nearly 16 days. She had pneumonia, but her parameters got better and she recovered.” Yet, it is a challenging time.

Coping and moving on

Dr Anjali Chhabria, a psychiatrist who has been counseling COVID-19 patients from all over the world, pointed out that COVID-19 patients with preexisting anxiety and other mental health issues are trapped in a vicious circle with anxiety aggravating physical symptoms of the infection, which leads to more anxiety.

“But even otherwise, in coronavirus patients who have no psychiatric issues, anxiety and fear are at its peak because of the ambiguity. I know of people who have written their wills in the last month,” she said. “Patients tend to overthink and overanalyse. Some want to get tested even though they are okay, and begin to imagine that they are feeling feverish, constipated and so on.”

Kanjani, who has grappled with anxiety for years, said he pushed himself to remain positive and that during his own quarantine period at home, he prayed, meditated, did yoga, and played Housie online. “At the hospital, there was a lot of positivity around, everyone from the doctors, nurses to the housekeeping staff kept me motivated. But I got scared whenever my soundproof door opened as noises from the ward would pour in. I completely stopped reading the paper as I knew I will go into a spiral.”

Ennamsetty, who tested negative in the relapse tests, has coped by concentrating on college assignments. Anand, on the other hand, experiments with cooking and has returned to an old hobby: sketching. “I can do it comfortably while lying down and even used to do it at the hospital. It relaxes me,” he said. Like the rest of the world, he too watches Netflix, and motivational clips. “It’s an escape mechanism. But what else can you do when you are so helpless?”

“Right now everyone is very scared and worried,” he continued. “But hopefully one day, I will be able to look back at this time and have some stories to tell my grandchildren.”

 

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