Staying positive while taking good care of one's health is very important for those recovering from COVID-19


Different studies across the world have shown that some COVID-19 patients face some kind of problems in their regular activities even after recovering from the infection.

According to the World Health Organisation (WHO), whether the COVID-19 infected were hospitalised or not, some of them continue to experience symptoms, including fatigue, respiratory as well as neurological symptoms.

Sharing the definition of 'post- COVID-19 recovery' by British scientists, Dr Sher Bahadur Pun, a virologist at Sukraraj Tropical and Infectious Disease Hospital, Teku explained, "Post-COVID-19 recovery phase includes occurrence or continuation of different COVID-19 symptoms even after being discharged from hospital."

Dr Pun clarified that normally the period of around three weeks of COVID-19 infection are regarded as the phase of acute COVID-19. If it is prolonged for more than three weeks, then it is regarded as long COVID-19 or post-acute COVID-19.

Though there has been no study about post-COVID-19 recovery in Nepal as of now, virologist Dr Basu Dev Pandey, Professor of Molecular Epidemiology at Nagasaki University, Japan advises those who have recovered from COVID-19 not be negligent about his/her health.

Post-acute COVID-19 symptoms

As per Dr Pun, the symptoms of the post-acute COVID-19 phase vary widely. Such symptoms include cough, low-grade fever, fatigue, difficulty in breathing, muscle pains or weakness et cetera. But not all symptoms are seen in everyone.

Likewise, some people may face multiple health problems in different body parts - chest, lungs, and kidneys. The post-acute COVID-19 symptoms tend to disappear gradually after three months in some people, while they may disappear even before that in other cases.

"If any person recovering from COVID-19 is showing the aforementioned symptoms, we suggest they consult specialised doctors rather than virologists depending on the nature of their problems. The doctors will treat them and arrange the best possible remedies as they are the specialists for such problems, and we are just virologists," Dr Pun said.

The post-acute COVID-19 symptoms are mostly seen in COVID-19 patients who have recovered from severe illness, as observed by Dr Pandey. Such symptoms are mostly common in those patients who had required oxygen support for treatment, and needed to revisit the hospital within a few days' of their discharge among others.

However, he also clarified that the symptoms they show after being discharged from hospital are not symptoms of COVID-19. Rather they are the side-effects of medication given against COVID-19, which may have led to other health problems in the post-recovery phase, Dr Pandey said.

He explained, "The severely ill patients are given medicines for at least a month even after they are discharged from the hospital to maintain their oxygen level and to control the infection. Though the doses of medicines are reduced when their health starts improving, the side-effects are seen till the time they are on medication."

Usually, such patients are treated using medicines including steroids like dexamethasone, and heparin among others. He explained, "Steroids can have lots of side-effects when given to patients for long period. They may cause ulcers, gastritis, affect the liver, kidneys et cetera. They may cause diabetes in some people, increasing their blood sugar level."

He added, "Heparin may cause bleeding in the gums, develop blood clots, and affect the brain. Similarly, aspirin, used in the treatment of severe COVID-19 patients, thins the blood due to which it becomes difficult to stop bleeding if the patient gets injured."

Dr Pandey added, "We also give anti-fibrosis medicine to avoid shrinkage of lungs in case of severe COVID-19. Due to the use of such medicines, even those with the possibility of getting diabetes after five years can get immediate diabetes."

However, such problems are seen mostly in critically ill patients who have underlying health conditions.

Those without any prior health problems usually are not affected by such side-effects, according to Dr Pandey.

Some people tend to develop pneumonia after being infected with COVID-19. As per Dr Pandey, the lungs of such patients get inflamed even after recovering from both pneumonia and COVID-19 because of his/her body's reaction and infection. "Then lungs will get fibrosis and it can affect oxygen saturation for a long time, maybe for around six or more months," he cautioned.

Psychological effects

Along with the effects of medicine, those recovering from COV- ID-19 can also face psychological impacts. According to Dr Pun, some COVID-19-recovered people reach hospitals with complaints of fatigue, fear, loss of memory, high body temperature, et cetera.

"Such symptoms are psychological effects people tend to experience while recovering from COV- ID-19. The symptoms usually do not last longer than a week to three months," he shared.

Dr Pandey added that severely ill patients experience weakness, both physically and mentally. Their muscles get weak for around one month even after medication, he said and suggested family members and loved ones take proper care of the family member recovering from COVID-19 for their physical and mental well-being.

"They will have a stressful life even after recovery as people tend to stay away from them thinking they are COVID-19-infected. In such an environment, they might have anxiety and depression for around six months despite recovering from this viral disease. It is the longterm mental impact of COVID-19," Dr Pandey informed.

Chances of re-infection

Dr Pun admits that virologists in Nepal are not yet sure if symptoms similar to that of COVID-19 in the COVID-19-recovered people is re-infection or not.

Re-infection of COVID-19 means that the people who have recovered from COVID-19 show symptoms and difficulties similar to that of coronavirus again after recovery.

He observed that it is very rare that recovered COVID-19 patients are re-infected within three to five months of their recovery. That's because the COVID-19 antibody is expected to last three to five months, which reduces the chance of being re-infected, as per Dr Pun.

Sharing the findings of a study, he said, "A study from Denmark shows the rate of COVID-19 re-infection is very low, less than one per cent ."

And added, "In Nepal also, we have found very rare cases of re-infection."

So, what is the re-infection like? "Re-infected patients usually have symptoms like fever, tiredness, cough et cetera. But it is difficult to diagnose whether the symptom is of the earlier infection or a re-infection.

There is no uniform answer to this as all countries are studying COVID-19 according to the COV- ID-19 cases available in their countries.

In Nepal, we have been guessing the symptoms to be of COV- ID-19 if seen after three months of his/her recovery."

The chance of re-infection is higher in those COVID-19-recovered patients who had mild illness and were treated in home isolation - that's because they have low immunity and the capacity of the antibodies to fight the virus is also weak, as per Dr Pun.

However, since such patients don't take a lot of anti-COVID-19 medicines, they usually don't experience many side-effects of the medications, he explained.

People with COVID-19-induced pneumonia may also develop a chance of re-infection. However, if the immunity of the pneumonia patient is stronger, then there will be less chance of being infected with COVID-19 again immediately.

But since the variant keeps mutating, it can't be said that such virus won't attack the pneumonia patient again, he warned.

Take good care

Dr Pandey shared that physical effects like fatigue, weakness, muscle pain are temporary post- COVID-19 symptoms and they can be minimised by consuming homemade food rather than taking additional vitamins. When the body's immunity starts to work actively, such effects will disappear on their own.

Nonetheless, if anyone suspects s/he is experiencing COVID-19-like symptoms three months after recovering from COVID-19, Dr Pun suggests they consult the doctor who had treated him/her earlier.

If s/he has no difficulty due to the symptoms, he suggests such people go for a PCR test and stay in a well ventilated room in isolation for around 10 days.

"After 10 days of home isolation, the retest may come out positive - as the virus is in a passive state inside the body - even if you do not have the symptoms of COVID-19.

This is usually true in the case of people whose health condition is improving. So, what we say is if the condition gets better after staying in isolation for 10 days, it is not necessary to do a PCR test. The PCR test might come out positive as the virus is inside your body but in a passive state - the passive virus won't be transmitted. So, one can come out of isolation if his/her condition improves after 10 days. However, you need to continue checking your oxygen level," Dr Pun suggested.

Checking of oxygen level is important to address the problem of silent hypoxia - a condition where people might feel like they are fine but their oxygen level keeps on decreasing.

"This has been mostly seen in COVID-19-recovered patients who have taken steroids without consulting doctors," Dr Pandey shared, and added, "If a person's oxygen level drops below 90 per cent, s/he should be rushed to the hospital. Oxygen saturation and lung function are the two major things that matter in the post-recovery phase. Thus, one should consult a doctor in case of any problem in breathing."

In the case of patients with COV- ID-19 pneumonia, he said, "Lungs of pneumonia patients are weak. So s/he should stay in a well-ventilated room, do regular exercises, consult a physiotherapist to remove sputum, do exercise for lungs' hygiene, have a diet rich in protein, and have a proper environment for mental well-being after recovery. One should take proper care at least for a month," suggested Dr Pandey.

To help COVID-19 patients live a healthy life post-recovery, family members should support them with positive vibes, he added.

A version of this article appears in the print on May 30, 2021, of The Himalayan Times.