Shahid Akhter, Editor-in-Chief, ETHealthworld, spoke with Dr Kumud Dhital, Senior Consultant Cardiothoracic Surgeon, Director, Heart and Lung Transplant Program and MCS, Yashoda Hospitals, Hyderabad, to learn more about the implications of Covid in long term and the need for policies to manage them.
Covid-19: the persistent problem
Right now everyone is focusing on Covid, the immediate impact and where we’re pretty much in a war zone that at times truces and skirmishes, but it looks like we’re at least coming to the end. And that brings a very different perspective in two ways, one is that Covid, unlike other infections, poses lingering health care challenges for patients who have been so affected.
We have three categories, those who appear to be recovering with very minimal symptoms and some appear to be recovering asymptomatically, they remain in the community, but those who required hospital care and those who are undergoing therapy have recovered at home. We have those who have degenerated into their medical condition requiring intensive and complex intensive care and then have recovered enough to be sent home and others in hospitals without a transplant option often do not survive. Now, for those who have been released, there is something called Long Covid that is becoming the center of attention in many parts of the world now. Namely, because it is more of a syndrome, it is this continuous injury and not just the lung that continues to discuss the capacity of our patients. But it is the neurological symptoms, the heart symptoms, the joints and the muscles, and not just the psychiatric problems that are going to have a very important impact on family life, societal responsibilities and health systems. So how do you manage them? It requires a different way of thinking about the consequences of the infectious episode of covid that we are currently going through.
Covid-19: Covid management (long term)
How to put in place infrastructure policies to adjust and manage covid in the long term? To this end, the UK recently announced plans to create 40 high-end, more holistic long-term covid monitoring clinics. We expect the UK National Institute for Clinical Excellence to publish its guidelines. Likewise, the WHO should publish its own policy on the management of covid and long covid. I’m sure other countries are doing it.
I don’t know how far this has reached within the Indian Ministry of Health in terms of when the state health department to tackle this problem in the long term as we will need an effort concerted. It just shouldn’t be left to clinicians to think about their own small area, but these patients will need a holistic approach to their management in an integrated way so that we have the data and in India, given the population, this data will become so valuable. this will help India to drive the evolution of a much better therapy with evidence in the data, you can create artificial intelligence and algorithms to determine what are the most important aspects of long covid and which part of the syndrome needs be addressed at what stage and what are the results and we would then be there to change that and inform others, in more countries, of the best form of management.
Covid-19: impact on heart surgeryCovid-19 has had a huge impact in all surgical disciplines and not only in heart and lung surgery, but also in cardiothoracic surgery. All over the western world and including India there have been numerous reports in and after publication explaining and detailing the significant reduction in the amount of cardiothoracic surgeries which are for the heart and lungs which are normally performed. as elective cases. So many institutions have stopped making the elective cases which unfortunately have repercussions which tend to deteriorate at home and then perhaps come to you later and with more serious situations.
However, we are now starting to see an increase in the number of transplants and an increase in the number of donations which again dropped significantly during the covid era. Not the least, because here again the constraints of intensive care beds. Now, covid specifically for the lungs will continue to become an issue, for a long time covid will have issues with patients who are below normal functionality or who continue to deteriorate in terms of lung function who may still be discharged from hospitals. under oxygen therapy and not recovering. And these patients are likely to require lung transplantation and therefore, given the scale of the number of infections, globally we are going to see a huge increase in the number of patients requiring lung transplantation for this new indication in the healthcare of this. which we call long covid or more specifically post fibrosis covid.
Yashoda Hospitals: Heart and Lung Transplantation and MCS
Yashoda Hospitals stand out from many other institutions in two ways, one in terms of presence within its institutions. It is fortunate that those who are concentrated in the city of Hyderabad, provide a significant number of beds and therefore internally a significant number of donors within its own campus.
The hospital of course stands alongside the existing liver and kidney programs which are very mature and with excellent results. The heart and lung transplant program is new and a concerted effort is being made to build this program on the basis of a number of transplants performed in the past.
It is not discharge from the hospital that determines success. For me, success only occurs when recipients have been sent home and are alive in good condition beyond the time they would have already died from the natural history of their original state of health without the intervention. And therefore, there are certain conditions where this is achieved in just a few days and weeks after the transplant and many other conditions where you will have to wait several months before you can claim to have brought any benefit to this patient, not just in terms of prognosis and survival but also in terms of quality of life.