Francis Naratefeliciano during his physiotherapy session at Canadian Hospital in Dubai last month. Image Credit: Ahmed Ramzan/Gulf News

Dubai: Francis Naratefeliciano represents a classic case of what possibly lies in store for COVID-19 patients under a prolonged process of recovery.

Naratefeliciano, 46, an executive in a multinational company, was recently discharged from the Canadian Hospital after 116 days, 72 of which were in intensive care. He spent 60 days under induced coma on a mechanical ventilator.

However, his real ordeal has just begun.

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Fallout from COVID-19

“Although I will be 47 this November, I always felt like I was in my 30s. But after this illness, I have brain fog, excessive hair fall, my toes are numb, I feel extremely fatigued, my muscles have wasted so I require regular physiotherapy. My lungs have been permanently damaged and I will now have to wear a mask all my life to prevent any chest infection.”

Naratefeliciano speaks to his wife in Edmonton and son in Philippines regularly, but says he has big memory deficits. “I have a problem using my phone as I no longer know what some of the apps are for. My long-term memory is okay, but I cannot remember most of the incidents after I fell sick and all that transpired during the last three months,” he said.

He is working on physical rehabilitation and hopes to return to his sports routine one day.

Miraculous recovery

Dr Hayder Matouk, consultant intensivist at the hospital, told Gulf News: “Francis’s discharge is nothing short of a miracle. After being weaned off the ventilator after two months in induced coma, he actually suffered a brain stroke and we had to operate to stem the bleeding. He had horrific bed sores lying in bed for so long, his lungs have permanent fibrosis and we had to give him additional vaccination for seasonal flu and prevention of any pneumococcal diseases as his lungs have suffered too much damage. He faces long-term physical rehabilitation.”

Long-term organ damage

Dr Atul Aundhekar, CEO of Avivo Group, which has several clinics and hospitals under its wings and had COVID-19 patients reporting at those places, explained: “One has to look at the short-term, intermediate and long-term damage that a COVID-19 patient will face. As per statistics from around the globe, nearly 50-60 per cent of COVID-19 patients develop symptoms that can range from mild to moderate to severe. Nearly 40 per cent patients remain asymptomatic. Even as studies are underway in most countries, it is clear that the virus can impact any organ in the long term. Recovered patients are just starting to discover how fragile their health has become after COVID-19. Studies show that from brain fogging and memory lapses to eye infections, chronic fatigue, heart palpitations, fibrosis in the lungs to poor muscle tone, kidney damage and breathlessness, for the long haul, patients have to combat several conditions after recovery.”

Dr Aundhekar added: “Since COVID-19 impacts the lungs the most, the tidal volume (this is the amount of air that moves in an out of the lungs with each respiratory cycle) is drastically impacted. In a healthy young person, the tidal volume is 500ml per inspiration. The inflammation in the chest, even in mild-to-moderate infections, can cause permanent fibrosis and drastically reduce the tidal volume.”

Earlier, it was understood by the medical community that post COVID-19, a person could bounce back to good health in a few weeks. However, a research group at King’s College London has developed a COVID-19 tracker app for people to record their symptoms daily. An estimated 200,000 have been reporting symptoms for six weeks or even longer, ever since the tracker was launched.

Francis Naratefeliciano is now working on his physical rehabilitation and hopes to return to his sports routine one day. Image Credit: Ahmed Ramzan/Gulf News
Dr Atul Aundhekar

In Italy, in a trial conducted on one group of recovered patients, it was found that nearly 87 per cent of them were struggling with various health issues even two months after discharge. Data from the COVID-19 Symptom Study, which uses an app that is being used by millions of people in the United States, United Kingdom and Sweden, suggest 10 to 15 per cent of people — including some ‘mild’ cases — don’t recover quickly. The problem is complicated for those above the age of 60 and with co-morbidities.

So while the negative COVID-19 test is a harbinger of happiness, the battle for survival begins just then.

Let’s take a look at the top-10 organ dysfunctions after COVID-19:

1. Brain: More than 300 studies have found the presence of neurological abnormalities due to COVID-19. Dr Matouk said: “Recovered patients have reported symptoms like mild to severe headaches, short-term memory loss, brain fog, strokes and seizures that result in debilitation of the neurological health of a patient. We saw this in the case of Naratefeliciano who suffered a stroke and brain bleed after he was weaned off the mechanical ventilation.”

2. Eyes: While the World Health Organisation now includes conjunctivitis as a symptom of COVID-19, many patients have also reported weakening of eyesight post recovery although there are not enough studies to support this. According to the Royal College of Ophthalmologists and College of Optometrists, like in any other viral infection affecting the respiratory tracts, the novel coronavirus can cause irritation of the conjunctival membrane of the eye. In a recent study conducted on post COVID-19 patients in Wuhan, China, many have complained of recurrent eye infections and sticky eyes. Eye specialists say if these symptoms persist for long they can impact vision.

3. Heart: Patients who experienced hypoxia (organs in the body are deprived of oxygen) during COVID-19 suffer from post-viral myocarditis or weakening of the heart muscle. Dr Aundhekar explained: “It has been found that the virus uses the angiotensin-converting enzyme (ACE 2) pathway to enter the cells. ACE2 is a cardiogenic receptor and COVID-19 patients can suffer from long-term impact to the heart as the antibodies produced by our immune system can cause permanent damage to the heart muscle.” In a study conducted in Wuhan, about 1.2 per cent of COVID-19 patients showed signs of heart damage post recovery.

4. Lungs: the most vulnerable organ in a severe COVID-19 infection are the lungs. The virus causes build-up of toxins in the lung and the patients experience a ‘cytokine storm’ (where the body’s immune cells turn rogue and attack the lung tissue). As a result, lungs lose their elasticity and fibrosis can cause lung failure in extreme cases requiring a lung transplant.

5. Circulatory system: It has been reported that more than 31 per cent patients of COVID-19 suffer from strokes, embolisms, clots and blood clots. The virus adversely impacts the peripheral vascular resistance and patients have to be put on blood thinners for the long term to prevent blood clots. This kind of condition is more common in COVID-19 patients with co-morbidities such as obesity, diabetes and hypertension

6. Thyroid: The failure of many systems in the body impacts the endocrine system adversely and can cause hormonal imbalance, resulting in damage to the thyroid gland and impair metabolism.

7. Kidney: Post recovery, many patients have reported a spike in uric acid levels as digestion and metabolism of proteins are impaired. In the long term, this can cause kidney stones, nephro damage and gout.

8. Muscles and bones: With patients being confined to hospital beds, there is severe damage to musculoskeletal system. Muscle wasting, slow reflexes, stiff joints lead to poor gait and arthritis and this needs to be remedied with intensive physiotherapy and rehabilitation.

9. Sensory functions: Smell, taste and even touch are impacted by the virus. Patients have reported impaired sensory functions long after recovery. Many report impaired cognitive functions accompanied with dizziness, blurry vision, headaches, neuritis and neuralgia.

10. Poor emotional health: People who recover from COVID-19 have reported mood swings, anger, anxiety, and depression. Psychologists point out that long-term confinement in isolation exacerbates these symptoms and being exposed to the extreme human vulnerability triggers negative emotional response. Patients often require to go into counselling and therapy to be able to build motivation, set goals and reintegrate into the community.

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What you need to do to ensure a full recovery:

Dr Aundhekar and Dr Matouk provided some handy tips:

• The first and foremost factor is building strong immunity. Eat large portions of fresh greens in the form of salads, fruit and stir-fried vegetables, which have lot of anti-oxidants to reverse some of the damage.

• Have additional supplements of Vitamin C, zinc, selenium, vitamin D, B complex and other micronutrients.

• Keep yourself well-hydrated.

• A deep sleep is very healing. Make sure to go to bed early and correct your body’s circadian rhythms that will help trigger deep tissue healing.

• Try and keep stress levels low. For this, avoid flashpoint situations that could trigger stress, avoid extreme tempers or emotions, practise deep breathing and meditation.

• Exercise well: Introduce a regular routine or low-impact yet muscle-building, calorie-burning exercises that will energise your body and stimulate your sympathetic and autonomous nervous systems.

• Post-recovery, patients must also take care to have vaccinations for seasonal flu and other viruses that can cause chest infections, as their respiratory system is already fragile. They need to consult a doctor immediately for preventive screening the moment they detect the slightest discomfort.

• Patients who have suffered a lung damage are advised to avoid crowded places, wear masks life-long and use hand sanitisers to avoid coming in contact with any potential infections as their body is already weak and needs to be protected.