well, joining us now. A very special guest. Dr Soia Swaminathan, who was with the World Health Organisation as a principal scientist, looking at everything about, you know, the science and the research which emerged out of Covid. Thank you, ma'am, Very much for being with us. You had a look at this report. The C MC report indicates that Indians are impacted more by long covid than people in different parts of the world. Why is this the case? Well, uh, firstly, just, uh, a little bit about the study, Um, that you referred to. It was done at the Christian Medical College. Um, uh, it was a follow up of people who were, uh, admitted during the first wave of covid. And the median time that had elapsed between their discharge and when they were studied was about, I think, 65 days or so. So it was quite soon after recovery. It was about 2 to 3 months after recovery, and it was a one time assessment. And basically what it showed is that, uh, the diffusion capacity of the lung was significantly, uh, impaired. I mean, it was abnormal in about 45% of people uh, which means that certainly their lungs had been damaged. Uh, but there there hasn't been a longer term follow up, uh, of these people. Uh, most of the studies of long covid, you know, have, uh, followed people out over six months, 12 months, and even longer than that to really know how many people are, uh, continue to suffer from, uh, from, uh, the, uh, long term after effects of SE A. So it's clear that there is a a percentage of people say around 10% 10 to 20% in various studies. So it's very hard to compare what they've done in two months with other studies that have looked at different, uh, over different periods of time. But having said that, I think the one thing that uh is true is that, uh, Indians have a very high rate of comorbidities. And I think even in their study, something like 70% of people had comorbidities. And we know that that's associated with the most severe illness. But it's also probably contributing, you know, to a higher probability of having these, uh, long term respiratory, uh, problems. So that could be part of the reason but I think we need much more data on Long covid from India before we can, um, conclude that indians have a higher, you know, prevalence of lung covid than than other populations. 44% of patients show adverse impact of lung functioning for this, uh, report. How do comorbidities also impact the lungs? Yes. I mean, there are some comorbidities that can certainly affect lung function. I mean, diabetes has, you know, widespread, um, impacts on the microvascular on the small blood vessels, but the other major comorbidity could be, and I think we'll have to look into more details into the patient profile. Could be, uh, smoking for one and people exposed to other, uh, pollutants. You know, whether it's indoor household air pollution because of bio mass being used for cooking or whether it is air pollution externally, which many of us are exposed to now. And, um, you know, those could all be contributing to, uh, the underlying respiratory issues that could have been, uh, exacerbated by covid. So I think in general that comorbidities do contribute to having various kinds of post covid syndromes, including respiratory problems and ma'am. Statistically, what is data from other international surveys showing on the impact of long covid. So some of the risk factors for long covid, of course, are having very severe disease initially, though overall, if you look at numbers, the numbers of people who have long covid come more from the mild group because many more millions of people had mild rather than severe covid. So in terms of proportion, many more people from mild covid have had the post covid syndrome. Then, if you've had repeated infections, more chances of having, uh, these symptoms, you've not been vaccinated, more chances of having symptoms. And in some studies, poverty has been associated also with a higher proportion. Perhaps they attributed to the fact that there was those people did not have enough time to take rest, and maybe they didn't get adequate care. Also, the use of antivirals like Pax Floyd at the time of having covid is associated with a lower, uh, frequency of having uh, long covid in terms of what lies behind this, what's a pathology? There are still many hypotheses or theories around. None of them have been conclusively proved. Some suggest that there's persistent virus, maybe in the gut and so a bit of antigen keeps, you know, getting released into the blood. Some studies suggest it's an autoimmune phenomenon, that there are auto antibodies that get generated, especially in people who don't have a good initial immune response to the, uh, infection. And others have suggested that there there are other inflammatory pathways which get activated. Clearly, Covid is associated with inflammation. Uh, that causes a lot of the acute damage, and potentially it could cause some of this long term damage as well. Practically every organ in the body has been found to be affected. So Covid wasn't just a respiratory virus, but it had these effects on the cardiovascular system. So we've seen this increasing risk of heart attacks. People who recovered from covid. It causes more diabetes compared to people who have not had covid neurological problems. You know, they found a higher incidence of not only depression and anxiety, but also some cognitive impairment kidney problems, Um, and then this chronic fatigue syndrome, which of course, has been reported previously. You know, after other viral infections and we still scientists still don't know what causes that chronic fatigue syndrome. As far as treatment, there are some clinical trials going on, but there because we don't know the exact, uh, mechanism and pathogenesis There's no specific treatment for, uh, long covid, But, uh, of course, you can treat the symptoms based on which, you know, organ system is impacted. And there are there is a need for more trials, uh, both to find biomarkers that can tell if you know, somebody has this long covid or not, Uh, at the moment, there's no particular blood test to tell you whether you're suffering from long covid. So we need more research on biomarkers. We also need more clinical trials. Uh, and long term follow up studies, especially in different populations like you asked the question about Indians, Um, IC MR is, you know, following up some cohorts other other medical colleges are doing, so we need more of that data to come out. Right, ma'am, thank you very much for speaking to us, Doctor. So, Swaminathan and telling us about you know, the impact and what these results in these, uh, in these studies are now indicating, thank you very much indeed. A new study by the Christian Medical College Velo has some fairly important data coming in on the impact of long covid on Indians and how Covid has actually impacted Indians in a way, perhaps in a more severe way that in many cases in this trial than people in China or in parts of Europe joining us to talk about this Dr. DJ Christopher, one of the authors of this report professor of pulmonary medicine at the Christian Medical College in Velo. Also joined by Doctor Sunila Gar and Doctor Sudarshan Bal All experts in this field Um, Doctor Christopher, let me come to you first. Why? It's a basic question. Are Indians perhaps more predisposed to having a long term impact of covid than people in other parts of the world? Or is that assumption correct? Yeah, I think it's correct. But I would just step back and say that this study was done during the first phase of covid, uh, with the, uh, with some information that the previous SARS covid two that is SARS covid 21, which occurred 15 years before the SARS covid two, which we are very familiar with, and Ms Kovi left the lung with some scars that perhaps did not go away. So this is the basis for our study. And so we evaluated a series of patients and did detailed lung functions and their walking capacity, quality of life and so on. So what startled us was the fact that sensitive lung function tests showed that 44% had an impairment of their lung function. So that was the startling finding. And 35% had what is called a restricted effect, which essentially means that the lung doesn't inflate to normal capacity. And we know that will impact patients ability to work. And also 8% had what is called obstructive ventilatory defect, which is really a obstruction to the passage of air into the lungs. So this this was a summary of the impairments we saw on the Indian population, and this is higher than any study published. The studies done were in Europe and in China. Uh, and we compared the results and it appears that we have had it worse than them. Dr. Garg, you would have gone through this report again. The basic question. Are Indians necessarily more predisposed? See, primarily, it's a very, very important question because we see, you know Indians are more predisposed, but, uh, as we can see that. You know, when we went through the whole period of covid, what we realised was, you know, in terms of presentation of symptoms, it was lung function tests, you know, which are more impaired. And also during the course of time, what we realised was respiratory symptoms were most predominant in Still also, when we are studying, we did one study in Delhi also in which we have recently completed on long term covid. That means follow up from four weeks, 4 to 8 weeks and eight weeks onwards. What we are seeing that you know that respiratory symptoms are much more common. Lung impairment is much more common and definitely we are much more prone for respiratory infections right from our birth. So that's where as has been mentioned, your that you know, there has is prevalence of lung scarring and all that, so that also or chronic obstructive pulmonary disease that makes it more, you know, kind of the study to have presentation of more respiratory system, uh, symptoms as compared to other countries. Dr. Balal, you know, the report itself focuses on a small group in the initial phase of the of the outbreak. But just in terms of your own clinical experience in dealing with patients over a longer period of time, it's been a couple of years since the worst of covid. We do know, of course, that it's here to stay. It appears, you know, what are some of the long term long covid symptoms that you see most commonly? Uh, good evening. Uh, Vishnu, thank you for having me on the show and the devastating once in a lifetime epidemic pandemic of covid sort of shook the medical world and the citizens of this world, and we initially thought it was just a one time respiratory illness. However, we know that Covid is here to stay. And now there's this elegant study from C MC, which proves that Indians unfortunately are more prone. And, uh, I would like to add one more reason other than the panellists that have already given. I think in Indians inherently have less lung capacity, almost a third of less capacity than the Caucasians. And that may be one reason that we have less reserves. The same thing is true in many other organ systems in India, which means you need less of a damage to sort of tilt you over the hill. The second thing is, we have chronic pollution, chronic inflammatory state, maybe genetically more predisposed. And certainly there are more comorbidities in the group of patients like diabetes and hypertension. And I'm sure that's one of the reasons why we saw more lung damage. Lung fibrosis, obstructive lung disease, so on and so forth. The symptoms of lung covid that we see, uh, one of the very common symptoms is very non-specific. People are dull, sort of out of, uh, sorts not feeling up to it. Uh, confused state. This has been going on for long time. We certainly have seen the lung symptoms and diseases that, uh, the panellists have mentioned a very increased incidence of coronary artery disease strokes so on and so forth is something that we have seen. So I think covid has manifested in multiple ways not only in the acute stage, but also is here to stay as long. Covid. Doctor Christopher, what was the breakup of the sample? Men. Women ages. What could you share with us? Uh, so the total sample was 207. Uh, it was, uh, slightly, uh, more male population. I think about 60 or 65% were males. Uh, and you know, for any study where people volunteer, Yeah, you would probably have more males than others. Otherwise, it covered the entire spectrum of patients from 17 years of age, all the way through to perhaps 80 years of age. So we have the entire age spectrum of patients. I just want to, uh, concur with the previous speaker that, uh, you know, there are several likely explanations of why Indians had it worse. Uh, in particular. In this study, we showed that the Indian population had a phenomenally high degree of co comorbidities. We had 72% of our study population, with comorbidities diabetes being the highest in 38% hypertension, 33% and chronic respiratory disease, 29%. So we had a population that was, uh, inherently more unwell. And so it is conceivable that they may have worse damage due to the covid. Um, doctor G. Here's a basic question, and it's simple, but I think a lot of people would want to know. How would you respond to somebody who says if I have diabetes, why should that necessarily affect my lungs. See primarily when you have any of the comorbidities any infection and particularly this SARS covid two when we are talking of this was severe acute respiratory infection, which was predominantly affecting lungs. So any of the comorbidities you know is going to change the spectrum of the disease, whether it is SARS covid two or any other infection, particularly in this case when we were looking at, you know, SARS covid two infection. So that is bound to get exacerbated because of the presence of diabetes and diabetes and hypertension both. And we all know that, you know, now India is a diabetic capital of the world. So you know all the infections they manifest in a much more you know, I'll say that severe form as compared to, you know, the, uh if you don't have any comorbidities. And that's why government of India test on the vaccinations of release and also people younger people with comorbidities Also elder people, in any case are having much more comorbidities as compared to younger ones. But now, with the changing spectrum, you know of the population and demographic divide and stress and strain within the population levels. We know that younger people are also getting diabetes and hypertension comparatively at a much younger age, as compared to, you know, earlier times, Dr. Balal, would you like to add to that that you know it's not? It's an assumption to say that only those beyond a certain age are more susceptible to the impacts of long covid. In fact, a lot of people across sexes and across the age spectrum are equally vulnerable. Is that correct? Uh, yes. Even though it's probably a little more of the elderly population now because they have more comorbidities. I would like to add a couple of things about diabetes. We people generally think, uh, diabetes is just a problem with the sugar. That's not true. It's a systemic disease of metabolism and affects all the blood vessels. And interestingly, Covid also is known to affect blood vessels. The second thing is, diabetes, uh, makes you more prone for infections. And one evidence of this was the devastating black fungus, or mucormycosis infection we had during Covid. So I think there are many reasons why people with diabetes are more prone for any other effects of other diseases, and I'm sure that probably has contributed some to the long covid effects in diabetic and hypertensive patients. Interestingly, I think that there is some suggestion that it also might induce diabetes. Uh, there are. There are suggestions that there was increased number of, uh, diabetes in patients with covid. Covid is a very funny virus. I mean, it's not like the usual virus that only affects the respiratory system. It has multitude of effects. It has vascular effects where you have heart attacks, strokes, gangrene of the intestines, uh, amputations requiring amputations. For people with peripheral vascular disease, it reduces the immunity. It induces diabetes and does a whole host of things. So I think it's a very, very different virus. Um, Doctor Christopher, how do the results of your study compare with other studies elsewhere in the world? How is it different in terms of long covid and data? Yeah. So we were really looking at lung health in the context of, uh, if you would call it lung covid. We are looking at residual lung damage, which which may, you know, kind of continue forever. So, comparison with other data. We we found that, as I said earlier, the impact of on lung function was in 44% of the population, whereas a meta analysis which is a combination of all the studies published which covered China and Europe. These were the places where previously studies had been done. It was 31% so 44% versus 31%. So in comparison with the other studies published, we had more lung function impairment and and in terms of comorbidities which we spoke about, you know, as I said that 72% of our population had comorbidities in a Chinese cohort a Chinese population of exactly the same age, which is an average age of 48 years, the comorbidities for 40%. So we have a clear 30% higher comorbidities than the Chinese group. So these were probably the major differences, So I just wanted to make one point with regard to your previous question on comorbidities. Uh, so we said comorbidities means, uh, you know, we we you know, we always knew that people with comorbidities had more severe covid. People with comorbidities died more. That was kind of foundational knowledge at the time of covid. Also, we know that people with comorbidities have more severe disease, and our study shows that the more severe the initial covid infection, the more affected the lung. So the residual damage to the lung is proportionate to the severity of initial disease, so that that's another factor that we need to be. And by initial disease. In all cases, those affected by Delta have had worse lung damage than those, for example, who had a bad case outbreak of, for example, omicron or some of the other variants and sub variant. Is that right? Absolutely right, so critical, severe, moderate and mild. So in this category, the mild would have the least damage, and the critical and severe would have the highest damage. Ultimately, Um, Doctor Bilal, why don't you take this question? It's about the quality of life which has been impacted for millions of people in India around the world. Billions, not millions, you know, with the lung damage, which people have suffered the long covid that's happening. It's not something that necessarily will just go away. People will just need to adjust and live with it, right? Uh, there's always a silver lining at the end of a cloud, and I think the simple lining is that, uh, we have come out of, uh, covid much better than any other countries. And of course, the hope is that even people with, uh, uh, respiratory damage as long term have good, uh, ways of, uh, good, uh, therapeutic means like pulmonary rehabilitation, nutrition, oxygen support, counselling them on lifestyle modifications. And, of course, the pulmonologist also have drugs that can improve the inflammation of the lungs. So it's not at the end of the world. Certainly there is going to be some discomfort, and a few might actually have severe damage that requires lung transplantation. But it's not like we have lost all hope. Uh, the good news is we have come out of, uh, covid. Uh, I wouldn't say unscathed, but less scared than the rest of the world. All right. I'd like to thank you all very much for joining us. Um, Doctor G, you had a point to me. Go ahead, ma'am. Yeah. Be because when we talk about quality of life, that means we are talking of different domains. When we are talking of different domains. We are talking of six. You know, domains. Whether we talk of physical domain whether we talk of interpersonal domains social domain, you know, So that way you know when we see overall, you know Covid affects. You know, the person as a whole when we talk of fatigue, when we talk of fogging when we talk of forgetfulness. So we see that all domains whether we talk of you know any of the domains, they are all affected by covid as a whole, you know. So overall any disease is we have gone through very bad phase of HIV infection also in recent past. So you know, when we talk of quality of life, we have to express in terms of domains also So it is overall affected the quality of life of the individual as a whole and both, you know, our lens commissions study and the study has been completed in Delhi. Also, they have come up with the similar findings that long term covid is definitely affecting not only the quality of life, but overall, you know, in terms of presentation of symptoms also, that is very important. We all right? A frightening reminder of how this has impacted us in so many ways. I'd like to thank you all very much for joining us and sharing this very important data. Thank you very much.
