Too early to say second wave over, though there are encouraging signs, says PHFI’s K Srinath Reddy

Public Health Foundation of India president Prof K Srinath Reddy.

Prof K Srinath Reddy, President, Public Health Foundation of India (PHFI), and adjunct professor of epidemiology at Harvard’s  TH Chan School of Public Health, says only a small number of people who have had Covid have troubling heart problems or suffer long-term damage to the heart.

During the devastating second coronavirus wave, there have been several reports of people suffering heart attacks even after recovering from Covid. Reddy says the heart can be affected directly or indirectly during Covid or after but in most cases people recover.

Under the leadership of Reddy, a former head of the Department of Cardiology at New Delhi’s AIIMS, PHFI has set up five Indian Institutes of Public Health to advance multi-disciplinary health education and research to strengthen the country’s healthcare system, which is the need of the hour. In an interview, Reddy talks about heart and lungs problems and the precautions people recovering from Covid must take. Edited excerpts:

What are the possible heart problems that can arise after Covid? What are the symptoms that one should watch out for after recovery? Is screening of the heart needed even there are no visible symptoms?

Let me start by saying that most people will have COVID without troubling heart problems or long-term damage. Some problems can occur in a small proportion of people,

The heart can be affected directly or indirectly during the active phase of COVID infection or thereafter. During the active phase, the heart muscle or the covering membrane of the heart can be inflamed, resulting in myocarditis or pericarditis.

Extensive thrombosis (clotting) can occur in the veins and arteries in several parts of the body. These can be micro-thrombi or large clots.

Deep-vein thrombosis of the large veins of the legs can lead to pulmonary embolism, when the clots travel to the lungs that can compromise the circulation and stress the heart.

Clotting can also occur in the coronary arteries that supply blood to the heart. Blood vessels of the heart can get inflamed, as part of a general inflammatory state and pre-existing plaques can rupture precipitating heart attacks that causes heart attacks. In a cytokine storm, there can be circulatory collapse and irregularities of the heart beat (arrhythmias) occur.

In later phases (long Covid), heart muscle damage may manifest as fatigue, breathlessness and irregular heartbeats. MRI imaging of the heart have shown some areas of fibrosis in young persons who had clinically mild Covid. Even athletes who have been screened have shown this after full clinical recovery. However, there has been disagreement on how frequently this occurs and what its effects on cardiac function will be.

In most persons, where this has been observed, this finding has not affected heart function. Long-term follow-up studies are going on.

Is the damage caused by Covid to the heart permanent? What are the precautions that should be taken during recovery? Should one take blood thinners or aspirin to avert a heart attack? What kind of diet should be taken after recovering from Covid?

It appears that most people recover. If heart attacks or venous emboli have occurred, there will be long-term adverse effects. Usually, mild cases under home care do not need any medicines to protect the heart, if they have previously not had a problem and have not been on cardiac medicines.

Persons who are hospitalised and have raised markers of risk for coagulation (like the D Dimer) and inflammation (like CRP) receive blood thinners while in hospital. These are usually advised to be continued for three weeks into recovery even after return home. Such blood thinners are also sometimes advised for elderly or obese patients who have low mobility, even during home care. More than aspirin, anticoagulant drugs are used to protect against both venous and arterial thrombosis.

During recovery, diet should have high amounts of vegetables and fruit as well as moderate amounts of protein to help strengthen the immune response that has been triggered by the infection. Plenty of water should be consumed. Curds or butter milk will help the growth of friendly bacteria in the gut, which too aids immunity.

Why are young people who never had any heart issues getting heart attacks after Covid?

Inflammation and thrombosis are the two key pathways by which the blood vessels of the heart can be affected. These can happen even in young people during a severe infection.

Besides heart, many people are complaining of lung fibrosis after recovery. Can lung fibrosis be reversed? What is the best treatment?

Lung fibrosis is a cause for concern. Regular breathing exercises, with deep breathing, can help in limiting damage and preserving function. Radiologists will evaluate lung pathology (through scans) and pulmonologists will evaluate lung function to decide whether any specific drugs are needed. In very extreme cases, lung transplants have been performed.

Can a person who has had Covid get reinfected? Why have there been cases of Covid even after two doses of vaccine?

A Covid reinfection can recur if the immunity has waned and fresh exposure to the virus has happened.  Breakthrough infections can occur even after full vaccination in some persons, as the systemic vaccines build a systemic immune response to fight the virus after it has entered the body. They help to prevent severe disease and death. They may not prevent entry of virus into the body or mild infection.

What are the risks associated with those people who have to be on oxygen support for a long time even after testing negative for Covid? What are precautions they should follow?

It depends on the reason they have to be still on oxygen support. Is the infection still active, even if the test is negative?  Or is it the result of severe lung fibrosis or even multiple pulmonary emboli? Competent medical advice should be sought, so that the right diagnosis can guide the treatment.

Is the second wave over? What should India do to avert a future wave?

It is too early to say the second wave is over, though there are many encouraging indicators. We still have to see if there will be a rebound after the lockdowns in several states are lifted. To avert a future wave, we must adopt all effective measures to prevent transmission (masks, good ventilation, avoiding crowds and super-spreader events), while accelerating the speed and geographic coverage of vaccination. With a commitment to these, we can restrict the third wave, even if it happens, to a ripple rather than a tidal wave.