The second covid wave in India was caused by a predominant mutant corona virus, which was more virulent and which resulted in more serious lung disease and hospitalisation. With the second covid wave declining in India, and increase in recovery rate, post recovery many patients are coming with various complications.

Most people who had COVID-19, recover completely within a few weeks. But some people, even those who had milder versions of the disease-continue to experience symptoms after their initial recovery. These health issues are called post-COVID-19 syndromes. They're generally considered to be effects of COVID-19 and persist for more than four weeks after been diagnosed with the COVID-19 virus.

Older people, patients with many comorbidities, patients who had prolonged hospitalisation and have been on oxygen therapy and on ventilator, are the most likely to experience lingering COVID-19 symptoms. Common signs and symptoms that linger over time include:

• Fatigue
• Shortness of breath or difficulty breathing
• Cough
• Joint pain
• Chest pain
• Memory, concentration or sleep problems
• Muscle pain or headache
• Fast heartbeat
• Loss of smell or taste
• Depression or anxiety
• Fever
• Dizziness

Although COVID-19 is seen as a disease that primarily affects the lungs, it can damage many other organs as well. This organ damage may increase the risk of long-term health problems. Organs that may be affected by COVID-19 include, brain, heart and increase in clotting and blockage of blood vessels. These patients are also prone to various secondary bacterial or fungal infections.

The most common complication is lung fibrosis. This type of pneumonia which is often associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to long-term breathing problems. Lung fibrosis post-SARS-CoV-2 infection has been observed in people with an older age, history of smoking, severe illness with CT scan severity score 17/25 and above, prolonged ICU stay and mechanical ventilation. The respiratory fibrosis caused due to infections is unlikely to recover after 21 days of duration. It takes a long time to reverse, till then patients require supportive care and aggressive pulmonary rehabilitation efforts to recover. These patients have progressive and exertional dyspnoea and reduction in walking efficiency (6MWT is reduced). The patients may need to do lung function test and a repeat CT scan chest after three weeks of covid infection to rule out lung fibrosis.

Mild or severe signs of lung impairment post initial infection might go as long as four months. These patients end up with permanent lung damage of varying degrees and might require home oxygen supplementation for a prolonged duration, even after recovering from COVID 19 infection.

The role of available anti-fibrotic therapies like Nintedanib and Pirfenidone, which are used for the treatment of idiopathic pulmonary fibrosis, is still being evaluated for the prevention or reduction of post-COVID fibrosis. Some of these patients may need low doses of corticosteroids.

Also, one should be put on a small dose of blood thinners for at least a month in order to reduce the chances of patient getting a heart attack or a brain stroke.

Some post COVID care such as drinking plenty of fluids, breathing exercises, meditation, nutritious diet, adequate sleep, avoid smoking and drinking should be considered as precautionary measures.It is also important to brisk walk in the first week post recovery, followed by doubling the time in the second week.Post covid, it is ideal to get vaccinated after 90 days.

Secondary bacterial infections with pneumococcus commonly follow influenza disease and use of influenza vaccine and PCV13 may reduce this burden in the elderly and those with underlying illnesses.

Lowering the risk of acquiring a respiratory infectionwill allow for less visits to clinics and less hospital admissions, thus decreasing the burden on the health infrastructure at this time and lowering ones’ exposure to acquiring COVID-19 in the hospitals/clinics.

While the recently authorized COVID-19 vaccines remain the most important strategy for preventing COVID-19, it has been seen that older adults who received pneumococcal conjugate vaccine (PCV13), which prevents acquisition of certain pneumococcal strains, experienced 35% lower incidence of COVID-19 diagnosis, 32% lower incidence of covid hospitalisation, 33% lower incidence of COVID-19 deaths as compared to the adults who did not receive the vaccine. In contrast, an alternative pneumococcal vaccine (PPSV23), which prevents severe pneumococcal disease but does not block acquisition of the bacterium, was not associated with protection.

Pneumococcal vaccination protects against pneumococci after one has had COVID-19. Also, it is safe to get the pneumococcal vaccination; no unexpected side-effects will occur.

Other adult vaccination to prevent Flu is influenza vaccine, also commonly known as Flujab. Flu jab is the best protection against serious complications from flu. After the flu jab, one will have a lower risk of getting flu. And even if one gets the flu, the chances of becoming seriously ill is less, with reduced rate of hospitalisation.