LONG TERM COMPLICATIONS OF CORONA

“It is a merry go round of symptoms and severities, with each new day offering many unknowns”

After recovery, the difficulty is sorting out long-term consequences. Because Covid-19 is a new disease, there are very few studies about its long-term trajectory. The new studies give us a glimpse of what may be in store for patients who battle moderate-to-severe cases of COVID-19. Doctors say that novel coronavirus can attach to human cells in many parts of the body and penetrate many major organs, including the heart, kidneys, brain, and even blood vessels that may lead to lung scarring, heart damage, and neurological and mental health effects. It will take time to finally understand how COVID-19 impacts health in the long run, but till now here are the findings:

Lung scarring: When the body is exposed to COVID-19, it mounts an excessive inflammatory immune response that it could harm the critical organs of the body such as lungs. The body tries to heal itself and this healing process itself can lead to irreversible scarring to the lung (lung fibrosis). This can dampen the lung capacity and can also lead to SOB, burning in the lungs and a dry cough. During infection, the spaces in the lungs get filled with debris and pus, making your lungs less pliable. CT scans show Covid-19 patients’ lungs frequently have lighter grey patches, called “ground-glass opacities” — which may not heal and cause permanents damage. The pulmonary function never goes back to baseline. 

Stroke, embolisms, and blood clotting: Many patients diagnosed and hospitalized for Covid-19 are experiencing unexpectedly high rates of blood clots, likely due to inflammatory responses. These blood clots can cause blocks in blood vessels to the brain (stroke), lung blockages (pulmonary embolism) and heart attacks. Studies suggest that between 23 and 30% of people with severe Covid-19 are having pulmonary embolisms.

Heart damage: Being critically ill, with low oxygen levels, puts additional stress on the heart. But these viral particles might also be specifically inflaming the heart muscle. The heart has many ACE2 receptors may act as an entry point for the SARS-CoV-2 virus inflaming the heart muscle according to a study, about 20% of the total patients with COVID-19 in China had heart damage during hospitalization and another study found out that about 16% of patients developed arrhythmia. According to the American College of Cardiology, there were also cases of acute onset heart failure, heart attack and cardiac arrest after the coronavirus infection.

Kidneys: According to the International Society of Nephrology, about 20-50% infected with Covid-19 showed abnormalities in the kidney. Though there is no such evidence of whether coronavirus affects kidneys or not, such cases could be worrisome.

Neurocognitive and mental health impacts:  Covid-19 also seems to affect the central nervous system, with potentially long-lasting consequences. Long-term complications could include decreased attention, concentration, and memory, as well as dysfunction in peripheral nerves. A study published in JAMA Neurology found that symptoms such as dizziness, headache and taste and smell impairment, were seen in 36% of the 214 COVID-19 patients in China. ARDS survivors frequently have increased rates of depression and anxiety, and many doctors are still trying to find out any deep connection between the COVID-19 and the nervous system.

With these wide varieties of symptoms and consequences, it will take months to completely understand long term complications 

Miss.AKHILA SUSAN JOHN, IVth PHARM.D

DID LOCK DOWN REALLY LOCKED DOWN THE SPREAD OF COVID-19 SPREAD IN TAMIL NADU?

India had declared the longest lockdown of about 57 days in the nation to prevent the spread of COVID-19 spread. We analysed the efficiency of COVID-19 lockdown in Tamil Nadu with Autoregressive integrated moving average ARIMA (1,1,3)(0,0,0) model. We carried out the analysis with the assumption that, the COVID-19 cases reported till the 14^th day (April 8^th) after the declaration of lockdown would have been acquired before the lockdown period.

W used the data of cumulative cases until April 8th to forecast the cases till May 3rd. The hypothesis tested: If the forecasted cumulative cases were lesser then the real cumulative cases reported, it can be attributed that lockdown was efficient in preventing the spread of the pandemic. Statistical analysis: Moving average range was fixed as 3, Upper and lower confidence limit was also assessed with 95% CI.

Fig: ARIMA based forecasting with Cumulative cases in Tamil Nadu.

The cumulative cases on May 3^rd:3023 Forecasted cumulative case on May 3^rd:2018Forecasted upper confidence limit on May 3^rd: 3495The cumulative cases raised about 49.80% than the forecasted cumulative case by May 3^rd. In contrary the cumulative cases achieved about 86.49% of upper confidence limit by May 3^rd It’s also evident that the cumulative cases were in the range of forecasted range till April 20^th (26^th day of lockdown). 

This analysis proved that a long term lockdown, in a place where there was evidence of a community spread lockdown won’t be efficient in preventing the spread of the pandemic. Since most of the cases are reported from Chennai which is the most populated district in the state (26553 ppl/sq.Km) gives more insight about the impact of population density in the spread of COVID-19. Hence the state will have to research on more interventions to prevent the spread of disease in the state.

Thus in a state where there were prominent evidence of community spread associated with a socio-cultural event the lockdown wouldn’t yield a fruitful result. The lockdown might give a bridging period to develop the medical facilities including testing strategies to meet this highly demanding situation.

Mr. Aby Paul, Pharm.D Intern

IMPACT OF CORONA ON MENTAL HEALTH

Infectious disease outbreaks, the current coronavirus (COVID- 19), can be terrifying and can affect our mental health. The novel coronavirus disease that emerged at the end of 2019 began spreading like a wildfire intimidating the health and lives of millions of people after a few weeks. Highly contagious with the possibility of causing severe respiratory disease, it has quickly affected the governments and public health systems. These have responded by proclaiming a public health emergency of national and international concern, as well as by adopting extraordinary measures to prevent the contagion and limit the outbreak. Millions of lives have been notably altered, and a global, multi-level, and demanding stress-coping-adjustment process is ongoing.

The coronavirus pandemic could have a "profound" effect on people and mental health - now and in the future. It has lead to a massive increase in levels of stress and anxiety in the public. People were already struggling to access the support they needed and special support would need to be provided to specific groups, such as children and front-line health workers.   So, a moment-to-moment" monitoring of the mental health of the population acts as an effective tool. It can be designed quickly to help people at home. Increased social isolation, loneliness, health anxiety, stress and an economic crisis are the perfect storm to harm people’s mental health and wellbeing. Researchers said “Doing nothing would risk a rise in conditions such as anxiety and depression, more people turning to alcohol, drugs and gambling, as well as other consequences, such as homelessness…

The most significant problem is that many with mental health conditions presented their concerns about accessing support and services of the pandemic, as well as they, fear that their existing health problems might get worse. There can be a risk that the number of people with depression and those self-harming or taking their own lives will increase thereafter. During the SARS epidemic of 2003, there was a 30% increase in suicide in the age group over 65. 

Some revealed worries about the effect of social isolation and financial difficulties created by the response to the crisis. The policies used to manage the pandemic would automatically have serious effects on mental health by increasing unemployment, financial insecurity and poverty. 

A group of 8 are listed as the most vulnerable group. 

·         Children, young people and families (due to school closures, domestic violence, no free school meals)

·         Older adults and those with underlying health issues (isolation, loneliness, bereavement)

·         People with existing mental-health issues (disruption to services and relapses)

·         Front-line healthcare workers (fear of contamination, increased work stress)

·         People with learning difficulties (change of practice and support)

·         People on low incomes (job and financial instability)

·        Prisoners, the homeless and refugees (social exclusion).

·        Society in general might experience increased health inequality and a rise in use of food banks. 

How to stay strong?

It is normal to feel sad, stressed, angry, confused, and fearful during a crisis. So, keeping in touch with the family and friends may help to cope up with the situation. If you feel overwhelmed talk to your health care provider. Always have a good promising plan about where to go, how to seek help for physical and mental health if required. Always make time to unwind. Be more involved in activities that make you feel comfortable and optimistic. Try to make new skills or draw on skills that helped you control the previous life's hardship and focus to manage your emotions during these difficult times. Find a credible source of information which you can trust and gather the facts that will help you to look forward. Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can also be upsetting. Also, collect information to analyze your risks so that you can take reasonable precautions. Be a role model – Develop a healthy lifestyle which consists of proper diet, exercise, good sleep, secure social interactions, proper connection with the loved ones at home and away from home. Try to keep up with regular routines. Even though the schools are closed, create a regular schedule for learning activities and relaxing or fun activities. To support a child - Reassure your child or teen that they are safe and let them know it is ok if they are worried. Share with them how you deal with your stress so that they can learn how to cope with you.

The World Health Organization has issued guidelines for managing the problem from both biomedical and psychological points of view. While medical action and preventive measures are very important at this stage, emergency psychological crisis and interventions for people affected by COVID-19 are also critical. This includes direct interventions for patients, and indirect for relatives, caregivers, and health care professionals.

After the first experience in China, clinical institutions have internationally opened online platforms to provide psychological counselling services for affected people. Moreover, some research has stated that the mental health of COVID-19 patients (including confirmed patients, those with suspected infection, family members in quarantine, and health care workers) has been poorly considered and controlled. Furthermore, to develop psychological interventions for all or specific (e.g., more vulnerable) groups, important issues to address consist of the adverse psychological impacts and psychopathological symptoms in the general population during the pandemic. So, we must find a way to live in the present.

Pandemics are not just a medical phenomenon; they affect individuals and society on many levels, causing chaos. Stigma and xenophobia are the two main aspects of the societal impact of pandemic infectious outbreaks. Panic and stress have also been linked to outbreaks. As concerns over the perceived threat grow, people start to collect masks and other medical supplies. This is often followed by anxiety-related behaviour, sleep disturbances, and overall lower perceived state of health. It is now crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic. A failure to take people's emotional well-being seriously will lead to long-term social and economic costs to society. The researchers say a database should be set up to monitor any psychological or brain effects of Covid-19.

“We make a living by what we get, but we make a life by what we give. Attitude is a little thing that makes a big difference”. Stay safe and be optimistic and fill life with the new light.

-Beenu Maria Joseph 4th Pharm.D 

Digital Therapeutics

Digital Therapeutics is one of the novel concepts of evidence-based clinical practice for the management of diseases via software. The main aim of digital therapeutics is to improve the clinical outcomes, reduce healthcare cost and promote patient satisfaction. Examples for digital therapeutics include mobile devices, apps, sensors and other IoT devices. Since the non-communicable disease is prevalent in the community and accounts for 80% of healthcare cost, the digital therapeutics is concentrating on lifestyle modification and prevention strategies. The principles of digital therapeutic products are, it should be useful for preventing or managing a disease condition; should have an intervention strategy driven by software; ensure patient privacy; user friendly; and collect real-world data to promote evidence-based practice

Digital therapeutics will be effective only when patients, caregivers and clinicians can access the data and act proactively when the situation needs. At the same time, it should ensure the privacy of the patient. Studies have done to analyze the cost-effectiveness of such interventions especially in HT and DM and found that 97-145 dollars per patient per month (PPPM) could be saved and achieved almost 25-30% reduction in total medical costs. This was observed in patients with moderate to severe disease states. It is also is proven that the benefits of these interventions are comparable to drug treatment and helps to taper or deprescribe medicines for a few patients.

Many Pharmaceutical and IT companies are focusing on digital therapeutics, which helps the patient and health professionals to monitor the progress of disease or effectiveness of therapy. The software used in such devices collects the data from all perspective including physical, mental and behavioural aspects. This method is used in many clinical conditions such as diabetes, hypertension, asthma, COPD, CHF, Alzheimer’s, obesity, depression and so on. Prevention of DM & obesity is the field of interest for many researchers. Along with the treatment pattern, this method can be used for smoking cessation and other lifestyle modifications. Asthma MD, Autism and developmental delay screening app, CKD app, Cure App for liver disease, Mood hacker app for mental illness etc. are some of the healthcare apps widely available. All these apps track patient behaviour and give personalized information for the prevention and treatment of diseases. Because of the present scenario, the use of health technologies will help patients to adjust with the lockdown restrictions and maintain social distancing. At the same time, this can reduce the burden on healthcare professionals during COVID-19 pandemic.

-Dr. Suja Abraham