By Shaurya Kshatri
Kathmandu, July 7: Indira Shrestha, a 36-year-old mother of two, returned home triumphant over the worst that COVID-19 had inflicted on her health. After 41 days of constant battle with the severe effects of COVID pneumonia, her family members were ecstatic to finally wheel her out of the hospital on June 27.
But, just a few weeks ago, slumped in her ICU bed, a frailer Indira wasn’t certain of her fate. Neither were her doctors. Every day, her Complete Blood Count (CBC) report revealed distressing news of her deteriorating health. “Doctors had warned us to prepare for the worst,” reflects Jabhi Lal Shrestha, Indira’s younger brother, who kept a constant vigil on his ailing sister. “Sometimes it did feel hopeless, but I was sure that she (Indira) would eventually pull through,” he says. While she did pull through, the road to recovery has been a long and arduous one.
“Indira Ji’s oxygen saturation was sharply declining. She had a high respiratory rate, above 35 breaths per minute” explains Dr. Pradeep Tiwari, Critical Care Physician at Civil Service Hospital. The virus had invaded the lungs, resulting in COVID pneumonia. Her CT scan severity score was 23 out of 25. Both her lungs were severely damaged.
“We had to keep her in the noninvasive ventilation -- bipap,” informs Dr. Tiwari. But bipap masks are notorious for causing discomfort. She wore the tight-fitting mask for two weeks and even to this day, Indira still bears the signs of deep skin wounds on her face -- her battle scars.
“While Indira doesn’t need high-flow oxygen anymore, she
still has a long way to go in terms of full recovery,” stresses Dr. Tiwari. According to him, being stable enough to leave the hospital does not mean that the patient is well enough to resume her normal life.
Largely overlooked in the coverage of the devastation caused by the coronavirus is the fact that leaving the hospital is far from the end of the story.
Several critical care doctors like Dr. Tiwari strictly recommend patients and their caregivers to purchase oxygen concentrators to keep at home.
“We do not know for how long they will require oxygen. Some do not need it after a month, but others have to take it for over three months,” informs Dr. Parshuram Ghimire, General Physician at Himal Hospital.
Mostly, patients who develop lung fibrosis have to take extra care after returning home, as per Dr. Ghimire. Pulmonary fibrosis causes lung scars, which makes it harder for patients to breathe.
Virologist Dr. Sher Bahadur Pun has often seen fibrosis among patients who have had to spend a considerable amount of time in the ICU.
Sheela Kshatri, 56, a recently discharged COVID pneumonia patient was also diagnosed with lung fibrosis. Like many patients who develop fibrosis, she feels short of breath even after walking a few paces. However, Kshatri has been routinely carrying out breathing exercises, which have significantly improved her oxygen level and heartbeat.
“There is no cure for fibrosis or a compromised lung apart from regular exercise,” explains Dr. Tiwari. For three times every day, Kshatri uses a spirometre to improve her breathing and lung capacity.
Furthermore, doctors have also observed irregular heart rates in several post-COVID cases. “The pulse rate usually remains above 100 beats per minute and can spike to more than 130 during activity. It is important to not drain oneself. Resting and mild exercise will gradually normalise the heart rate,” says Dr. Pun.
So how long does it take for long COVID patients to return to their normal healthy selves?
Health experts don’t have a concrete answer. It might take a month or two or even more. But no matter how long it takes, the key is to gradually reduce supplemental oxygen dependency and progressively increase breathing exercises.