COVID-19 which was considered a viral pneumonia when it was first detected eight months ago, is now a multi-systemic disease with many extra-pulmonary manifestations, warn experts and top doctors at the All India Institute of Medical Sciences (AIIMS). The medical experts added that involvement of other organs due to COVID-19 warrants that patients be closely followed up to check for any long lasting sequels, including reproductive health in young patients.
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“While pulmonary manifestation of COVID-19 is still dominant, we are now getting a significant number of patients who have other symptoms along with respiratory distress and those with no pulmonary manifestation,” said AIIMS director Randeep Guleria at the national Clinical Grand Round (CGR), organised by the Institute with the NITI Aayog to discuss the possible range of extra-pulmonary complications from COVID-19.
This, he added would mean that seemingly asymptomatic people could be showing symptoms not commonly associated with COVID. Dr Guleria stressed that doctors need to be trained about a widening range of symptoms and use a high index of suspicion while isolating, suspecting and treating any patient.
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The National CGRs include presentation of clinical cases by physicians directly involved in their management. Challenges faced in the management will be discussed by a panel of experts across the country and outside India. Each case discussion is followed by a short presentation on clinically relevant topics in managing COVID-19.
NITI Aayog member and a key member of the Centre’s COVID-control team V.K. Paul, said the world is learning about the virus and awareness is key to fighting it.
Speaking exclusively to The Hindu, Dr Paul said: “We are seeing patients coming in with symptoms other than those commonly associated with COVID. The most significant and life threatening symptoms of COVID that we are seeing and recording are clot formation which can affect the brain, limbs and other parts of the body, heart dysfunction and irregular heartbeat, auto-immune disorder and inflammation of the blood vessels. Physicians have been alerted to the fact that when a patient comes in with a stroke or sudden collapse, besides the regular suspects, COVID status of the patient also needs to be investigated.”
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He added that the virus travels through the tissue and affects various parts of the body adversely. “It is now understood that COVID-19 is not a localised disease,” said Dr. Paul.
“What started off as a viral pneumonia is now a multi-systemic disease,” explained Neeraj Nischal, Associate Professor, Department of Medicine with AIIMS in Delhi, adding that SARS CoV-2 has the potential to affect almost all organs, but whether it does so, is still a matter of debate.
“It could also be a case where COVID is just an innocent bystander with all these complications happening alongside. Till now we are grading the severity of the disease based on the lung and respiratory condition but now that we are seeing cases with life threatening involvement of other organs without any or [just] mild respiratory involvement, it is time to relook at the way we grade COVID severity,” Dr. Nischal said. He added that the attack on other organs by COVID warrants that these patients are closely followed up to see any long lasting impact including reproductive health in young patients.
Interactive map of confirmed coronavirus cases in India
Stating that COVID-19 continues to be a pulmonary disease in large majority (more than 90% cases) Ambuj Roy, cardiologist at AIIMS, Delhi confirmed that they are seeing patients with other symptoms also.
Head of the department of Respiratory Medicine, at HCMCT Manipal Hospitals Puneet Khanna said, “We now have enough empirical evidence that individuals infected with COVID-19 experience fever, cough and shortness of breath. These symptoms are primarily taken into consideration by physicians to prescribe COVID test.”
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However, he added that, in addition to these three symptoms, “the COVID-19 infected persons are likely to experience loose motions, nausea & vomiting or both, chest pain or even stroke, and loss of taste and smell. They may also have symptoms of uncontrolled diabetes or worsening of underlying kidney failure. Hence, it is advisable that if any of these symptoms appear, people should immediately consult a doctor and get tested. This will help in getting timely treatment and care, in case tested positive.”
Meanwhile, in an effort to address the dual morbidity of Tuberculosis and COVID-19, the government has now directed bi-directional TB-COVID screening and TB screening for influenza like illness/ Severe acute respiratory infections cases.
