COVID-19 POST-COVID MANAGEMENT PROTOCOL July 21 CME INDIA CME 1 CME INDIA CME INDIA Post-COVID-19 Management Protocol First published: 16th August 2021. With the rapid rise in Covid-19 cases in INDIA, CME INDIA has now compiled its own guidelines with inputs from key medical experts. The goal of this document is to help the medical community in managing the current Covid-19 situation. This document will be updated from time to time, so please check www.cmeindia.in and CME INDIA Downloads section regularly. Alternatively, you can choose to navigate to the various key sections of CME INDIA: Explore CME INDIA Repository Examine CME INDIA Case Study Read History Today in Medicine Register for Future CMEs View CME INDIA Downloads 2 CME INDIA Basic Framework By: Dr. Nishith Kumar, MD, FAPSR, Consultant Department of Pulmonary Medicine, OMC, Ranchi. Dr. Akash Kumar Singh, Internist and Diabetologist, Spandan Multi-Specialty Hospital, Vadodara. Dr. Sankararaman N, DM Pulmonary Medicine Fellow at Vallabhbhai Patel Chest Institute, New Delhi. Edited By: Dr. N.K. Singh, MD, FICP, Diabetologist Physician, Dhanbad, Editor - cmeindia.in. Advisor and Reviewer: Dr. Shashank R Joshi, MD, DM, FICP, FACP(USA), FACE(USA), FRCP (Lon, Glsg & Edin) (Padma Shri Awardee 2014). Chair, International Diabetes Federation Southeast Asia, Past Dean, Indian College of Physicians. Member, Covid 19 State Task Force, Maharashtra. Invitee Reviewer Dr. Banshi Saboo, National President, RSSDI, Ahmedabad. Dr. Mangesh Tiwaskar, Consultant Physician & Diabetologist, Mumbai, Hon. General Secretary, API. Invitee Editor Dr. S. K. Gupta, MBBS MD (Med), CFM (France), Senior Consultant Physician, Max Hospital, Delhi. Reviewer Dr. Amita Nene, MD, DETRD, FCCP, Head - Dept. of Pulmonary Medicine, Bombay Hospital & Medical Research Centre, Mumbai. Dr. Chandrakant Tarke, MD, DNB, DM, MNAMS, EDRM, Pulmonologist, Apollo Hospital, Hyderabad. Dr. Murali Mohan BV, Pulmonologist, Narayana Medical Centre, Bengaluru. Inputs: Dr. Anil Kumar Virmani, MD, DRM, FICP, FIACM, FACP, FDI, Consultant Physician and Cardio-Diabetologist, Jamshedpur, Jharkhand. 3 CME INDIA Prof (Dr.) Aravinda J, MD, MRCP (London), Triple FRCP (Edinburgh, London, Glasgow) Chairman & Chief Diabetologist, Dr. Aravind's Diabetes Center, Basaveshwarnagar Bengaluru. Dr. Arvind Gupta, MD, FRCP (Glasgow), FRCP (Edin), FICP, FACE, Senior Consultant and Head, Department of Diabetes, Obesity and Metabolic Disorders, Rajasthan Hospital, Opposite, Jaipuria Govt Hospital, Jaipur-302018 Dr. Brij Mohan, Kanpur, MD, FICP, FICAM, Fellow Diabetes India, Consultant Diabetologist Physician, Kanpur. Dr. Prof Deepak Kumar Jumani, Senior Sexual Health physician and counselor, Asst. prof of medicine Sir JJ group of Govt Hospitals & Govt medical college, Mumbai. Dr. Meena Chhabra, Senior visiting consultant and diabetes specialist sir Gangaram hospital, Delhi. Dr. Sanjeev R. Pathak, Diabetologist, Ahmedabad. Dr. Noni G Singha, MD, FICP, Consultant Physician, Dibrugarh, Assam. Dr. Prabhat Agrawal MD (gold medalist) P g diploma of diabetes (London) MAMS, FRCP, FICP, FACP, FIACM, Professor of medicine, S N Medical college, Agra. Dr. Basab Ghosh, Sr Diabetologist, Agartala, Tripura. Dr. Th. Premchand Singh, MD, FCCP, Commonwealth Medical Fellow, UK. Retired Professor of Medicine, Regional Institute of Medical Sciences, Imphal. Dr. Bijay Patni, Diabetologist & Physician, Kolkata. Dr. Somnath, Medical Director & Chief of Medicine Diabetes Critical care, Tricolour Hospital, Hyderabad. Dr. B. Harish Darla, MD, DNB, MRCP(Endocrinology), MRCP(Medicine), FRCP (Edinburgh & Glasgow), Consultant Physician in Diabetes & Endocrinology, Director: Darla's Health Care, Mysore. Dr. Amit Kumar, M.D. (Derm. & STD), Cosmo, Ranchi. Dr. Vaibhav Agnihotri, (DCH, DNB (Paediatrics), Fellowship Neonatology (IAP), PGPN, Boston, PCBD USA), Jaipur. Dr. Richa Agnihotri, MBBS, DGO, DNB (Obs & Gynae), FGES (lap surgeon), Jaipur. Special Thanks to Dr. Suresh Kumar, Infectious disease specialist, Apollo Hospital, Chennai. Special Thanks to Dr. B. B Rewari, MD, FRCP, Former Asso. Prof. of Medicine, Dr. RML Hospital, New Delhi. Scientist HIV/AIDS/STI/Hepatitis at WHO SEARO. Design and Content Management: Mr. Rishav Manaswi, Founder (Dynamic Cognition), MBA (France), [email protected] 4 CME INDIA Disclaimer This is the first-ever guideline by CME INDIA on Post-COVID-19 Management. It has been framed and reviewed by experts. As there are lots of guidelines and not all agree on the same protocol, physicians are advised to apply their own wisdom especially as recommendations keep changing. Document Flow (Best viewed using Google/Drive pdf viewer. Use below links to go to a specific part.) Introduction (1,2) ................................................................................................................... 7 Timeline of Acute Covid-19 And Post-Acute Covid-19 Phases (1,3,4) ........................................ 8 Epidemiology (3,5) ............................................................................................................... 10 Mechanisms Involved in Post-Acute Covid-19 Syndrome (6) ................................................. 12 Common Lingering Symptoms of Post-Acute Covid-19 Syndrome (7-13) ................................ 13 Post-Covid-19 Symptoms by Organ System ........................................................................... 14 Timing of Follow Up (14-18) .................................................................................................. 18 Assessment (19-20) .............................................................................................................. 19 General Laboratory Testing (19-20)....................................................................................... 20 Cardiopulmonary Assessment (21) ....................................................................................... 21 Chest Imaging (16,22-24) ...................................................................................................... 21 Timing of Chest Imaging (25) ................................................................................................ 22 Cardiac Testing (26) .............................................................................................................. 23 Pulmonary Function Test (16,27,28)...................................................................................... 23 Evaluating Exercise Capacity and Oxygenation (26) ............................................................... 24 Six-Minute Walk Test Technique (29-31) ............................................................................... 24 Alternative To 6 MWT (32) ................................................................................................... 25 Management of Dyspnea ..................................................................................................... 25 Breathing Control (32) .......................................................................................................... 26 Breathing Techniques (32) .................................................................................................... 26 5 CME INDIA Management of Cough (26) .................................................................................................. 27 Management of Chest Discomfort/Tightness/Pain ................................................................ 27 Management of Orthostasis (34) .......................................................................................... 29 Management of Hypercoagulability/Thrombosis .................................................................. 29 Management of Olfactory/Gustatory Symptoms (35-39)....................................................... 30 Management of Fatigue (40) ................................................................................................ 31 Management of Lung Fibrosis (61) ........................................................................................ 31 Rehabilitation (28,41-42) ...................................................................................................... 32 Yoga Practices for Prevention, Rehabilitation, and To Increase Immunity (43-51) .................. 33 Long Haul Syndrome in Children (54-56) ............................................................................... 35 Post-Covid Pregnancy Related Pearls (58,59,60) .................................................................... 39 Post-Covid-19 Diabetes (61-62) ............................................................................................. 40 Post-Covid Dermatological Manifestations ........................................................................... 41 Post-Covid Sexual Issues (67) ................................................................................................ 42 Suggested Useful Link ........................................................................................................... 44 References ........................................................................................................................... 46 6 CME INDIA Introduction (1,2) The COVID-19 pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen which has resulted in both global healthcare crises and strained health resources. The pandemic has also caused morbidity and mortality at an unprecedented scale globally. COVID-19 is now recognized to affect multi-organs