Covid-19 infection affects the respiratory system — mainly the lungs — and while most people recover completely, some are afflicted with prolonged symptoms that can last for several months. This is known as ‘long Covid‘, and it can be mighty damaging for the overall health of a person.
A pathbreaking multi-centre international study, however, has put the spotlight on surgical intervention in patients who have thoracic complications caused by Covid. It has been done in collaboration with Italy, USA, UK, Brazil and India.
The study states that thoracic complication is defined as any condition involving the thorax, which is a “direct or indirect consequence of Covid-19”.
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Speaking with indianexpress.com, Dr Nasser Yusuf, a cardiothoracic surgeon in Kochi — who was involved in the research — explained that just like how tsunami strikes and then vanishes — and leads behind a trail of death and destruction — Covid-19 also incapacitates people. While some die, others manage to survive.
Some others, however, are left with complications. “They are either bed-ridden or living on oxygen. Or they have repeated infections, cough, chest pain, fever, blood in cough,” he said.
Dr Yusuf added that the mainstay of treatment for Covid is medical treatment, cautioning that the infection damages the lungs where there can be formation of blood clots in the post-Covid phase. When medical management fails, and both the lungs are affected, surgical intervention can be considered.
Elaborating on the research, the doctor said they found that while both the lungs of a patient can be affected by Covid — with one lung doing fairly better than the other — one portion of a lung can be drastically affected, which can lead to blood in cough, localised pneumonia, pus in the chest, etc.
The doctor shared a list of conditions wherein a patient could benefit from surgery in post-Covid lung complications:
1. Burst lung (Bronchpleural fistula)
2. Bulla (Blister-like structure on surface of lung that can become large: 10 to 12 cm, and cause severe respiratory distress)
3. Non-resolving pneumonia
4. Pus in the chest cavity (Empyema)
5. Bronchiectasis (honeycomb appearance of the lung), causing recurrent infection
6. Fungal infection (Aspergilloma), which causes hemoptysis
7. Black fungus (Mucormycosis of lung)
8. Pulmonary infarction, where the blood supply to a portion of the lung is cut off due to clots resulting in that part becoming non-functional
“It was a thought: if we could deal with that one diseased/destroyed area of the lung, why not do a surgery and take it out? This was the logic. There was no prior reference to this,” Dr Yusuf shared.
For the study, a total of 83 patients were enrolled, drawn from intensive care, pulmonology and internal medicine departments at different levels of care. All of them were still positive for SARS-Cov-2 RT-PCR at the time of surgery.
At 30 days from surgery, 23 patients died, 45 survived and were discharged and the remaining 15 were still recovering in hospital; 5 patients died after 30 days during hospitalisation; no discharged patient died at home within 30 days. Among the 23 patients who died within 30 days, 13 (16 per cent) died because of postoperative complications, whereas 10 (12 per cent) died for reasons apparently unrelated to surgery and rather linked to the underlying Covid-19 or the disease already present before intervention, the study states.
Ever since the paper was published, the efficacy of surgical methods has increased, the doctor said, adding that more patients are coming in now.
Dr Yusuf said that some “high-risk” patients, however, may not benefit from a surgery if they have comorbidities. Patients who are on extracorporeal membrane oxygenation (ECMO) — an artificial lung — may not do well. Aged people, over the age of 70, may not show desired results post surgery either, along with those who have renal failure and are on dialysis.
“Other comorbidities are fine, for example diabetes, hypertension, mild heart disease; they can be managed,” he concluded.