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Iqra Mazhar

طویل عرصے تک چلنے والے کوویڈکے بارے میں ایک مختصر تباہ کُن کہانی

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

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Debunking Myths About COVID-19 & Anti-Malarial Drugs

Introduction

A pandemic is often a cause of panic, and rightly so, as things are often difficult to make sense of at the start or even in the middle. The looming threat of a deadly illness can lead to irrational fears among people. As expected, the <a href="https://www.merisehat.pk/disease/covid-19">COVID-19 pandemic</a> also gave birth to some strange fears across the world. These ranged from thinking 5G networks cause <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> to drinking disinfectants as a preventive measure. There has also been a lot of misinformation about coronavirus treatments. While some have touted eating garlic to be lifesaving, others have stuck to drinking camel urine.

According to the World Health Organization (WHO), as of 19th May, the world has reported more than 520 million COVID-19 cases and 6 million deaths<a href="#accordion">[1]</a>. Although the first COVID-19 case emerged in November 2019, Pakistan did not report a case until February 2020<a href="#accordion">[2]</a>. However, the fear of an outbreak had already gripped the country way before the detection of the first case. Soon enough, people were sharing various home remedies and myths about the novel coronavirus. Moreover, the pandemic also led to the prescription and use of unauthorized drugs for the treatment of COVID-19. These included antibiotics and antimalarial drugs, among others.&nbsp;

&nbsp;

Understanding The Dangers Of Unsubstantiated COVID Treatments

At the start of the pandemic, scientists conducted multiple studies in hopes to find a cure for the novel coronavirus. They investigated existing drugs such as ivermectin, anti-viral drugs, and antimalarial medications chloroquine and hydroxychloroquine as experimental therapies for COVID-19. Short on time, many doctors also began prescribing these drugs to COVID patients, without any conclusive scientific evidence of their effectiveness.&nbsp;

To make matters worse, the then U.S President, Donald J. Trump admitted to taking the antimalarial hydroxychloroquine as a preventive strategy. Many of Trump&#39;s advisers and doctors supported his decision. The statement was backed by a French trial that had demonstrated a decrease in viral load after just 6 days of treatment with hydroxychloroquine<a href="#accordion">[3]</a>. However, many experts labeled the results from the small-scale study anecdotal and insufficient.&nbsp;

As a result of the drug demonstrating anti-viral effects in experimental models, the U.S. Food and Drug Administration (FDA) further granted both chloroquine and hydroxychloroquine emergency use authorization early in the pandemic. And researchers around the world began conducting large clinical trials to evaluate the drug&#39;s safety and effectiveness against COVID-19. However, many of the trials had to be stopped in the middle due to the drug&#39;s adverse effects on participants. Moreover, many failed to show a significant benefit compared to a placebo group. In a study done among rheumatoid arthritis patients, researchers found a similar incidence of COVID-19 among both groups: 0.89% in hydroxychloroquine users and 0.62% in non-users<a href="#accordion">[4]</a>. Thus, showing that the antimalarial drug does not provide protection against the novel coronavirus.&nbsp;

As a result of the negative results in multiple trials, the FDA later revoked its emergency use authorization for chloroquine and hydroxychloroquine<a href="#accordion">[5]</a>. According to the regulatory body, the benefits no longer outweighed the risks associated with drug use. Thus, resulting in a reversal of the decision.&nbsp;

Despite the evidence, several countries such as Brazil, Pakistan, and India continued administering the antimalarial. Pakistan even banned exports of the drugs to have more available for the treatment of COVID-19. However, the increased prescription and self-medication of the drug resulted in a shortage for those that truly needed them.

&nbsp;

Both chloroquine and hydroxychloroquine are used for the treatment of malaria. Chloroquine works by preventing the malarial parasite from multiplying within the red blood cells. There was a time when it was hailed as a highly effective drug and was widely used to treat malaria. However, over the years, malaria strains have developed resistance to the drug. Therefore, in areas with chloroquine resistance, doctors usually prescribe other antimalarials such as mefloquine or atovaquone.&nbsp;&nbsp;

Hydroxychloroquine is a safer and more soluble metabolite of chloroquine. Both are used for treating or preventing malaria. However, due to their immunosuppressive effects, they are also FDA-approved for treating autoimmune conditions, such as lupus and rheumatoid arthritis.

The most common side effects of using antimalarial drugs are headache, nausea, diarrhea, itchiness, hives, double vision, anxiety, and hair discoloration. Although both are fairly safe, long-term use of these drugs can lead to retinal toxicity, heart toxicity, and even death. Moreover, in COVID-19 patients, antimalarial drugs have been shown to exert severe cardiac side effects. These include disturbances in the heart&#39;s rhythm and, in certain cases, sudden death.&nbsp;

&nbsp;

Chloroquine and hydroxychloroquine are not the only antimalarial drugs that people have used to treat COVID-19. Many have also experimented with the Artemisia plant in the form of herbal teas or supplements to cure the viral disease.&nbsp;

One of the commonly used antimalarial drugs, artemisinin-based combination therapies (ACTs) are produced from extracts of the Artemisia plant. However, no study has found the drug or the plant to exert a positive effect against COVID-19. The WHO has also found no evidence of the plant&#39;s effectiveness against the novel coronavirus.&nbsp;

One antimalarial drug, atovaquone, has shown anti-viral activity in a lab study. Atovaquone is an effective antimalarial drug used in combination with proguanil. Sold under the brand name Malarone, the medication is highly effective in treating chloroquine-resistant malaria. Moreover, atovaquone is also used to treat toxoplasmosis and mild pneumocystis pneumonia infections. Due to the drug&#39;s anti-viral effects against viruses such as Zika and dengue, scientists conducted a laboratory study investigating its effect on infected human lung cells.

The study not only demonstrated the drug&#39;s ability to prevent coronavirus replication in cells but also its effectiveness against various coronavirus variants<a href="#accordion">[6]</a>. Based on these results, researchers are now conducting clinical trials of atovaquone for COVID-19 treatment.

&nbsp;

Conclusion

The start of the COVID-19 pandemic led to scientists scrambling for a cure or breakthrough in the treatment of the novel coronavirus. Since developing new treatments can take a lot of time, researchers turned to drug repurposing. This involves investigating new uses for existing drugs. The strategy is often employed for its time and cost-effectiveness, especially in times like the pandemic.&nbsp;

During the COVID-19 pandemic, researchers repurposed various drugs such as remdesivir, ivermectin, steroids, antidepressants, vitamin C and D, Zinc, and even immunosuppressants. While this led to several safe and effective coronavirus treatments, it also helped establish which drugs don&#39;t work.&nbsp;

Antimalarial drugs, such as chloroquine and hydroxychloroquine, are among the treatment options that did not show a favorable profile against COVID-19. Although, at the start of the pandemic, many countries adopted the drugs without any validated scientific evidence. Antimalarial use was further exacerbated when the then U.S. President Donald J. Trump reported using hydroxychloroquine as a precautionary step. Despite the lack of evidence, people rushed to get their hands on a prescription for the medicine. Moreover, the increased demand led to pharmaceutical companies putting all their resources into increasing drug production. This diverted attention from the production of important pandemic supplies, like face masks, ventilators, and gowns. Experts have criticized people for hoarding these medications and causing shortages for those suffering from malaria, lupus, or rheumatoid arthritis. Moreover, recent trials and studies have proven hydroxychloroquine and chloroquine as ineffective against COVID-19. Many have also related severe side effects to the drug&#39;s use.&nbsp;

Therefore, the WHO urges people to not self-medicate with these or any drugs that have not been backed by any health regulatory body. Moreover, physicians are advised to refrain from administering such treatments to COVID-19 patients.

In conclusion, prevention is the best strategy against COVID-19. Washing hands, maintaining social distancing, and wearing a mask continue to be the best precautionary steps for preventing COVID-19.

&nbsp;

Key points

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The COVID-19 pandemic began in November of 2019 and has infected more than 520 million people across the world.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The pandemic gave rise to several myths and theories about the spread and treatment of COVID-19. From eating garlic to drinking disinfectants, people have done some rather outlandish things to protect themselves.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">One such myth surrounded the use of antimalarial drugs to treat COVID-19. Early in the pandemic, several scientists also supported the theory, citing successful result from small scale in-vitro studies.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">As the use of chloroquine and hydroxychloroquine increased worldwide, it also led to the development of severe side effects among COVID-19 patients.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Multiple trials also investigated the effects of these drugs on the novel coronavirus. However, none could demonstrate any benefits. Moreover, many clinical trials ended halfway due to the occurrence of severe cardiac side effects among trial patients taking hydroxychloroquine.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Other than chloroquine and hydroxychloroquine, people have also explored the Artemisia plant for its anti-viral properties. The plant's extracts are used for making artemisinin-based combination therapies (ACTs) for malaria. However, studies have not found the plant to have anti-COVID activity.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">So far, atovaquone is the only antimalarial that has shown anti-viral properties against COVID-infected lung cells. The laboratory study is now being converted into a clinical trial to help scientists better understand the drug's mechanism of action and safety.&nbsp;</li></ul>

[1] WHO, 2022. WHO Coronavirus (COVID-19) Dashboard. [Online].

[2] Habib, M. & Abbas, M., 2021. Facing the Threat of COVID-19 in Pakistan: A Nation’s Dilemma. Value in Health Regional Issues, Volume 24, pp. 90-95.

[3] Gautret, P. et al., 2020. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents.

[4] Favalli, E. G. et al., 2020. Role of antimalarials in COVID-19: observational data from a cohort of rheumatic patients. Annals of the Rheumatic Disease, 80(5).

[5] FDA, 2020. Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine. [Online].

[6] Carter-Timofte, E. M. et al., 2021. Antiviral Potential of the Antimicrobial Drug Atovaquone against SARS-CoV-2 and Emerging Variants of Concern. ACS Infectious Diseases, 7(11), pp. 3034-3051.

Nimrah H. Sattar

COVID-19: The Chronicles of CKD

Studies have shown that <a href="https://www.merisehat.pk/disease/chronic-kidney-disease">chronic kidney disease (CKD)</a> patients are more vulnerable to COVID-19 infection and mortality, than the general population.

In December of 2019, the emergence of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> led to countries and governments implementing several compulsory measures to curb the spread of the virus. These included quarantine measures, restricting mass gatherings and events, closure of schools and businesses, and reducing the frequency of public transport. While these measures have had a great impact on everyone&rsquo;s mental health, the unpredictability of the virus has further exacerbated the psychological distress.

&nbsp;

Understanding The Effect Of COVID On CKD

Throughout the pandemic, researchers have hypothesized that the SARS-CoV-2 virus not only affects the respiratory system but also other organs and systems in the body. So the question arises are the kidneys also at risk of the effects of COVID-19?&nbsp;&nbsp;

People with severe COVID and no underlying kidney problems often show signs of kidney damage such as blood in the urine. Moreover, studies have shown that chronic kidney disease (CKD) patients are more vulnerable to COVID-19 infection and mortality than the general population<a href="#accordion">[1]</a>. The infection can lead to a high frequency of renal abnormalities, including protein and blood in the urine with elevated levels of creatinine and urea in the blood<a href="#accordion">[2]</a>. Additionally, CKD is associated with an increased risk of pneumonia and pneumonia-related deaths in COVID-19 patients<a href="#accordion">[3]</a>. However, despite all this evidence, there is a lack of information on the impact of COVID-19 on various stages of CKD.&nbsp;

Chronic kidney disease (CKD), or chronic kidney failure, results in the loss of kidney function. The organs lose their ability to filter excess fluid and waste products from the blood. As a result, fluids, electrolytes, and waste products build up in the blood leading to kidney damage. The common signs and symptoms of CKD include nausea, vomiting, fatigue, loss of appetite, muscle cramps, swelling of feet and ankles, hypertension, and shortness of breath. CKD eventually results in end-stage kidney failure, which requires frequent dialysis or a kidney transplant.

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Studies have shown that 30% of patients hospitalized with COVID-19 develop kidney injury. Whereas more than 50% in the intensive care unit may require dialysis<a href="#accordion">[4]</a>. However, with improvements in treatment, there has been a significant decrease in the rates of dialysis. The risk of kidney disease is higher in patients with co-existing chronic conditions such as high blood pressure and diabetes.&nbsp;

The impact of the coronavirus on the kidneys is quite complex. Below are some explanations of how COVID-19 may damage the kidneys:&nbsp;

&nbsp;

<h5>1. The Virus May Target The Kidney Cells&nbsp;</h5>

Kidneys have receptors that enable the coronavirus to attach to them and infect the renal cells. The virus invades the cells, replicates, and damages the kidney tissues. Researchers have also found similar receptors on the cells of the lungs and heart, making them vulnerable as well.&nbsp;

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<h5>2. A Lack Of Oxygen Can Cause Kidneys To Malfunction&nbsp;</h5>

In severe COVID, pneumonia can cause critically low levels of oxygen. It is hypothesized that these abnormally low levels can contribute to renal problems in COVID patients.

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<h5>3. Cytokines Can Destroy Kidney Cells&nbsp;</h5>

From what we know so far, the body releases too many cytokines at a much higher rate than normal as a reaction to the coronavirus infection. This is known as a &lsquo;cytokine storm&rsquo;. The immune response to COVID-19 can be quite extreme in some people, causing a sudden influx of cytokines. Cytokines are small proteins that communicate with the immune system and fight off infections. This immune response can cause severe inflammation that can destroy healthy tissue, including tissues of the kidneys.&nbsp;

A cytokine storm is not only a common complication of COVID-19 but also other respiratory diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).&nbsp;

&nbsp;

<h5>4. COVID-19 Blood Clots Can Clog The Kidneys&nbsp;</h5>

The kidneys&rsquo; function is to filter out waste products, toxins, and extra water. However, COVID-19 can significantly impair renal functioning by forming blood clots within renal vessels. The cytokine storm associated with the viral infection results in the release of clotting factors into the bloodstream. Thus, resulting in clot formation within the blood vessels in the lungs, legs, and kidneys.&nbsp;

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People with chronic kidney disease, or any other chronic medical condition, are at a higher risk of developing severe illness. Additionally, people on dialysis have a weaker immune system which makes it more difficult to fight off infections. Similarly, people with kidney transplants are on anti-rejection medications, also known as immunosuppressive medications, to keep the immune system less active. This makes it more difficult to fight infections. While it is important to keep taking these medications, it is equally important to wash your hands, maintain good hygiene and follow COVID-19 precautions.&nbsp;

Though kidney patients need to continue with their follow-ups and dialysis treatments, it is also essential to take the following precautions:

<ul>
	<li>Limit close contact in public spaces and keep away from those who are sick.</li>
	<li>Wear a mask outdoors and indoors.</li>
	<li>Wash your hands often.</li>
	<li>Avoid crowds.</li>
	<li>During an outbreak, try and stay at home.</li>
</ul>

&nbsp;

Key Points

<ul><li>During the lockdown period, a lack of personal protective equipment, and limited transport for follow-ups and acquiring drugs caused an increased threat to the health of CKD patients.</li><li>Studies have shown that compared to the general population, chronic kidney disease patients have an increased risk of severe illness.&nbsp;</li><li>COVID-19 can also lead to kidney damage. Thus, kidney patients need to take precautions to prevent the severe consequences of infection.</li></ul>

[1] Okoro, R.N., 2021. COVID-19 pandemic: The role of community pharmacists in chronic kidney disease management supportive care. Research in Social and Administrative Pharmacy, 17(1), pp.1925-1928.

[2] Naicker, S., Yang, C.W., Hwang, S.J., Liu, B.C., Chen, J.H. and Jha, V., 2020. The novel coronavirus 2019 epidemic and kidneys. Kidney International, 97(5), pp.824-828.

[3] Henry, B.M. and Lippi, G., 2020. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. International urology and nephrology, 52(6), pp.1193-1194.

[4] Hirsch, J.S., Ng, J.H., Ross, D.W., Sharma, P., Shah, H.H., Barnett, R.L., Hazzan, A.D., Fishbane, S., Jhaveri, K.D., Abate, M. and Andrade, H.P., 2020. Acute kidney injury in patients hospitalized with COVID-19. Kidney international, 98(1), pp.209-218.

Staff Writer

Ismail Munir

This article or video has been viewed by many visitors, and is popular.

COVID-19: Unmask Your Mental Health

The COVID-19 pandemic has drastically changed people&rsquo;s lifestyles. The new normal is a combination of altered daily routines, uncertainty, social isolation, and financial pressures. People are constantly worried about getting sick, their jobs being affected, and the pandemic never-ending. Moreover, the rumors and overload of misinformation can make individuals feel out of control or unclear about their goals. The pandemic can lead to <a href="https://www.merisehat.pk/article/how-to-manage-anxiety">feelings of anxiety</a>, stress, fear, and loneliness which can all worsen with time

According to surveys, there is an increase in the number of adults who report symptoms of stress, anxiety, insomnia, and <a href="https://www.merisehat.pk/disease/depression">depression</a> during COVID-19 compared to the ones before the pandemic. Some people have also increased their consumption of alcohol and smoking, both of which can trigger depression and anxiety. Moreover, substance abusers, especially those addicted to tobacco or opioids, are at a higher risk of COVID-19 and adverse outcomes such as hospitalizations and death<a href="#accordion">[1]</a>. This is because addictions can harm the function of the lungs, and weaken the immune system. Furthermore, they lead to chronic conditions, like heart and lung diseases, which can increase the risk of serious COVID-19 complications. Therefore, it is important to learn self-care strategies and get the required care.

&nbsp;

Understanding The Impact Of COVID On Mental Health

The high number of cases during the COVID-19 pandemic has placed immense stress on healthcare professionals (HCPs). Long work hours and limited resources further add to their mental distress. Therefore, the mental health of caregivers should be given equal importance.

A cross-sectional study, conducted across multiple hospitals in Karachi, Pakistan, assessed depression and anxiety scores of healthcare professionals posted in the COVID-19 wards. The Depression Anxiety Stress Scale-21 was used to calculate their scores. According to the results, 72.3% of the participants suffered from moderate to extremely severe depression, 85.7% suffered from moderate to extremely severe anxiety, and 90.1% of participants reported moderate to extreme levels of stress<a href="#accordion">[2]</a>.

The presence of psychological ailments such as stress, anxiety, and depression in HCPs points to the need for regular mental health checks. However, that cannot be possible without the intervention of higher authorities.

&nbsp;

The COVID-19 pandemic caused the implementation of social restrictions, leading to an increase in mental health issues among people.&nbsp;

A study conducted in Lahore, Pakistan measured the impact of COVID-19 on anxiety levels and obsessional thinking in clinical and non-clinical populations. The online survey consisted of a demographic profile and two scales: CAS (Coronavirus Anxiety Scale) and OCS (Obsession with COVID-19 Scale). All the participants were aged eighteen and above. A total of 240 people filled out the survey, comprising 20% men and 80% women.

According to the results, there was a positive correlation between anxiety and obsessions related to COVID-19. Overall results of the study depicted that the average adult population of Lahore does not suffer from dysfunctional anxiety or obsessions linked with COVID-19<a href="#accordion">[3]</a>. In contrast, studies conducted in other countries have indicated high levels of anxiety and obsession related to COVID-19 within their population.&nbsp;

&nbsp;

<h4>"Not all COVID infections lower the oxygen saturation. Check out your oxygen levels with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

The CDC claims that people with specific mental health conditions have a higher risk of COVID-19. They may require hospitalization and ICU admission. Moreover, the severity of the symptoms can also lead to death among these patients.

The mental disorder schizophrenia ranks second to aging as a risk factor for COVID-19<a href="#accordion">[4]</a>. A study published in JAMA Psychiatry demonstrated higher COVID-19 mortality rates among schizophrenics<a href="#accordion">[5]</a>. However, other factors could also play a role, for example, age, race, medical conditions, and sex. Another study reported higher odds of COVID-related death and hospitalizations in people with mood disorders<a href="#accordion">[6]</a>.

Therefore, it is recommended that people who are at a higher risk of severe COVID-19 work in collaboration with their healthcare providers for the management of their condition. Moreover, getting vaccinated and keeping up with booster shots are a must.

&nbsp;

Stress is a normal human response to unforeseen circumstances. Everyone reacts to stress differently and it is completely normal to be stressed during a pandemic. However, multiple challenges, for example, the effects of COVID-19 can push you beyond your coping capabilities. As a result, many people develop mental health concerns like anxiety symptoms and depression during this period. Despite multiple efforts, some of them will feel helpless, sad, and angry, which further hinders their overall quality of life.&nbsp;

If you notice a decline in your mental health, ask for help.

&nbsp;

[1] Volkow, N., 2020. New evidence on substance use disorders and COVID-19 susceptibility. NIDA.

[2] Sandesh, R., Shahid, W., Dev, K., Mandhan, N., Shankar, P., Shaikh, A. and Rizwan, A., 2020. Impact of COVID-19 on the mental health of healthcare professionals in Pakistan. Cureus, 12(7).

[3] Majeed, S., Schwaiger, E.M., Nazim, A. and Samuel, I.S., 2021. The Psychological Impact of COVID-19 Among Pakistani Adults in Lahore. Frontiers in Public Health, 9.

[4] Mohan, M., Perry, B.I., Saravanan, P. and Singh, S.P., 2021. COVID-19 in people with schizophrenia: potential mechanisms linking schizophrenia to poor prognosis. Frontiers in Psychiatry, 12, p.684.

[5] Nemani, K., Li, C., Olfson, M., Blessing, E.M., Razavian, N., Chen, J., Petkova, E. and Goff, D.C., 2021. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA psychiatry, 78(4), pp.380-386.

[6] Ceban, F., Nogo, D., Carvalho, I.P., Lee, Y., Nasri, F., Xiong, J., Lui, L.M., Subramaniapillai, M., Gill, H., Liu, R.N. and Joseph, P., 2021. Association between mood disorders and risk of COVID-19 infection, hospitalization, and death: a systematic review and meta-analysis. JAMA psychiatry, 78(10), pp.1079-1091.

تعارف

کوویڈ 19 کا پہلا کیس نومبر 2019 میں سامنے آیا۔ مگر مارچ 2020 میں عالمی ادارہ صحت نے اس بیماری کو وبائی مرض قرار دے دیا۔&nbsp; 
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گزشتہ سال کےدَوران،بہت سے لوگوں نے یورپی ممالک میں سفر کرنا شروع کیا۔ لاک ڈاؤن کےحالیہ اقدامات،اورہوائی سفر پربین الاقوامی پابندیوں کی صورت حال کے پیش نظر،اِس معاملے پربہت سےلوگوں کو کوئی تعجّب نہیں ہوگا۔لیکن حیرت انگیز بات یہ ہےکہ اُن میں سے ہزاروں لوگ اپنی زندگی بھرکی جمع پونجی کو اِن یورپی ممالک تک پہنچنےپرخرچ کر رہے ہیں۔کیا اُنہیں ایسی چُھٹّیوں کی اشد ضرورت ہے؟یا وہ کسی اور بڑی بات کی تلاش میں ہیں؟ 
 
BMJکے ایک مطالعے کے مطابق،زیادہ دنوں کےکوویڈ کے ساتھ سُوِٹزر لینڈ،قبرص،اور جرمنی کا سفر&quot;خون صاف کرنے&quot;کےلئے کر رہے ہیں.<a href="#accordion">[1]</a>&nbsp;اگرچہ یہ بات ایک شیطانی عمل کی طرح لگتی ہو،تاہم یہ ایک تجرباتی علاج ہےجو اِن ممالک کے پرائیویٹ کلینکس کی جانب سے پیش کیا جارہاہے۔ایک اطلاع کے مطابق،مریض 15,000یورو سے40,000یورو تک اس علاج پر،اپنی تکلیف دہ علامات میں کچھ آرام حاصل کرنے کے لئےخرچ کررہے ہیں.<a href="#accordion">[1]</a> اگرچہ،کوویڈ 19کے علاج کےحوالے سےخون کی صفائی کے علاج پر تاحال تحقیق کی کمی ہےتاہم زیادہ دنوں &nbsp;کے کووِیڈ کے مرض میں مبتلا افراد اِس ضمن میں بے چَین ہیں۔صحت کے بہت سے ماہرین کی جانب سے اُن کی علامات کی نفی کئے جانے اور ہر قِسم کے کتابی علاج کےبعد وہ کچھ بھی کرنے کے لئے تیار ہیں۔

یہ صورت حال بڑی حیرت انگیز ہے کہ&nbsp;زیادہ دنوں تک جاری رہنے والا کووِڈ کا مرض کس قدر سنگین ہے کہ لوگ دُور افتادہ مقامات پر،خون کی صفائی والے غیر تصدیق شُدہ علاج کے لئے،جانے پر تیار ہیں۔

&nbsp;اِس عالمی وبا کے دَوران،تحقیق کاروں کو اس عجیب کرونا وائرس (SARS-CoV-2)کی شِدّت،منتقلی اور اس کے طریقہ کار کے بارے میں نمایاں معلومات حاصل ہوئیں۔اس طرح وقت گزرنےکے ساتھ،&nbsp; کوویڈ 19سانس کی بیماری سے بڑھ کر مختلف جسمانی نظاموں کو متاثر کرنے کا ذریعہ بن گیا ہے۔ اگرچہ کرونا وائرس اور کوویڈ 19 کے حوالے سے ہمارے بہت سے سوالات کے جوابات مِل گئے ہیں لیکن اب بھی بہت سے راز باقی ہیں۔ایک ایسا ہی راز&nbsp; زیادہ دنوں &nbsp;تک لاحق کوویڈ 19ہے۔ 
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کوویڈ کے طویل مدتی اثرات کی وضاحت

کوویڈ 19 کاپہلا کیس نومبر 2019 میں سامنے آیا۔تاہم عالمی ادارہ صحت نے اسے مارچ2020اِسےایک عالمی وبا قرار دِیا۔<a href="#accordion">[2]</a>29 جولائی2022 تک دُنیا بھر میں&nbsp;کوویڈ 19کے57 ملین انفکشن اور6.3 &nbsp;ملین اموات کو ریکارڈکیا گیا۔<a href="#accordion">[3]</a>

اُصولی طورپر،ہلکے یا معتدل درجے کاکرونا وائرس انفکشن دَو ہفتوں تک رہتا ہے۔تاہم بعض صورتوں میں اِس کی علامات انفکشن سے کئی مہینے بعد تک جاری رہتی ہیں یا ایک بار بھالی کےبعد دُوبارہ بھی لاحق ہوجاتی ہیں۔اِسے زیادہ دنوں سے لاحق کووِڈ کہتے ہیں۔

عالمی ادارہ صحت کے مطابق، زیادہ دنوں تک لاحق کووِڈ ایسے افراد کو ہوتا ہےجن کو ممکنہ طور پر یا یقینی طور پر کرونا انفکشن رہا ہو،خاص طور پر COVID-19 کے آغاز سے تین ماہ کے دَوران&nbsp;اِس کی علامات کم از کم دَو ماہ تک جاری رہتی ہیں۔<a href="#accordion">[4]</a> اور انہیں کسی اور بیماری سے منسلک نہیں کیا جاسکتا۔

کوویڈ 19 کےتقریباً10-20%مریضوں کو زیادہ دنوں تک لاحق کووِڈ ہوجاتاہے۔<a href="#accordion">[4]</a>Lancetمطالعےکےمطابق،برطانیہ کی آبادی میں سے 1.5%لوگوں نے،جولائی2021 میں،زیادہ دنوں تک لاحق ہونے کی اطلاع اپنے طور پر دی۔<a href="#accordion">[5]</a>مزید یہ کہ،انفکشن کی سب سے زیادہ شرح35 سے69 سال کی عمر والے افراد میں پائی گئی۔اس کے برعکس،جنوب مشرقی ایشیا میں زیادہ دنوں &nbsp;تک لاحق کووِیڈبڑی حد تک نامعلوم ہے۔ممکن ہے کہ اِس کا سبب تحقیقی مطالعات کی کمی ہو۔ہندوستان میں کئےجانے ایک مطالعےکےمطابق، 29.2%مریضوں کو &quot; زیادہ دنوں &nbsp;تک لاحق &quot; کووِڈ تھا۔ایک اور مطالعہ&nbsp; پاکستان میں کیا گیا تھا۔اِس کےمطابق83.7%مریضوں میں علامات کی موجودگی،کووِیڈ سےایک ماہ بعد تک بھی رہی۔<a href="#accordion">[6]</a> 
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یہ علامت اکثر اوقات نہایت پریشان کُن ہوتی ہیں اور یہ انسان کی زندگی کو مجموعی طورپر متاثر کرتی ہیں۔عالمی ادارہ صحت نے زیادہ دنوں &nbsp;تک لاحق کووِیڈ کی33 علامات بیان کی ہیں۔سب سے زیادہ عام علامات درج ذیل ہیں

<ul dir="rtl">
	<li>تھکن</li>
</ul>

<ul dir="rtl">
	<li>سانس لینے میں دُشواری</li>
</ul>

<ul dir="rtl">
	<li>دِماغ میں دُھندلاہٹ یا توجّہ مرکوز کرنے میں دُشواری</li>
</ul>

<ul dir="rtl">
	<li>سَردرد</li>
</ul>

<ul dir="rtl">
	<li>سُونگھنےیاچکھنےکی صلاحیت میں تبدیلی</li>
</ul>

<ul dir="rtl">
	<li>دِل کی دھڑکن</li>
</ul>

<ul dir="rtl">
	<li>جوڑوں یا عضلات میں درد</li>
</ul>

<ul dir="rtl">
	<li>ماہواری میں بے قاعدگی</li>
</ul>

<ul dir="rtl">
	<li>پیٹ میں درد</li>
</ul>

<ul dir="rtl">
	<li>دستوں کی بیماری 
	&nbsp;</li>
</ul>

پاکستان میں کئے جانے والے ایک سروے کے مطابق،کوویڈ 19کے مرض سے زندہ بچ جانے والے افراد میں،جسم میں درد،مزاج کی شگفتگی میں کمی،اور کھانسی سب سے زیادہ عام علامات پائی گئیں۔<a href="#accordion">[7]</a>حال ہی میں برمنگھم یونیورسٹی کے تحقیق کاروں نےبرطانیہ کے کووِڈ مثبت افراد کی صحت کے ریکارڈز کا تجزیہ کیا۔<a href="#accordion">[8]</a>&nbsp;اِس مطالعے کا مقصد یہ تھا کہ ہسپتال میں داخل نہ ہونے والے مریضوں میں،انفکشن سے12ہفتوں کے بعد،سب سے زیادہ پائی جانے والی علامات کا پتہ لگایا جاسکے۔حاصل ہونے والے نتائج کے مطابق،شُرکاء میں ،زیادہ دنوں &nbsp;تک سے لاحق کووِیڈ کی سب سے زیادہ عام علامات میں،سُونگھنے کی حِس کا ختم ہوجانا،بالوں کا گِرنا،چھینک آنا،انزال میں دِقّت ہونا،اور جنسی خواہش میں کمی آنا،شامل تھیں۔<a href="#accordion">[8]</a>

لیکن یہی مکمل احوال نہیں ہے۔زیادہ دنوں &nbsp;تک سے لاحق کووِڈ کا تعلق طویل عرصے تک جاری رہنے والے نفسیاتی اثرات سے بھی ہے۔

ایک عام اشاعت سے پہلے کے مطالعے کے مطابق،کووِیڈ کے مریضوں کی 22 مہینوں کے فالو اَپ کے بعد ظاہر ہونے والی نفسیاتی علامات کےخاکے میں، ڈپریشن اور تشویش&nbsp; کی بڑھی ہوئی علامات پائی گئیں۔<a href="#accordion">[9]</a>&nbsp;اس طرح ایسے مریضوں کی ذہنی صحت کی مانیٹرنگ اور معاونت کی فراہمی کی اہمیت اُجاگر ہوتی ہے۔ 
&nbsp;

<h5 dir="RTL">اتنی طوالت کیوں؟</h5>

اس بات سے قطع نظر کہ آپ کا انفکشن ہلکے درجے کا تھا یا سنگین درجے کا، لیکن زیادہ دنوں &nbsp;تک لاحق کووِڈ کا خطرہ موجود رہتا ہے۔یہ صورت کیوں کہیں ظاہر ہوتی ہے اور ظاہر نہیں ہوتی،اس کا سبب معلوم نہیں ہے۔مزید یہ کہ علامات اور اِن کی شِدّت بھی ہر فرد کے لئے مختلف ہوتی ہے۔

زیادہ دنوں &nbsp;تک لاحق کووِیڈ&nbsp; کے حوالے سےتحقیق کاروں نے مختلف نظریات پیش کئے ہیں،جب کہ بہت سے مطالعات ابھی جاری ہیں،تاہم درج ذیل عوامل سے خطرات کا ِمکان بڑھ جاتا ہے<a href="#accordion">[10]</a>

<ul dir="rtl">
	<li>COVID-19 کا شدید انفکشن</li>
</ul>

<ul dir="rtl">
	<li>صحت کی متعلقہ کیفیات</li>
</ul>

<ul dir="rtl">
	<li>ویکسین نہ کروانے والے افراد</li>
</ul>

<ul dir="rtl">
	<li>COVID-19 کا دُوبارہ انفکشن</li>
</ul>

<ul dir="rtl">
	<li>کووِڈ کے شدید انفکشن کے دَوران ،اعصابی علامات کی موجودگی </li>
</ul>

<ul dir="rtl">
	<li>انفکشن کے دَوران ہسپتال یا آئی سی یو&nbsp; میں داخل ہونا</li>
</ul>

تاہم بہت سے صحت افراد&nbsp; میں جنہیں مندرجہ بالاکوئی بھی&nbsp; صورت درپیش نہیں تھی لیکن اِن میں طویل عرصے سے لاحق کووِیڈ کی علامات ظاہر ہوئیں۔ 
&nbsp;

<h5 dir="RTL">آنکھیں&nbsp;زیادہ دنوں&nbsp; تک لاحق کووِیڈ کا اشارہ دیتی ہیں</h5>

تحقیق کاروں کا نظریہ ہے کہ زیادہ دنوں &nbsp;تک لاحق کووِڈ کے مریضوں میں اعصابی علاما ت کی موجودگی،اعصاب کےضائع ہونے کی نِشان دہی کرتی ہے۔لہٰذا، آنکھ کےقرنیہ میں چھوٹے اعصابی فائبر کےضائع ہونے کی صورت میں اس کیفیت میں مبتلا فرد کی نِشان دہی ہوسکتی ہے۔<a href="#accordion">[11]</a>&nbsp;تاہم فی الوقت،طویل عرصے سے لاحق کووِڈ کی تشخیص کے لئے کوئی ٹیسٹ دستیاب نہیں ہے۔اِس کے علاوہ اس کی مختلف علامات کی وجہ سے ڈاکٹر کے لئے درست تشخیص کرنا مشکل ہوتا ہے۔ 
&nbsp;

خون کی صفائی جسے apheresisبھی کہا جاتا ہے۔اِس پروسیجر میں خون کے انفرادی اجزاء کو ایک مشین کے ذریعے فلٹر کیا جاتا ہے۔اسے sickle cell anaemia اورleukaemiaجیسی بیماریوں کے لئے استعمال جاتا رہا ہے۔اِس پروسیجر میں،ایک بازو میں سے سوئی کےذریعے خون کو نکال کر اسےفلٹر&nbsp; سسٹم سے گزارا جاتا ہے اور اس کے بعد فلٹر کئے ہوئےکو سوئی کے ذریعے دوسرے بازو میں داخل کیا جاتاہے۔

زیادہ دنوں تک لاحق کووِڈ کی صورت میں،ڈاکٹرزمندرجہ بالا طریقے کو lipids اورسوزش پیدا کرنے والےproteins متعلقہ فرد کے خون سے نکالا جاتا ہے۔ تحقیق کاروں کا نظریہ ہے کہ خون کےخوردبینی لوتھڑے،جنہیں خورد بینی لوتھڑے بھی کہا جاتا ہے،جو باریک &nbsp;شریانوں میں رُکاوٹ پیدا کرنے والا مادّہ بن کر جم جاتے ہیں۔اس طرح آکسیجن کی فراہمی کم ہوجاتی ہے اورطویل عرصے سے لاحق کووِیڈ کی راہ ہموار ہوتی ہے۔<a href="#accordion">[1]</a>&nbsp;لہٰذا،اُن کی تجویز یہ ہے کہ سوزش کرنے والے proteins کو متعلقہ فرد کےخون سے باہر نکال دِیا جائے۔خون کی صفائی علاوہ مریضوں کو خون پتلا کرنے والی اور لوتھڑے نہ بننے والی ادویات دی جاتی ہیں۔تاہم اس پروسیجر کے مؤثر ہونے کی تصدیق ہونا ابھی باقی ہے۔

اگرچہ چند لوگوں کی علامات میں بہتری آنے کی اطلاعات ہیں، بہت سے لوگوں کو کوئی فرق نہیں پڑا۔درحقیقت کلینیکل ٹرائلز کے بغیر اس پروسیجر کے فوائد اور خطرات کے بارے میں کچھ نہیں کہا جاسکتا۔ 
&nbsp;

اگر چہ،زیادہ دنوں &nbsp;تک لاحق کووِڈ کا فی الوقت کوئی علاج دستیاب نہیں ہیں،تاہم بہت سی احتیاطر تدابیر سےانفکشن کےخلاف بچاؤ ہوسکتا ہے اور بالآخر کووِیڈ کےبعد کی علاما ت کو بھی ختم کیا جاسکتا ہے۔اپنے بچاؤ کے لئےدرج ذیل طریقے بہت اچھے ہیں:

<ul>
	<li dir="rtl" style="text-align: right;">جہاں لوگوں کی کثرت ہو (خاص طور پرعمارت کے اندر)وہاں&nbsp;چہرے کا ماسک استعمال کیجئے &nbsp;</li>
</ul>

<ul dir="rtl">
	<li>اپنے ہاتھوں کو صابن اور پانی سے دَھولیجئے۔</li>
</ul>

<ul dir="rtl">
	<li>چھینکتےیا کھانستے وقت اپنےہاتھ سے ناک یا مُنہ کو ڈھک لیجئے</li>
</ul>

<ul dir="rtl">
	<li>کوویڈ 19سےبچاؤ کی ویکسین لگوائیے</li>
</ul>

<ul>
	<li dir="rtl" style="text-align: right;">کوویڈ 19کی علاما ت والے افراد کے قریب نہ جائیے&nbsp; 
	&nbsp;</li>
</ul>

خلاصہ

اگرچہ اس نئےکرونا وائرس کو طویل مدّتی پیچیدگیاں پیدا کرنے کی وجہ سےکراب نام دِیا گیا ہے،لیکن اس معاملےمیں یہ اکیلا نہیں ہے۔بہت سے انفکشن والےدیگر امراض&nbsp; کا بھی انفکشن کے بعد کا نام ہے، مثلاًEpstein Bar Virus (EBV)، Lyme disease&nbsp;,Giardia lambila&nbsp;اور بہت سے دیگر وائرل انفکشن۔اِن امراض کےبعد بیان کی جانے والی باتوں سے تھکن،فہم کی عدم فعّالیت،عضلات میں درد، مزاج میں خلل،اور اعصابی علامات پیدا ہوسکتی ہیں۔مزید یہ کہ، عام طور پر وائرل انفکشن کے بعدتھکن کی علامات پیدا ہوجاتی ہیں۔

کووِڈ انفکشن کےبعد ظاہر ہونے والی نئی علامات کا بیان کرنا اہم بات ہے،اور انہیں صِرف خیالی سمجھ کر نظر انداز نہیں کرنا چاہئے۔مزید یہ کہ زیادہ دنوں &nbsp;تک لاحق کووڈانفکشن کسی بھی فرد کو اُس کی صحت کی حالت سے قطع نظر لاحق ہوسکتا ہے،تاہم انفکشن سے بچاؤ کے لئے ہُشیار رہنے کی ضرورت ہے۔لہٰذا، سماجی فاصلہ رکھنے،ماسک پہننے،اپنے ہاتھوں کو دَھونے،اور کوویڈ 19&nbsp;سے متعلق اپنی ویکسین کا تازہ ترین ڈوز لگوائیے۔&nbsp; 
&nbsp;

اہم نکات

<ul>
	<li dir="rtl" style="text-align:right">&quot; زیادہ دنوں تک لاحق&nbsp;کووِیڈ،کی تعریف یہ ہے کہ کسی فرد میں &nbsp;کووِیڈکی ہسٹری کے ساتھ مستقل علامات ہوں،عام طور پر انفکشن کے آغاز سےتین ماہ کےبعد۔ مزید یہ کہ،یہ علامات کم از کم دَو ماہ تک جاری رہتی ہیں اور کسی دیگر تشخیص سے اس کی وضاحت نہ کی جاسکے۔ &nbsp;</li>
</ul>

<ul dir="rtl">
	<li>عالمی ادارہ صحت &nbsp;نےزیادہ دنوں &nbsp;تک لاحق کووِیڈ کی 33 علامات بیان کی ہیں۔ تھکن،سانس میں دشواری،دِماغ میں دُھندلاہٹ،بالوں کا گِرنا، سُونگھنے اور چکھنے کی حِس میں فرق ہوجاتا ہے، اور ذہنی صحت کے عارضے،زیادہ دنوں تک لاحق&nbsp;کووِیڈ کی عام علامات ہیں۔ </li>
</ul>

<ul dir="rtl">
	<li>تحقیق کاروں کا&nbsp;یہ نظریہ ہے کہ بعض عوامل کی وجہ سےزیادہ دنوں تک لاحق&nbsp;کووِیڈ ہونے کا اِمکان بڑھ جاتا ہے۔اِس میں شدید کووِڈ انفکشن شامل ہے،صحت کی متعلقہ کیفیت،ویکسین کا نہ لگوانا، آئی یو سی میں داخل ہونا، اور بار بار کووِڈ انفکشن ہونا&nbsp; شامل ہیں۔تاہم یہ بات واضح نہیں کہ کووِیڈ کا انفکشن ہلکی علامت والے افراد یا کوئی بھی علامت نہ ہونے والےافراد کو کس طرح ہوجاتا ہے۔ </li>
</ul>

<ul>
	<li dir="rtl" style="text-align: right;">مطلوبہ علاج دستیاب نہ ہونے کی وجہ سے،زیادہ دنوں &nbsp;تک لاحق&nbsp;کووِیڈ والےمریضوں نے بہت سے غیرتصدیق شُدہ علاج مثلاً خون کی صفائی&nbsp;یا apheresis اختیار کر لئے ہیں۔&nbsp;&nbsp;</li>
</ul>

[1] Davies M. Long covid patients travel abroad for expensive and experimental “blood washing” BMJ 2022; 378 :o1671 doi:10.1136/bmj.o1671

[2] Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta bio-medica : Atenei Parmensis, 91(1), 157–160.

[3] World Health Organization. (n.d.). WHO Coronavirus (COVID-19) Dashboard. WHO Health Emergency Dashboard.

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