Mumtaz Ahmed is a 56 year old teacher from Budgam who had been sick with COVID19 in October last year. He was admitted to a hospital for over two weeks. He improved and came back home, but is yet to be back to his ‘pre-COVID’ life. Chronic, persistent fatigue has confined him to his home mostly. Routine daily activities like buying groceries feel like a hard task to him. He has applied for extension of leave from the administrative work in the education department that he was engaged in. Months on COVID19 continues to infringe upon his life.
In the nearby district of Srinagar, Shakeela is a 45 year old healthcare worker who survivedCOVID19 earlier last year. She, along with her family was infected with the virus at the time when not much was known about it. What the family faced when the news of their infection reached the neighborhood is something Shakeela feels “shook my faith in humanity”. She has recently started seeking help from a professional for depression that started with her SARS-CoV2 infection.
These cases are not rare. Doctors in Kashmir and across the world are dealing with a mounting tally of people suffering Post-COVID19 complications. Dr Naveed Nazir Shah, head department of Chest Medicine at GMC Srinagar said that Post COVID19 complications were well established now. He cited a number of research and study papers that document the various facets of how patients, weeks and months after recovering from the infection, suffer physical and neuropsychiatric complications that require intervention by a professional.
Dr Shah said that fatigue and weakness, debilitating in some cases, is the most common post COVID19 symptom. “Some suffer lung complications and recurrent lung infections, especially those who have been on steroids,” he said. Many, he said, find it difficult to be weaned off oxygen support.
While elaborating upon a study carried out together by the Department of Psychiatry, Department of Chest Medicine and Department of Social and Preventive Medicine at GMC Srinagar, he said, “We started with studying the healthcare workers and their mental health. The results were shocking.” As per the study titled “Healthcare Providers on the Frontline: a Quantitative investigation of the Stress and recent Onset Psychological impact of Delivering Health Care Services During COViD-19 in Kashmir”, Over 50 percent of the frontline healthcare workers had a severe psychological impact owing to COVID-19. The study found that nurses had significantly higher stress as compared to doctors. The stress manifested in a number of ways, he said.
A more recent study and a broader one titled Psychiatric comorbidities among COVID‑19 survivors in North India: A cross‑sectional study was carried out by Department of Psychiatry, Government Medical College, Srinagar Department of Clinical Psychology, College of Health and Rehabilitation Princess Nourah Abdulrahman University, Department of Social and Preventive Medicine, Government Medical College, Department of Respiratory Medicine, Government Medical College, Srinagar. The study found that anxiety, depression, post traumatic stress disorder and other symptoms are common among COVID‑19 survivors. “Our data support the proposal that public health advice during pandemics should incorporate mental health wellness campaigns aiming to reduce the psychological impact of pandemics. Cognitive behavior therapy and interpersonal therapy need to be explored as part of overall mental health‑care package interventions,” the researchers state.
Researchers have studied the role of the prevalent socio-cultural scenario as a contributing factor to the psychiatric illnesses that erupt after the viral infection. A study carried out in December 2020 titled “Stigma in coronavirus disease-19 survivors in Kashmir, India: A cross-sectional exploratory study” noted that fear of COVID-19 is likely due to the uncertain character and unpredictable course of the disease, perceived risk of acquiring the infection and non- availability of a trusted and approved treatment, unpredictable outcome, high fatality, and novelty of the infection. This generates negative psychological responses including maladaptive behavior, and avoidance reaction among people.
“Thus, people are likely to be labeled, stereotyped, and discriminated against, treated differently, because of real or perceived links with the disease; therefore, the first quantitative assessment study was taken to determine the prevalence of stigma, its socio-demographic correlates, and association with time since discharge among COVID-19 survivors in a developing country.” In context of Kashmir, it found “high levels of enacted and perceived externalized stigma reported by survivors”. The high prevalence of enacted and externalized stigma highlights the need for consultation, liaison services to work in proximity to medical services.
In Children, Prof Muzaffar Jan, Head department of Pediatrics at GMC Srinagar said, Multi-system Inflammatory Syndrome in Children (MIS-C) is being seen frequently at the GB Pant Pediatric Hospital. Last year, the hospital had admitted 19 children with COVID19. However, MISC was seen in 52 children. This year, he said, the numbers are rising. “Post COVID19 complications take a few weeks to develop,” he said.