The excessive and inappropriate of antimicrobials in treatment of COVID-19 (azithromycin, doxycycline, ivermectin) and in secondary infections are fuelling the raging pandemic of antimicrobial resistance, said Dr Tanu Singhal, Pediatrician and Infectious Disease Specialist, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
She was speaking at the plenary session on “Long Term Consequences of Covid-19 Infection,” during the 108th Indian Science Congress here today. The session was chaired by Dr. Rakesh K. Agrawal, Director, Brahma Management Services, Lucknow, and co-chaired by Dr. Devendra K. Agrawal
Professor and Director, Department of Translational Research, Western University of Health Sciences, Pomona, USA.
Delivering a lecture on “Covid-19 associated secondary infections,” Dr. Tanu Singhal said, secondary infections have been responsible for considerable morbidity and mortality in the pandemic. These secondary infections include drug resistant bacterial infections such as blood stream infections, pneumonia, urinary tract infections and fungal infections like invasive candidiasis, invasive aspergillosis and mucormycosis. The most dramatic secondary infection in the Indian context has been COVID associated mucormycosis(CAM) also termed as “black fungus” in lay media. More than 50,000 cases of CAM were reported in India chiefly during the second wave.
She emphasized that the main reasons for CAM are the immunosuppressive effects of COVID-19 itself, the excessive use of steroids, coexisting diabetes and high fungal spore counts in the Indian environment. While ROM is relatively easy to diagnose, diagnosis of pulmonary mucormycosis is challenging. Treatment of CAM involves surgical debridement and antifungal therapy and is very expensive. The surge of CAM cases actually led to a shortage of liposomal amphotericin B in the country.
Dr. Devendra Agrawal provided a brief overview of Long COVID19 which occur in less than 30% subjects, long-term effect of cytokine storm on body’s immune system, recurring symptoms, stroke, impaired lung function, anosmia, ageusia, overactive autoimmune response, mood changes, anxiety, depression, and others.
Dr Vineet Agrawal, Assistant Professor of Medicine and Cardiology, Vanderbilt University Medical Center, Nashville, USA provided the updated epidemiologic and prognostic evidence defining the long-term myocardial, ischemic, autonomic, and arrhythmogenic complications of COVID-19.
He discussed both common and rare manifestations of cardiomyopathy as a result of COVID-19 infection, including right heart dysfunction, myocardial stunning, and myocarditis related fulminant heart failure.
In particular, he deliberated on the role of COVID-19 infection in acute coronary syndrome, long term symptomatic challenges as a result of COVID-19 infection, and management options and recommendations for chest pain. He discussed the epidemiologic and prognostic implications of arrythmias, both common and life-threatening, as a result of COVID-19 infection. He highlighted the progress that has been made in understanding the mechanisms that drive cardiovascular complications in COVID-19, and emerging management strategies for mitigating these complications.
Dr Vithyalakshmi Selvaraj, Psychiatrist and Managing Director, Omaha Insomnia and Psychiatric Services, USA, spoke on the Long-term impact of COVID-19 pandemic on mental health.
There is significant change (ranging from 10% to ~40%) in the prevalence and burden of mental disorders due to COVID-19 pandemic all over the globe. Symptoms of anxiety, depression, PTSD, stress, and psychological distress have been reported in the general population and the incidence has further increased following COVID-19 infection.
The lockdown during COVID-19, social distancing, reduced social support, loneliness, loss of job, and financial stress are few of the factors to worsen cognitive function and change in the memory.
It is critical to mitigate the hazardous effects of COVID19 on mental health. He discussed high risk factors for emergent and chronic psychiatric disorders due to COVID-19 pandemic, potentially decreased immune response due to depression and other psychiatric illness. He further identified the impact of COVID-19 on patients with psychiatric diagnosis, and potential preventative measures to attenuate the detrimental effects of long COVID/post-COVID-19 syndrome on mental health and cognition.