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Extreme fatigue persists even post-COVID-19 recovery

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With COVID-19, evidence is mounting that some people who have had relatively mild symptoms at home may also have a prolonged illness. It is estimated that nearly 75% of patients complain of prolonged signs and symptoms for weeks or months after making a full recovery (testing COVID negative).5 Long haulers, as they are being called, can experience mild to severe symptoms. Support groups on social networking sites have a lot of long-haulers, comprising COVID-19 survivors, who talk about and discuss the struggle to get out of bed, or to work for more than a few minutes or hours at a time, making this a real problem with COVID-19 survivors.

Overwhelming fatigue, palpitations, muscle aches, pins and needles and many more symptoms are being reported as after-effects of the virus. Over the past nine months, an increasing number of people have reported crippling exhaustion and malaise after having the virus.1 Professor Paul Garner2, of The Infectious Diseases Division at Liverpool School of Tropical Medicine, described his experience of COVID-19 as a roller coaster of ill health, extreme emotions, and utter exhaustion. A recent study published in Journal of American Medical Association found that in patients who had recovered from COVID-19, 87.4% reported persistence of at least 1 symptom, particularly fatigue and dyspnea.3 Post-viral fatigue was also seen in a quarter of those infected with the original severe acute respiratory syndrome (SARS) virus in Hong Kong in 20034 which makes it important to understand the post-COVID-19 fatigue. Evidence from previous coronavirus outbreaks, especially the SARS epidemic, suggests that these effects can last for years.1

A study3 from Rome with people post-COVID-19 recovery found that 53% had reported fatigue and 43% had shortness of breath an average of 2 months after their symptoms started. Similarly, a report6 from China showed that 25% had abnormal lung function after 3 months, and that 16% were still fatigued.

Speaking on the subject, eminent clinician and Past President of the Indian Medical Association, Dr. KK Aggarwal mentioned that while cytokine fatigue occurs in the first 9 days and continues up to 28 days, fatigue from COVID-19 is being seen to last for up to 3 months leading to signs of Chronic Fatigue Syndrome, which is a severely debilitating condition. He further added that this could start with the first signs and symptoms of COVID-19 or right after the patient recovers and could be due to prolonged exacerbation of symptoms after physical, cognitive or orthostatic exertion or stress e.g. unrefreshing sleep after sleeping for many hours. calculations, reasoning short memory, spatial disorientation are also some of the signs. Worsening of symptoms after maintaining an upright posture can also be seen in these patients. Details can be accessed on https://www.facebook.com/watch/?v=898525210554041 When it comes to treating chronic fatigue, the emphasis previously has been on effective treatment of the underlying disease, with the understanding that tackling the root cause would help ease the fatigue. However, for most viral infections, there is no specific treatment, and because COVID-19 is so new, research is still underway in its prevention and treatment.

Source:

1.Nature 2020;585, 339-41.
2.https://blogs.bmj.com/bmj/2020/05/05/paul-garner-people-who-have-a-more-protracted-illness-need-3.help-to-understand-and-cope-with-the-constantly-shifting-bizarre-symptoms/
4.JAMA. 2020;324(6):603-05.
5.Arch Intern Med. 2009;169(22):2142-2147.
6.https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/coronavirus-symptoms-why-7.breathlessness-and-fatigue-are-two-most-post-covid-common-symptoms/photostory/78632446.cms
8.EClinicalMedicine 2020;25, 100463.

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Coronavirus

Everyone can benefit from a probiotic

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Probiotics are live microorganisms that can be consumed through foods such as curd/yoghurt and through supplemental forms. Studies show that the balance or imbalance of bacteria in your digestive system is linked to overall health and disease and probiotics promote a healthy balance of gut bacteria. They are used in managing and treating a variety of disease states. They are live microorganisms that are known to help improve gut health and include benefits for weight loss, digestive health, immune function and more.

However, current research suggests that probiotic supplements may not benefit everyone and should not be prescribed as a one-size-fits-all supplement. However, when taken in moderation according to your clinician’s advice, probiotics have a plethora of benefits reported in literature. Recent researches point out that changes in the gut microbiota would lead to a systemic inflammation that in different ways would reach the CNS modulating inflammatory pathways and especially the microglia, which could influence responses to treatments. Probiotics have therefore shown antidepressant responses and anti-inflammatory effects.

Studies also show probiotics promote mental flexibility and alleviate stress in healthy older adults, along with causing changes in gut microbiota. The probiotics exert their beneficial effects through modulation of host immune responses, maintain gut homeostasis and produce interferon thereby suppressing the virus induced cytokine storm.

Studies have also shown probiotics could significantly decrease the serum levels of high-sensitivity C-reactive protein and interleukin-6 and increase the serum albumin levels, upper arm circumference, and triceps skinfold thickness in patients undergoing peritoneal dialysis. 

What’s more – Probiotics may potentially have a beneficial role in preventing COVID-19. A recent study quotes, “The efficacy of probiotics has been studied previously on several respiratory tract viral infections. Probiotics comprise living microbes that upon oral administration benefit human health by reshaping the composition of gut microbiota. The close kinship of the gastrointestinal and respiratory tract suggests why the dysfunction of one may incite illness in others. The emerging studies suggest the capability of probiotics to regulate immune responses in the respiratory system.”

However, some studies showed that bacterial overgrowth in the small intestine related to probiotic use can lead to bloating, gas, and other adverse side effects. Additionally, some studies show that probiotic treatment following a course of antibiotics may delay the natural reconstitution of normal gut bacteria.

Therefore, it is recommended that you get a health checkup done starting from consulting your family physician who will advise if you need probiotic supplementation or not.

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Fully vaccinated individuals have lower travel risk but can be carriers

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While the debate for vaccinations continues across the globe, there is good news for those who have gotten vaccinated. Vaccination reduces risk of infection about 15-20 days after the dosing is complete. According to the new guidelines issued by the Centre for Disease Control (CDC), US, it is okay to travel domestically if you are fully vaccinated. Which means, you have completed the two doses of the two-dose vaccines or one dose of the J&J vaccine. Or as the CDC puts it’s, “you’re considered fully vaccinated 2 weeks after you receive the last required dose of the COVID-19 vaccine”.

While the US has issued statements that fully vaccinated domestic travelers don’t need to be tested before or after traveling unless their destination requires it, in India the rules for entering different states by air need to be checked well in time because a lot of states mandate a negative RT-PCR test for entry requirements. The Ministry of Health and Family Welfare in India has issued guidelines for International Travel and so has the Ministry of Civil Aviation for domestic travel on 30th March 2021. The DGCA has stated that surveillance across the airports in India will now be increased to ensure all COVID-19 protection protocols are taken into account.

On 13th April 2021, the Indian Railways has also confirmed that in view of the COVID-19 pandemic and related hygiene issues, they have also stopped service of cooked food and replaced the same with Ready to Eat (RTE) meals in trains. In addition, they have ensured that the COVID-19 related protective items such as masks, sanitizers, gloves etc. and takeaway bedroll kits/items, are available for sale through Multi-Purpose Stalls at Stations.

However, as is recommended, even fully vaccinated travelers should still follow the recommendations for traveling safely, including wearing a mask over your nose and mouth, staying 6 feet away from others and avoiding crowds, washing your hands often or using hand sanitizer, self-monitoring for COVID-19 symptoms after traveling, and isolate and get tested if symptoms develop

It is still very important to stay cautious and avoid potential exposures to the coronavirus whenever possible during travel, mainly because vaccination drives are still ongoing, and it is not recommended to travel unguarded since a lot of COVID-19 patients remain asymptomatic and can continue to spread the virus to other unvaccinated people. Also, no vaccine is a 100% fail safe yet, so a very small fraction of fully vaccinated people may still be at risk because emerging variants of the virus add a measure of uncertainty.

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Real-world data shows 90% efficacy of Pfizer-BioNTech and Moderna COVID-19 vaccines

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Pfizer-BioNTech and ModernaCOVID-19 vaccines are messenger RNA (mRNA) vaccines but are not available in India yet. These COVID-19 vaccines have been shown to be effective in preventing symptomatic SARS-CoV-2 infection in randomized placebo-controlled Phase III trials.

A new study has shown that the Pfizer-BioNTech and Moderna-NIAID vaccines are effective at preventing infections in the real world. According to the CDC, the authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.

 This study has been published March 29 in Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention (CDC) in the USA. Study analysts have seen that the two-dose vaccine regimen was 90% effective at preventing infections 2 weeks after receiving the second dose.

This new study restores faith in the COVID-19 vaccines and has shown to be highly effective at preventing symptomatic and asymptomatic infections in real-world settings. As per the study results, this data is similar to those from earlier phase 3 clinical trials published in the journal New England Journal of Medicine, which found an efficacy of more than 90% for both the Pfizer-BioNTech and Moderna-NIAID vaccines. This is encouraging news for everyone across the globe because real-world effectiveness is often conservative and therefore, lower due to a number of factors.

Dr. James H. Conway, a pediatric infectious disease specialist at the University of Wisconsin-Madison, said what we really care about is a vaccine’s effectiveness — its real-world potential. He further added that such studies are not only proving how effective the vaccines can be for the studies and research data, but also show the true power of vaccines for real-world COVID-19 pandemic. Therefore, results published in the recent report from the CDC reassure that the vaccines are working as well as they are hoped to, in curbing the pandemic and in turn, stopping the spread of the virus.

Get vaccinated today!!

Read about the vaccination registration procedure here. For details about the type of vaccine and the dosing schedule, read here.

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Sputnik V submitted for DGCI approval for emergency use authorization

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On 13th April 2021, the Drug Controller General of India (DCGI) has approved the Sputnik V COVID-19 vaccine for emergency use.  After Covishield, developed by Oxford University-AstraZeneca and manufactured by the Serum Institute of India (SII), and Bharat Biotech’s Covaxin, this will be the third vaccine against the novel coronavirus that has been granted emergency use authorization in India.

India is the 60th country to approve Sputnik V—the rollout for which is likely to begin by end of April or early May.Currently, the Sputnik V will be imported before the local production kicks in. It is hoped that this emergency approval of Sputnik V will strengthen the government efforts to scale up vaccination, as India is battling the second wave of the pandemic with close to 1.4 lac cases reported on 12th April 2021.

India is also the leading production hub for Sputnik V, since its parent manufacturer company has reached agreements with the leading pharmaceutical companies in India such as Gland Pharma, Hetero Biopharma, Panacea Biotec, Stelis Biopharma, Virchow Biotech aimed at production of more than 850 million doses per year, sufficient to vaccinate more than 425 million people around the world.

The vaccine Sputnik V ranks second among coronavirus vaccines globally in terms of the number of approvals issued by government regulators and has an efficacy of 91.6%. It has shown encouraging results in protection against severe cases of COVID-19 as demonstrated by the data published in one of the leading medical journals The Lancet.

Sputnik V uses two different vectors (adenovirus 26 and adenovirus 5) for the two shots in a course of vaccination, providing immunity with a longer duration than vaccines using the same delivery mechanism for both shots.The safety, efficacy and lack of negative long-term effects of adenoviral vaccines have been proven by more than 250 clinical studies over two decades. There are no strong allergies caused by Sputnik V and with a storage temperature of 2-8 degrees Celsius, the vaccine can be stored in conventional refrigerators without the need to invest in additional cold-chain infrastructure.

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37 vaccinated doctors are Covid-19 positive at Delhi’s Sir Gangaram Hospital

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Delhi recorded 7,437 fresh COVID-19 cases on April 8 — the highest single-day surge this year – with 24 more people dying due to the coronavirus infection, taking the death toll to 11,157, according to the Delhi Health Department. In what makes the situation worse, at least 37 doctors of Delhi’s Sir Gangaram Hospital have tested positive for coronavirus, as per the hospital sources on Thursday, 08th April 2021. These doctors had received both doses of COVID-19 vaccination during the first phase of the vaccination drive that was launched on 16th January 2021, thereby cautioning vaccinated individuals to be as cautious as ever to prevent the COVID-19 infection.

The hospital sources have confirmed that a majority of the COVID-19 positive doctors currently have mild symptoms – out of which, 32 doctors are in home isolation and 5 are admitted in the hospital.

Sir Ganga Ram Hospital in New Delhi has been at the forefront of the war against the pandemic that has crippled normal life for more than a year now. Here’s wishing all Corona Warriors a speedy recovery from Health Patrol!

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