Citizens report rise in prevalence of severe medical conditions in their close network: 51% citizens surveyed have had 1 or more individuals in their close network facing a severe medical condition

December 10, 2022, New Delhi: The COVID virus via Alpha, Beta, Delta and Omicron variants has kicked off a health pandemic that no one could have imagined till late 2019. The virus that started spreading from Wuhan, China in December 2019 reached every part of the world within a year. It caused symptomatic disease in many leading to deaths post infection and as the Omicron variant started spreading in December 2021, majority of those infected reported a mildly symptomatic illness. However, mildly symptomatic illness does not necessarily translate to no impact to health in the medium to long term. Researchers estimate that over 200 million people worldwide may currently be having Long COVID condition where they are experiencing myocarditis, pericarditis, brain fog or memory issues, sleep apnea, fatigue, joint pain and other health conditions. In addition to these, several cases have been reported in media just in the last 3 months where healthy, young and middle-aged individuals, both men and women have experienced a heart attack and died. In several of these cases, the individual was engaged in some physical activity like dance, gym, walking etc. when they experienced the cardiac event. This has led to worries and anxiety in the minds of many, wanting to understand what is driving such sudden deaths.

“Stroke has been seen as a manifestation of COVID-19 in various studies showing that 0.9% to 23% COVID-19 patients developed stroke,” states Bengaluru headquartered Narayana Health, which has a network of hospitals across the country. Based on its study of Covid-19 impact, Narayana Health in a blog post states stroke can manifest in severely affected COVID-19 patients who initially develop COVID-19 symptoms and later on develop stroke as a multi-organ involvement. Else, as few studies have shown, some patients present with stroke as an initial manifestation and later on are found to have COVID-19, these are young patients without risk factors for brain stroke.

Though the Ministry of Health and Family Welfare came out with a “National Comprehensive Guidelines for Management of Post-COVID Sequelae” for doctors last year, not much seems to have been done to inform citizens, both vaccinated and unvaccinated, who survived more than one bout of COVID or its variants, on possible complications and the need to avoid COVID reinfections. The government guidelines at the onset states “Cardiovascular sequelae not only occur in symptomatic COVID-19 patients but have also been reported in asymptomatic patients. Up to 20%–30% of patients hospitalized with severe COVID19 have evidence of myocardial involvement manifested by elevated troponin levels, venous thromboembolism, heart failure and arrhythmias”.

Based on case studies, the health ministry guideline states: “Chest pain has been reported in ~20% of COVID-19 survivors at sixty-day follow-up. Palpitations have been reported in ~10% of COVID-19 survivors at sixty-day follow-up. Ongoing chest pain and palpitations have been reported in 5% and 9% respectively at six-month follow-up post-acute COVID-19. Stress cardiomyopathy is 4-5 times more common during the COVID-19 pandemic when compared to pre-pandemic periods (7.8% versus 1.5-1.8%). Myocardial inflammation detected on cardiac MRI was found in as many as 60% of affected people more than 2 months after a diagnosis in one study. However, such high prevalence of myocardial involvement has not been replicated in other studies and the clinical implications, if any, of these findings is not known.”

As a follow-up to its efforts to bring to fore the severe health issues being faced by citizens due to COVID and during the pandemic, many of whom have been sharing their experiences on its platform, LocalCircles has conducted a national survey to find out the prevalence of severe health conditions in people’s close networks (family, friends, neighbours, colleagues, etc.). It also attempted to understand the vaccination status of these individuals and whether they were infected with COVID once or more. The survey received over 32,000 responses from citizens located in 357 districts of India. 67% respondents were men while 33% respondents were women. 47% respondents were from tier 1, 33% from tier 2 and 20% respondents were from tier 3, 4 and rural districts.

51% citizens have one or more individuals in their close network who has experienced heart or brain stroke, blood clots, neurological complications, cancer acceleration or other sudden medical conditions in the last 2 years

The first question in the survey sought to understand the magnitude of prevalence of such conditions in people’s close network. It asked respondents, “How many individuals in your family or close network (extended family, friends, neighbours, colleagues) do you have who have experienced heart or brain stroke, blood clots, neurological complications, cancer acceleration or other sudden medical conditions in the last 2 years?” Out of nearly 11,000 respondents to this query, 40% stated “No one, thankfully” and 9% did not give a clear response. In the case of 51% remaining respondents, 23% indicated 2-4 individuals; 11% stated 5-10 individuals; 17% indicated one individual. In effect, more than half the respondents knew of at least one or more individuals who are suffering due to aftereffects of COVID. This is a high percentage which clearly indicates that prevalence of these severe conditions is very much a reality.

Percentage of those knowing 1 or more individuals with sudden severe ailments or complications rose from 31% to 51% within a year

Probing further to find out the time frame of the medical complications, the survey sought to know, “How many individuals in your family or close network (extended family, friends, neighbours, colleagues) do you have who have experienced heart or brain stroke, blood clots, neurological complications, cancer acceleration or other sudden medical conditions in the last 2 years?” Of the total respondents, 63% indicated that during the first year there were “No one, thankfully” but by the second year, the number of this group dropped to 40%. In the category of those who knew of 5-10 individuals with sudden medical complications, the percentage rose from 4% in late 2021 to 11% in late 2022. In 2022, the spread of COVID has been dominated by the Omicron variants. Similarly, those who indicated knowing 2-4 individuals with sudden severe ailments or complications, the percentage rose from 12% to 23% from late 2021 to late 2022 and in the category of people knowing 1 individual with such severe conditions, it rose from 15% to 17% in 2022.

A study done by Queen Mary University of London on the after effects of Covid on heart and heart related ailments has found in non-hospitalised patients there is a 2.7 times risk of blood clots and 10 times higher risk of death. Based on data collected during the first two Covid waves from participants in the UK Biobank study, the research report published in the journal Heart, states that in the case of patients who were hospitalized, there has been a 118 times rise in the number of deaths. In addition, the study has revealed there has been a 27.6 times rise in incidents of blood clots, 21.6 times increase in cases of heart failure, 17.5 times rise in cases of stroke and 10 times rise in cases of arrhythmia or irregular heartbeat among people who were hospitalized due to Covid-19. The study states the associated risks were greatest in the first 30 days after infection but remained higher than controls even after this period.

Respondents state 62% of the people in their close network experiencing such severe conditions were double dose vaccinated; 11% were single dose vaccinated while 8% were unvaccinated

One of the issues raised by some citizens on LocalCircles has been that some of the COVID vaccines may be driving these conditions. The argument given by these individuals is based on the fact that the COVID vaccines were administered under “Emergency Use Authorisation” and listed some of these conditions as possible side effects. Some others indicated that it could be a particular vaccine, a particular batch number of a vaccine or a combination of vaccine and body type/blood group that could also be causing such severe health conditions. While only a study on a set of individuals like the ones who participated in vaccine trials can provide answers to such questions, LocalCircles attempted to atleast understand from people about the vaccination status of their close contacts who were experiencing such severe medical conditions.

The next question in the survey asked respondents, “Of those individuals in your family or close network who experienced conditions like heart or brain stroke, blood clots, neurological complications, cancer acceleration or other sudden medical conditions in the last 2 years, what was the status of their COVID vaccination?”. In response, of the nearly 11,000 respondents, 62% indicated “they were double dose vaccinated”. In the case of remaining respondents, 11% indicated “they were single dose vaccinated”; 8% indicated “they were not vaccinated” and 19% gave no clear response. Responses to this question are somewhat disturbing and need further probe by the medical fraternity as to why so many people with double dose vaccination seem to be facing severe health/ medical complications. In India 95% of the eligible population (12+) has received atleast one dose while 88% of the population (12+) is fully or double dose vaccinated. Over 220 million booster doses have also been administered.

Respondents state 61% of the people in their close network experiencing severe medical conditions had experienced COVID once or more while 28% said their contacts with such severe conditions did not have COVID

The next question in the survey sought to understand the COVID infection(s) status of the individuals experiencing these severe medical conditions. It asked respondents, “Of those individuals in your family or close network who experienced conditions like heart or brain stroke, blood clots, neurological complications, cancer acceleration or other sudden medical conditions in the last 2 years, what was the status of them getting infected by COVID?” Of the 10,922 respondents to this question, 22% said “their close contacts had COVID in the 1st wave during alpha or beta variants (March 2020-Feb 2021); 11% indicated “their close contacts had COVID in the second wave during delta variant (March 2021- October 2021); another 22% indicated “their close contacts had COVID in the third wave or during the Omicron variant (November 2021- October 2022); 6% shared they had COVID multiple times during the 3 waves. In all, the survey data for this question shows that 28% knew of people within their family or friends circle who experienced severe health conditions but did not have COVID. Of the total respondents to this query, 11% did not give a clear response. Special attention needs to be paid to this 28% who state that they did not have COVID, atleast that they knew of and were still facing these severe medical conditions. Health research must work towards identifying the root causes of severe medical conditions in such individuals. It must also be noted that the 22% who had close contacts getting infected with COVID during the first wave and facing severe medical conditions were not vaccinated at all and those who got infected with COVID during the second wave and facing severe conditions were likely single dose vaccinated at that time.

In summary, this LocalCircles survey brings to fore the serious health conditions (heart or brain stroke, blood clots, neurological complications, cancer acceleration or other sudden medical conditions) faced by a sizable number of people. As is evident from the survey data, 51% citizens now have one or more individuals in their close network who have experienced severe medical conditions in the last 2 years. It also finds that, 62% citizens had contacts facing severe medical conditions though they were COVID double dose vaccinated while 11% citizens had contacts facing severe medical conditions who were vaccinated with a single dose. 8% of those who reported severe medical conditions were unvaccinated. Finally, 61% of those whose close contacts have experienced such severe medical conditions in the last two years said they had COVID while 28% said their contacts did not have COVID. The need of the hour here is for the Government to take extensive research on these severe medical conditions experienced by people and study this in the context of impact of COVID by variant and impact of vaccine by vaccine make and batch numbers. At the same time number of COVID infections experienced should also be considered. All of this will bring some clarity to the issue as to what are some of the root causes behind these severe medical conditions experienced by people. It will also enable us to get better prepared for what could be coming, COVID management, vaccination strategy and equipping the health infrastructure to handle these reported severe medical conditions more effectively.

LocalCircles will escalate these findings to key stakeholders in Central and State Governments so the same can be evaluated for further research and on ground actions.