BENGALURU: Instead of patients with post-Covid complications landing up at the post-Covid clinic of Rajiv Gandhi Institute of Chest Diseases (RGICD), those who were discharged prematurely from smaller private hospitals, and on whom steroids were arbitrarily used, are turning up.
No repeat test is done prior to discharge, so many patients in smaller hospitals are discharged early and given oxygen at home. They turn breathless and develop fever and sepsis (secondary infection) at home. Around 15 per cent of the patients were still positive when they arrived at the post-Covid clinic at RGICD.
“Smaller hospitals do not follow guidelines, and don’t use steroids judiciously. This is not the case with tertiary care hospitals. While these have to be administered after day 7, some private hospitals give it in the initial days, hoping the disease will not progress. This leads to more complications like sepsis,” said Dr C Nagaraj, director of RGICD.
He informed that both premature discharge and overuse of steroids lead to multi-organ failure (with kidney and liver involvement) caused by sepsis or respiratory failure. These have been the leading cause of death among a majority of the 15 patients at the post-Covid centre. There were 17 post-Covid cases here in the first wave, but none of them succumbed to the infection. During the second wave, 62 cases reached the centre, with 15 fatalities.
Post-Covid complications happen 6-8 weeks after complete cure, with stable clinical parameters. These include air leak syndrome, where patients suffer chest pain, and air collection between the lung and pleura. This is a medical emergency, where the person has to be put on the tube, failing which they die. Those who suffer a stroke are referred to NIMHANS, and those who have cardiac complications are referred to Jayadeva Hospital. Other post-Covid complications include respiratory failure, underlying interstitial lung disease, or chronic obstructive pulmonary disease, which require non-invasive ventilation.
“The take-home message is that hospitals must not discharge patients early, as this prolongs the existing disease, nor must they give steroids irrationally. In addition, a monthly follow-up of Covid patients must be done,” he added.
CASE DATA AT RGICD
* 17 post-Covid cases in the first wave, none died
* 62 cases in second wave, 15 died
* Majority of the cases were men, 27% women
* 73% of cases were under 60 years old
* 70% had comorbidities, the most common being diabetes, followed by hypertension
* Around 15% of patients were still positive when they reached clinic
* 470 cases came to OPD, of which 16.80% were admitted, remaining sent home with advice
* 25%-30% had psychological symptoms, fatigue, weakness
* 8%-10% had actual post-Covid symptoms