Covid-19: Why are some patients presenting with ‘unusually high grade fever, prolonged cough’ even after two weeks?

What is causing the fever?

Dr Ravindra Mehta, senior pulmonologist, Apollo Hospitals, Bengaluru elucidated that such is the case with most viral illnesses. “Covid-19 is a viral illness and post the illness, often there is a chance of getting added bacterial infection.”

According to him, there are two possibilities for the scenario described – one is Covid is lingering or recurring which is highly improbable. “But more likely, there is a secondary infection such as some bacterial infection which has gone in the lungs. That leads to persistent fever. This is the pattern seen with most viral infections. For instance, influenza also will have secondary infections which can lead to problems. And Covid-19 too follows the same pattern,” Dr Mehta said.

According to Dr Anil Ballani, consultant, Internal Medicine, P D Hinduja Hospital and Medical Research Centre, Khar, it is important to “distinguish between the two” — there may be one group of patients with prolonged and high fever and another group of patients who do not have fever but simply have a prolonged cough. “In the first scenario, the patient has Covid and a high-grade fever persists for a number of reasons,” noted Dr Ballani.

Here’s when testing should be done (Source: Express Photo by Amit Mehra)

Normally, we know that Covid-10 only lasts approximately five to seven days, after which the fever and cough should go away, however some patients have persistent fever even after 12 to 14 days, noted Dr Ballani. “These patients may be immunocompromised, have inadequate immunity due to uncontrolled diabetes, cirrhotic liver, or have a persistent lung condition such as COPD (Chronic obstructive pulmonary disease), bronchiectasis, or asthma,” Dr Ballani told indianexpress.com.

Agreeing with Dr Mehta, Dr Ballani too pointed out how a secondary infection caused by a bacteria in addition to Covid-19 could “result in high fever for 12-14 days”. “The third cause is an autoimmune reaction after Covid leading to persistent inflammation, which can result in a high-grade fever. Sometimes we administer steroids too early in Covid patients, and they develop secondary fungal infections. If the fungal infection progresses, the patient will have a high-grade fever in the second or third week,” Dr Ballani said.

How about the persistent cough?

Explaning the scenario where the patient has recovered from fever and has begun to regain energy, but the cough persists, Dr Ballani said that “inflammation in the lung tissue” is one of the possible causes of this cough. “Inflammation of the windpipe, trachea, bronchi or bronchioles may occur, resulting in bronchospasm and an asthma-like appearance. As a result, the patient experiences bronchospasm, wheezing, and a chronic cough, Dr Ballani said.

The second cause in this scenario is when there are numerous secretions in the sinuses and nose, which causes post-nasal drip. “When the patient lies down, a lot of fluid drains down his or her posterior pharynx, causing post-nasal drip and a chronic cough. These are the two most common explanations,” Dr Ballani explained.

Dr Ballani went on to mention that inflammation, which appears two to three weeks later and leads to interstitial lung disease can be a “dreaded complication” that can occur as a result of a strong inflammatory response, which is a type of antibody antigen reaction that leads to lung fibrosis, also known as interstitial lung disease in common parlance.

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