No matter how mild or severe your Covid was, you are at risk of post-disease complications

Covid-19 survivors are at an increased risk of conditions such as heart attacks, irregular heart rhythm, clotting in the lungs, breathing difficulty, fatigue, pain and anxiety as compared to those who haven’t had the infection, shows an analysis of electronic health records of 63.4 million people released recently the US Centre for Disease Control and Prevention (CDC).
The analysis found that one in five Covid-19 survivors in the 18 to 64 age group experienced at least one of the 26 “incident conditions” a month after and up to a year after their infection. Those above 65 experienced at least one in four conditions.
What does the CDC analysis show?
The analysis compared the rates of the 26 incident conditions among those who had Covid-19 and those who didn’t. It found that 38 per cent of all adults, who had the infection, experienced at least one of these incident conditions as compared to 16 per cent of those who did not.

In the 18 to 64 age category, 35.4 per cent of those with the hory of Covid-19 had an incident as compared to 18.5 per cent among those who did not. The difference was higher for the older age group – 45.4 per cent of those above the age of 65 with a hory of Covid-19 experienced one of the incident conditions, as compared to 18.5 per cent among those who did not have the infection.
The risk for respiratory symptoms and pulmonary embolism (a condition where a clot blocks the blood flow in the lungs) among those with the hory of infection had more than doubled. “There has been a significant increase in the number of patients coming in with these conditions and lingering symptoms. We are seeing these even in patients who had mild disease or those who had Covid-19 one-and-a-half to two years ago,” said Dr GC Khilnani, former head of pulmonology at the All India Institute of Medical Sciences and the current chairperson of the PSRI institute of pulmonary, critical care, and sleep medicine.
In those over 65, the risk of all of the 26 incident conditions was higher in those who had Covid-19 as compared to those who didn’t.

In those between the ages of 18 and 64, the risk was higher for 22 of these conditions in those with a hory of Covid-19. The chances of developing conditions such as cerebrovascular disease, mental health conditions, mood disorders and substance-related disorders remained the same for both groups in those between the ages of 18 and 64.
Among those who had Covid-19, the risk for irregular heart rhythm was higher among the younger population whereas renal failure, thromboembolic events, cerebrovascular disease, type 2 diabetes, muscle disorders, neurologic conditions and mental health conditions were higher among those above the age of 65 years.
How was the study done?
The study used the electronic health records of 63.4 million people from the United States from between March 2020 and November 2021. Of these, 353,164 had a hory of Covid-19 while 1,640,776 were unaffected.
These patients were tracked up to a year to see whether they developed incident conditions: heart attack, irregular heart rhythm, other heart diseases, heart failure, inflammation of the heart muscles, clot in the lungs, respiratory symptoms, asthma, kidney failure, chronic kidney disease, other clotting and bleeding issues, gastro-intestinal symptoms, neurological conditions, smell and taste durbances, mood disorders and other mental conditions, anxiety, sleeping disorder, substance-related disorder, fatigue, pains, and diabetes.
Those living with any of these conditions from before were not included in the study in either group. This is one of the largest studies to quantify the long-term impact of the infection on other health conditions.
What is the situation in India?
Dr Rakesh Yadav, professor of cardiology at AIIMS-Delhi, said, “Heart conditions, fluctuating blood pressure, coagulation defects are very common post-Covid-19. Heart functions get deranged in many. What the study shows is absolutely correct and we can see that through the number of patients in our clinics. There will absolutely be an increase in the disease burden. So now, we routinely ask patients whether they have had Covid-19 when they come to the clinic with any symptoms.”
Describing the patient symptoms he has been observing in his clinic, Dr Khilnani said, “The most common is fatigue and general weakness, headaches, sleep durbances. People, especially those who had the infection during the third wave, have also been experiencing bowel durbances, inability to eat, and nausea. We also see more patients with clotting issues – in the lungs, heart, or sometimes even the abdomen.”
He added, “In fact, some of the people who did not have any symptoms during their Covid-19 infection during the third wave, started feeling unwell after four to five weeks with severe fatigue, headaches, persent coughs. Some reported breathlessness too. In some of them, this was the second or the third infection. After the second wave, we also saw people with lung fibrosis (scarring of the lung tissue).”
What should we do?
The most important thing, the doctors say, is not to ignore any symptoms. “Please consult a doctor whenever you feel something is abnormal. It doesn’t matter if you were hospitalised with Covid-19 or had no symptoms at all, you can still experience post-Covid-19 complications. So, people have to be watchful. There is no need to panic though,” said Dr Yadav.
Dr Khilnani, on the other hand suggested that some people should undergo basic tests four to six weeks after the infection. “If there is breathlessness, if oxygen saturation remains below 94 per cent, if there is persent cough – these patients must undergo some of the tests. They can undergo a lung function test. If everything is normal, they can be advised to take care of their lifestyle. However, if there are abnormalities in the test, then we give them a CT scan. There should be an evaluation of the heart as well. For clotting, we will have to depend on the symptoms and the D-dimer test. Clotting symptoms manifest as pain – in the chest, abdomen, or wherever else the clot might occur – and bleeding,” he said.