Three years after India’s first Covid case was diagnosed in Kerala, the state is set to undertake its first-ever large population-based post-pandemic study that will set up markers to distinguish Covid symptoms from ordinary ailments.
The lingering effects of Covid, also known as Long Covid, is a condition that includes a wide range of ongoing health problems that could last weeks, months, or even years after getting exposed to SARS-CoV-2 virus.
The one-year study — the first of its kind district-wide effort in India — will examine the “clinical spectrum, risk factors and outcome of the post-Covid syndrome among patients”.
The proposal received the nod of the Indian Council of Medical Research (ICMR), the country’s apex body for the formulation, coordination, and promotion of biomedical research, last year.
The state government sanctioned it on 17 January, and directed the Wayanad district administration to provide the necessary support.
The study will involve assessing the association between common risk factors (such as age, gender and comorbidities), the severity of initial Covid, and medications used, so that laboratory markers could be established with more certainty.
“Once completed, it will delineate the symptoms that are truly post-Covid from common problems prevalent in the population,” said Dr Aneesh Basheer, the study’s principal investigator.
“As a result, doctors will be able to make the best use of time and resources,” he told South First.
How the study will be conducted
Proposed by the DM Wayanad Institute of Medical Sciences (DM WIMS), the study will cover 1,200 people from Wayanad district.
Of these, 600 will be people who have recovered from Covid (hospitalised and non-hospitalised), the other 600 being those who have not contracted the disease.
The sample group is expected to represent all areas of Wayanad, though the majority would be from the municipalities of Mananthavady, Kalpetta, Vythiri, and Bathery.
According to the state Health Department, post-Covid conditions are a wide range of new, returning, or ongoing health problems which people can experience more than four weeks after first being infected with the virus that causes Covid-19.
Even those who did not have symptoms when they were infected can have post-Covid conditions that can have different types and combinations of health problems for various lengths of time.
Keeping this in mind, the sample group will be monitored for 12 months to determine factors associated with the post-Covid syndrome, another way to refer to Long Covid.
“For that, we will check symptoms and also measure blood pressure, blood sugar, oxygen level, and exercise stamina,” Dr Basheer said.
As per the action plan, trained field staff, many of the students studying medicine, will visit their houses to interview them and to conduct a six-minute walk test.
Research assistants /investigators will also monitor the enrolled people at outpatient visits.
The proposed lab investigations include measuring oxygen saturation using a pulse oximeter (resting and after a six-minute walk test in those with normal resting saturation), blood pressure, blood sugar, D-dimer test to rule out blood clot, and chest X-ray in case of symptomatic patients.
Every case will be reviewed at the third, sixth, ninth and 12th months.
How will the control group be assembled?
Given that, during the devastating omicron wave, it is believed that majority of the people were infected and many did not test, how would the study ascertain the uninfected status of the control group?
Dr Basheer agreed this is a concern, and said ICMR has been apprised of the problem.
“We will be taking people who had no clinical features or history of Covid, along with a negative test. As testing came down drastically after the first wave, we may not be able to get all persons with test — ICMR agreed that history and clinical features are sufficient.”
“We are planning to do rapid antigen wherever there is a suspicion… (but) regular testing may be difficult in practical terms as, during the follow-ups itself, some of these persons could develop Covid,” he noted.
“It is a limitation of the study, yes, but it is much better than having no comparison group at all,” he added.
Why is the study important?
The study is important as it is expected to identify long-term conditions resulting from Covid-19, explained Dr Basheer.
According to him, this will help spread awareness about the chronic nature of Covid-19, which in turn could motivate the public to get vaccinated, wear masks and follow social distancing.
The study participants will also benefit from early detection and treatment of complications and regular follow-ups, said Dr Basheer, who also teaches general medicine at DM WIMS.
Dr Aravind R, head of the Infectious Diseases Department, GMC Thiruvananthapuram, told South First that understanding post-Covid complications among the population and assessing its real burden is important.
“Post-Covid induced diabetes, heart disease, stroke, depression, neuropsychiatric manifestations are being treated. Thus, to know more about it is crucial from a public health perspective,” said Dr Aravind.
Common post-pandemic ailments
Dr Bipin Gopal of the Directorate of Health Services, who oversees Kerala’s post-Covid clinics in government hospitals, told South First that the most common complaints currently have to do with respiratory diseases.
It is followed by cardiovascular diseases, musculoskeletal disorders, memory loss, and miscellaneous ones like sleeplessness, hypersomnia or oversleeping, fatigue, anxiety, depression, and others.
People with genuine post-Covid-19 symptoms regularly land up at the outpatient department (OPD) of a hospital, said Dr Gopal.
As a result, he said, two registers are maintained at the OP: One for the general patient and the other for those who had got Covid. This is being strictly implemented in government hospitals.
“At the government level, there are around 1,118 post-Covid clinics,” Dr Gopal said.
“But there is a lull in patient footfall at these clinics nowadays.”
At the same time Dr PS Shajahan, professor, pulmonary medicine Government Medical College, Alappuzha told South First that post-Covid complications are less severe when compared with those reported in the first and second waves of Covid-19.
“Complications like pulmonary fibrosis, a lung disease, that claimed many lives in the previous waves are not that rampant now. Even if diagnosed it is not that severe now and thus less life-threatening. At present, many complain about having asthma-like symptoms,” said Shajahan.
According to him in some cases psychiatric support had to be provided for those who arrive at the post-Covid clinics with complaints of symptoms that are ‘imaginary’.
“Even after running every test, they turn out to be normal. But they refuse to yield and came back. For them psychiatric support is given,” said him
What makes the study different?
The two published post-Covid studies in Kerala have one thing in common: The respondents in both were people who had recovered from the disease.
What makes the Wayanad study special, Dr Basheer said, is the proposed control group of 600 people with no Covid-19 history.
“Without this group, the real picture of Long Covid cannot be worked out,” he said.
This is because, he explained, conditions such as headache, sleep disturbances and memory issues due to post-Covid are also common in general public.
“Lack of control groups in most studies leads to bias. Our study has a comparison group. This has not been done with most previous studies, especially in India,” Dr Basheer claimed.
This is the first-time that a district-level post-Covid study is being mulled in the state.
“This is the also largest to date study on post-Covid in Kerala,” he said.