Uttam Maharjan

The COVID-19 pandemic has been around us for one and a half years. Scientists are still scrutinising the disease. During the studies, they have explored complications associated with the disease. They have found that those who have recovered from the disease may suffer from long COVID, a condition marked by the presence of the symptoms from the original infection six months or more after recovery. Likewise, they have researched into the coinfections and superinfections associated with the fatal virus disease.

Weakened immune system
The immune system is a biological mechanism that protects the human body from infections by neutralising pathogens. Those with a strong immune system can fight invasion by pathogens. But those with a weakened immune system are vulnerable to infections to a great extent. It has been found that those who have contracted COVID-19 but who have a weakened immune system may develop coinfections or superinfections. Coinfections are other infections that can attack COVID-19 patients and are caused by many kinds of viruses, bacteria, fungi or parasites, whereas superinfections may arise after treatment with broad-spectrum antibiotics. Superinfections are caused by microbes resistant to antibiotics and usually follow a previous infection. Coinfections are caused by two or more viruses or bacteria at the same time. Black fungus, technically known as mucormycosis, is a coinfection that has been reported in India, China and elsewhere. It is a fungal disease.
Till now, over four million deaths from COVID-19 have been reported from around the world. According to scientists, not all deaths have been due to the disease alone; other infections, chronic diseases and risk factors are also responsible for such deaths. Now coinfections have emerged as an additional health challenge. Coinfections could complicate the condition of those who have recovered from the disease and who have a weakened immune system, thus increasing the rate of deaths. COVID patients are vulnerable to coinfections and these coinfections may prove more dangerous than the original infection.
Coinfections aggravate the processes of occurrence, development and prognosis of COVID-19. They may complicate the clinical diagnosis and treatment of the disease. They may exacerbate the severity of the disease and thus increase the rate of mortality. Many studies and investigations have revealed that there is a strong relationship between COVID-19 and other viruses, bacteria and fungi. COVID patients, who were previously infected with HIV-AIDS, are more likely to catch coinfections as they have an impaired immune system and their specific antibody responses are delayed or non-existent.
Coinfections with bacteria and fungi can greatly influence the progression and prognosis of COVID-19, leading to complications, especially in severe cases. In such a situation, the patients will have to be treated under intense care with antibiotics. This will increase the severity of the disease and prolong cure time, thus increasing the rate of mortality. Bacterial and fungal coinfections can increase the number of deaths from COVID-19 by up to two and a half times. Coinfections can also cause systemic inflammation in patients, which may result in a condition known as a cytokine storm or hypercytokinaemia. This is the condition marked by the release in large numbers of cytokines into the blood. Although cytokines have their own importance, a cytokine storm can be harmful. Sometimes, a cytokine storm may lead to multiple organ failure.
There are several causes for coinfections. The overuse of medicines is one of the major causes for coinfections. Haphazard use of drugs in the name of treating COVID-19 may invite troubles. Various antibiotics, drugs and steroids are used in COVID-19 patients to ease complications. This may weaken their immune system, giving rise to coinfections. It may not be reiterated that the overuse of antibiotics may give rise to antibiotic-resistant microbes.
Medical facilities, especially hospitals, could be a source of coinfections. Viruses, bacteria, fungi and parasites persist in such places for a long time. Such pathogens are found in wards, equipment, water pipes and other areas. Visitors to such facilities may also affect the patients. The nosocomial pathogens may be resistant to antibiotics and other drugs. Sometimes, the existing drugs may not work against such pathogens.
In order to avoid coinfections in health facilities, effective measures need to be taken such as disinfecting them with chemicals or disinfectants on a regular basis and managing the inflow of visitors. COVID-19 patients with coinfections should be isolated in separate rooms. Nosocomial infections should be avoided to the extent possible.

Empirical treatment
In order to get rid of coinfections, empirical (evidence-based) treatment procedures should be adopted. Empirical treatment is based on the symptoms of patients and relies on the most appropriate medicine for the patients according to the recognised guidelines and models. Clinical data of COVID-19 coinfections are of paramount importance in empirical treatment methods. High-risk groups are vulnerable to coinfections. Those over 50 years of age and suffering from chronic diseases like asthma and diabetes; those who have had renal transplants; and those who regularly use antibiotics and steroids are high-risk groups. Among them, the most vulnerable are those suffering from diabetes, renal disease, cancer and heart disease.
With the emergence of coinfections associated with COVID-19, the world has been in for a double whammy. The disease is more severe than other coronavirus diseases like SARS-Cov and MERS-Cov. It has stretched the global healthcare system. At the same time, there is a challenge of dealing with the offshoot of the disease: long COVID and COVID coinfections, for example. So, all the countries in the world should make concerted efforts to fight not only COVID-19 but also other complications associated with it.

(Former banker, Maharjan has been regularly writing on contemporary issues for this daily since 2000. uttam.maharjan1964@gmail.com)