Updated: November 16, 2020 3:07:34 am
Dr Jalil Parkar has treated more than 1,400 Covid-19 patients since March 11. By early June, by which time he had seen some 200 critical
Covid cases at Mumbai’s Lilavati Hospital, where he is a senior pulmonologist, he thought he knew “the a-b-c-d of the virus”. So if he ever felt the symptoms himself, he told himself, his plan of action would kick in effortlessly, one that he had prescribed to each of his patients — ivermectin (antiparasitic drug) and doxycycline (antibiotic).
But when he was diagnosed, the 62-year-old realised he had underestimated the virus. A diabetic, Parkar says that after being discharged, he would often lose track of what he was doing. Besides, he lived with an inexplicable “fear”.
Of all the unknowns that accompany SARS-Cov-2, the least discussed is what it does to the human mind. Long Covid — complications for those who have recovered from the infection — is now becoming a larger burden than actively infected cases.
In India, there are 4.89 lakh active Covid cases, 8 million of whom have recovered. Doctors say many of them have been returning with complaints of fatigue, headaches, insomnia, shortness of breath, body pain, lack of appetite, sore throat and diarrhoea. Add to that, mental health issues. There is now increasing evidence that Covid-19 can lead to anxiety, depression, psychosis, insomnia and memory fogs.
A Lancet Psychiatry study published last week found that 18.1% Covid patients had a psychiatric problem within 14 to 90 days of infection. Doctors and experts say the unpredictability of the virus is what is adding a mental dimension to the disease. Add to that the isolation that patients go through, and the fact that measures to check the spread of the virus have had economic ramifications.
Dr Shubhangi Parkar, former head of KEM’s Psychiatry Department, says she has been seeing Covid patients with the stress of job loss or insecurity at work. “Those already in financial distress find the stress hard to deal with,” she says, adding “lack of socialisation and forced isolation have increased the sense of loneliness”.
Dr Rajesh Parikh, Director of Medical Research at Mumbai’s Jaslok Hospital and co-author of the book The Corona Virus — What You Need to Know About the Global Pandemic, says, “We are seeing three categories of patients: first, where the coronavirus directly affects the brain; second of people with existing mental health problems; and third, where mental health issues are a result of complications caused by the infection.”
“Because the virus can get direct access to the brain through the olfactory nerve, many patients have loss of smell. But in some cases, mental disturbance could be the first signs of infection, even before loss of smell, taste or fever,” Parikh says.
As the virus begins its onslaught, the body’s immune system stirs awake and releases cytokines. But these, Parikh explains, are also known to affect neurotransmitters like serotonin, dopamine and glutamate. Serotonin and dopamine are feel-good hormones, and glutamate is key to learning and memory. A disruption can cause depression, delirium and memory loss.
Parikh says patients with existing mental health problems already have lower immunity. Once infected, their illness is aggravated by the virus. Patients may also struggle with survivor’s guilt if they lose a family member to Covid.
This is what the Gawdes went through. In October, Madhukar and Madhumati Gawde contracted Covid-19. While 60-year-old Madhumati, who is diabetic, was admitted to Mumbai’s Apex Hospital, Madhukar was taken to a civic isolation centre in Mulund, in Mumbai’s eastern suburb. They never saw each other again. Madhumati, who was on ventilator support for long, passed away a fortnight ago.
“Since then, he (Madhukar) hasn’t been sleeping. He doesn’t pay attention when we are talking and does not talk much himself. It’s as if his mind is elsewhere. He keeps saying if he were not in isolation, he would have saved his wife. He is now on anti-anxiety medication,” says Madhukar’s son-in-law Amit Aparaj.
In his book, Parikh has written about one of his patients — a 35-year-old fitness trainer who required critical care for an entire month. At the end of it, the trainer had muscle weakness and difficulty moving. For someone whose life revolved around staying fit, his weak muscles now became a cause for depression, fear and nightmares.
Dr Rahul Pandit, an intensivist at Fortis Hospital, says he makes it a point to counsel each of his Covid-19 patients about possible signs of mental issues. A member of the Maharashtra task force for Covid, Pandit speaks from personal experience. However, when he contracted Covid-19 in May, he did not realise he was battling a severe mental disorder until he came out of it.
“I just couldn’t sleep, I thought about Covid all the time, there was constant fatigue. Only after it settled down did I realise these were neuro-psychiatric symptoms,” says Pandit, 47. He adds that psychiatric episodes are more common in Covid-19 patients admitted to ICUs than those isolated at home.
For now, doctors say they don’t know how long it will take for Covid patients to recover fully, including from mental illnesses, except that most of them will need some kind of support.x