Recovered from Covid? Get flu shot to keep pollution impact at bay: Experts

Everyone who has recovered from the coronavirus disease (Covid-19) and lives in a city or region with high air pollution must get a flu shot, recommend clinicians.

Air pollution is known to raise susceptibility, hospitalisations and risk of death of Covid-19 patients, and clinicians warn that it may also exacerbate symptoms of “long Covid”, which is a term used to describe symptoms of Covid-19 persisting weeks and months after recovery.

Since a study found 87% of 143 patients in a Rome hospital had at least one symptom nearly two months after recovery, convalescent clinics have reported several recovered patients with symptoms of cough, fatigue, diarrhoea, joint pain, muscle aches, and lungs, heart, and kidney damage. Fatigue is the most common symptom, with more than half of the patents with “long Covid” in the Rome study reporting chronic fatigue, according to JAMA, the Journal of the American Medical Association.

Older people, women, overweight and obese people, asthmatics and those who have more than five Covid-19 symptoms in the first week are at higher risk of “long Covid”, according to a BBC News report, which quoted a yet-unpublished research at King’s College London to say one in 20 people are sick for least eight weeks.

There is newer evidence that even people with very mild or no symptoms can also develop post-recovery symptoms that may last for several months, with the winter cold and rising pollution worsening post-recovery symptoms.

“With rising pollution, falling temperature and increasing crowding during the festival season, everyone at risk and those with ‘long Covid’ must get vaccinated against the flu to lower severity of post-recovery symptoms and also protect against flu infection,” said Dr Randeep Guleria, director, All India Institute of Medical Sciences, Delhi.

Around 76·8% of India’s population across almost all states were exposed to annual population-weighted mean PM2.5 greater than 40 μg/m3, which is the cut-off set by the National Ambient Air Quality Standards, according to an Indian Council of Medical Research (ICMR) study published in The Lancet in 2018. Delhi, followed by Uttar Pradesh, Bihar, and Haryana, had annual population-weighted mean values of PM2.5 greater than 125 μg/m3, which are at least three times higher than the safe air limit.

It’s no wonder that Delhi-resident Manjiri Jain, 37, feels worse 63 days after recovering from Covid-19 than when she was diagnosed positive in early August.

“I had a very mild infection, with no fever, just a bit of a cough. I was relieved I had escaped the worst of Covid-19, but I was so, so wrong. The cough has persisted for more than two months, and become worse since air pollution has gone up. I now feel breathlessness and tired very quickly, and have a dull, chronic headache,” said Jain, who was told she had “long Covid” when her cough persisted for a week after recovery.

Jain continues to have regular online consultations with her clinician, but she still worries about whether her heart, lungs or kidneys have been damaged.

“The more I read about ‘long Covid”, the more I worry. I can’t go to a hospital for a medical check-up because I don’t want to risk re-infection,” said Jain, who sought treatment for anxiety last week because she is losing sleep worrying about her health.

“Hundreds of Covid-19 patients have been treated at Apollo Hospitals and what we’ve found in large follow-ups is that patients who had pneumonia on chest X-ray, needed oxygen or respiratory support have persistent symptoms beyond recovery, such as a nagging cough, breathlessness while walking, fall in exercise tolerance and chronic fatigue. Older adults and people on oxygen support are at maximum risk, but it doesn’t happen only to people in ICU. I recommend an annual flu vaccine to all recovered Covid-19 patients and a pneumococcal vaccine to protect against pneumonia to people before the age of 65 to protect them from chronic respiratory diseases when the weather turns cold and pollution level peaks,” said Dr Rajesh Chawla, senior pulmonologist and critical care specialist at Indraprastha Apollo Hospitals in Delhi, where he has been treating Covid-19 patients since the hospital established isolation wards on March 26.

A study published in the journal, Environmental Research, in August found that influenza vaccination may moderate the detrimental effects of ambient air pollution on lung function among children, and clinicians believe it will also benefit people with “long Covid”.

“It’s a new disease, we still don’t know enough. So, it’s best for people who have “long Covid” and those at risk to get a flu vaccine in the winter months when infection is likely to go up, and be in constant touch with doctors,” said Dr Chawla

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