COVID-19 surge: Why those with co-morbidities should be careful. How can they avoid hospitalisation?

At present, all infections across the country are being caused by Omicron sub-lineages. And, in most people, the infection has been causing mild symptoms such as low-grade fever, runny nose and body ache. The infection, however, is very contagious. If one member of the family has it, it is more likely than not that everybody else will get it.

But it is the people with co-morbidities, who are ending up in hospital ICUs or requiring oxygen support. Their CT scan shows COVID-19 pneumonia, which is not commonly happening in others this time. The patients in my ICU are those who are either over the age of 75 to 80 years or those living with other serious health conditions like cancer, heart failure, chronic kidney or liver disease, and those with poorly controlled diabetes. We are also seeing people who are on corticosteroids for other ailments. I say that they are in the hospital not because of COVID-19 but with COVID-19.

Would an additional vaccine shot help those who are co-morbid in reducing the risk of hospitalisation?

Fourth doses are, of course, not available. But if someone living with co-morbidities has not taken their third precaution dose, they should do so. The booster dose improves the existing immunity and quickly increases the antibody levels.

This will only help in reducing the risk of severe disease somewhat – there is no harm in getting the shot. Of course, the vaccine will not confer much additional immunity in those who have had an infection in the last few months; their antibody levels must already be up. It is this hybrid immunity from two doses of vaccine and at least one or two infections in almost the entire population that has resulted in milder disease; the vaccines are not very effective in preventing an infection.

With everything open and no masking mandates in place, what are the precautions people with co-morbidities must take?

First of all, those who are at a higher risk of severe disease should avoid travel and social gatherings. If I talk about my hospital, most of the people who are coming in with the infection have a history of travel to either Dubai or Goa. Or, they have been to a wedding. It is better to avoid leisure travel and gatherings for the moment as COVID-19 cases are definitely going up across the country. Flights, trains, and public transport should be avoided as much as possible. If and when one does travel, one should mask up. At offices with central air conditioning, those without co-morbidities can still function without a mask, but those with co-morbidities should definitely keep their masks on.

The infection is here to stay, it is endemic. So, people have to live with it and take these precautions whenever there is an increase in cases.

What is the impact of COVID-19, especially repeated infections, on heart attacks and strokes?

Clinicians have observed an increase in cases of sudden death with heart attack or stroke after the pandemic. And there is evidence to suggest that long Covid can lead to more thrombosis events – blood clots blocking vessels – which are what cause heart attacks and strokes. Some people suggest that the vaccines might also be causing these heart attacks and strokes. Studies are ongoing but there is no definitive answer. However, repeated infections are likely to increase the risk of developing these conditions. So, it is important that one be careful and get their third shot to enhance whatever protection it might offer.

Why Dr Khilnani? Dr GC Khilnani is currently the Chairman of Pulmonary, Critical Care, and Sleep Medicine at PSRI Hospital. He is the former HOD of Pulmonology and Sleep Medicine at AIIMS and has been practising for over 40 years. He was part of the expert panel initially constituted by the Delhi government when the pandemic began. He is also a part of several professional bodies and editorial boards of journals.