What are the long-term health risks following COVID-19?

Evelyn Lewin

24/06/2020 2:00:44 PM

Sequelae may include persistent pulmonary damage, post-viral fatigue and chronic cardiac complications.

Checking chest x-ray
Long-term effects of COVID-19 may include persistent pulmonary damage, post-viral fatigue and chronic cardiac complications.

Around 30% of patients who were in intensive care for COVID-19 may have long-term pulmonary damage.
Such are the suggestions by the National Health Service (NHS) in the UK NHS, as outlined in The Daily Telegraph.
The NHS said that figure might be accurate if COVID-19 follows patterns of similar diseases.
They also warn that up to half of patients treated for the virus in intensive care units (ICUs) may be left with ‘persistent physical, cognitive and psychological impairments’, including chronic fatigue.
That all makes sense to Associate Professor Hassan Vally, an epidemiologist at La Trobe University with a special interest in infectious diseases.
‘There’s mounting evidence that if you have more severe disease [with COVID-19], there’s a significant amount of damage being done to your body,’ he told newsGP.
He adds that any disease that is serious enough to send a patient to ICU can lead to a ‘whole range’ of long-term effects.
Associate Professor Louis Irving, Director of Respiratory and Sleep Medicine at the Royal Melbourne Hospital, agrees.
He told newsGP patients who recover following ICU admission for any severe disease may experience long-term health effects, and that permanent lung damage is particularly likely following a respiratory illness in that setting.
While there are no long-term studies on the respiratory effects of COVID-19 in recovered patients, Associate Professor Irving said such findings could be extrapolated from other diseases, such as influenza.
He said young, previously well patients with severe influenza who experience cytokine storm can end up with scarred lungs, so he believes the same may happen as a result of COVID-19.
‘I think the incidence of chronic lung disease in COVID-19 will probably turn out to be higher than what we see in influenza,’ he said.
‘And I think it’s because proportionally more are going to ICU [with COVID-19], and they do tend to intubated for a longer period of time.’
According to Associate Professor Irving, recent Australian figures show the mean intubation time for COVID-19 with acute respiratory distress syndrome (ARDS) is three weeks.
‘That’s a long time to be intubated with ARDS,’ he said.
‘So if you get intubated and you’re in ICU for three weeks with ARDS, almost everyone will come out with some scarred lungs.’
Meanwhile, Associate Professor Vally said a new study, published in The Lancet Infectious Diseases on 8 June, further highlighted the pulmonary damage associated with COVID-19.
The study, which analysed post-mortem lung samples from 38 COVID-19 patients in two hospitals in northern Italy, found the predominant pattern of lung lesions is diffuse alveolar damage.
Hyaline membrane formation and pneumocyte atypical hyperplasia were also frequent, as was the presence of platelet-fibrin thrombi in small arterial vessels, consistent with coagulopathy.
‘It just kind of showed the extent of the damage that can be done to the lung in a severe infection,’ Associate Professor Vally said.
‘So that makes sense that you would get long-term sequelae.’
This fits in with earlier reports from Hong Kong in March that noted patients who had recovered from COVID-19 had reduced lung function.
‘Some patients might have around a drop of 20–30% in lung function [after recovery],’ Dr Owen Tsang Tak-yin, medical director of the Hong Kong Hospital Authority’s Infectious Disease Centre at Princess Margaret Hospital in Kwai Chung, said.

Associate Professor Hassan Vally is surprised by the frequency of fatigue associated with recovery following COVID-19.

Meanwhile, research published in the European Respiratory Journal in June found that impairment of diffusion capacity was the most common abnormality of lung function in discharged survivors with COVID-19, followed by restrictive ventilatory defect, both of which were associated with disease severity.
But lungs are not the only organs to likely suffer long-term damage following COVID-19.
It has been reported that doctors at the Cedars-Sinai Medical Centre in Los Angeles noted chronic cardiac complications could arise in patients even after recovery as a result of persistent inflammation.
Associate Professor Irving said long-term cardiac issues have been recognised as a potential effect of COVID-19. This is potentially as a result of myocarditis, which can lead to cardiomyopathy and permanent myocardial damage.
Neurological sequelae are also concerning.
‘Even though neurological symptoms are less common in COVID-19 than lung problems, recovery from neurological injuries is often incomplete and can take much longer compared to other organ systems – for example, lung – and therefore result in much greater overall disability, and possibly more death,’ Dr Sherry Chou, a neurologist at the University of Pittsburgh, said.
Research published in Cureus in April suggests Guillain-Barre syndrome may occur following COVID-19 infection.
Post-viral fatigue seems to be another prominent feature after recovering from acute infection with COVID-19.
‘I’m surprised by the amount of description of the real deep fatigue that people seem to suffer and that maybe goes on for quite a long time,’ Associate Professor Vally said.
‘We know about post-viral fatigue syndromes, so we know that a virus can lead to this in certain people; however, it’s not something that’s particularly well understood.
‘We haven’t followed the virus for a long time yet so I’m not sure we can say long-term fatigue, but there seem to be people that really report of debilitating fatigue that lasts after they’ve recovered, or seem to have recovered in every other way.’
While there is no long-term data on the psychological impacts of COVID-19, researchers note the rates of post-traumatic stress disorder (PTSD) following SARS and MERS was more than 30%.
Associate Professor Irving is concerned about the long-term mental health of COVID-19 survivors. He believes being intensely sick during the current climate may ‘increase the likelihood of long-term psychological effects’.
‘Just because of the existential nature of the crisis of COVID-19, the psychological scarring must [not be overlooked],’ he said.
While they are willing to discuss potential effects of COVID-19 on recovered patients, Associate Professor Vally and Associate Professor Irving hesitate in offering definitive answers as to what may happen to such patients over the long term.
‘One of the other characteristics of COVID is [that] the spate of knowledge is rapidly changing, and what appears to be set in stone three months ago turns out to be incorrect later,’ Associate Professor Irving said.
‘And it’s not just false reporting or bad science; it’s that different things occur to different populations [and so on].’
He said reports from other countries in terms of what happens to recovered patients seem ‘plausible’.
‘But all of that is tempered by the fact that these are anecdotal observations at the moment; they’re not careful clinical studies,’ Associate Professor Irving said.
Associate Professor Vally agrees it is difficult to speculate what percentage of recovered COVID-19 will experience long-term sequelae, and what they will be.
‘I think it’s going to be one of the interesting things that we find out, over the next while, what kind of effect does this have on the body,’ he said.
‘The story will emerge over the next while as we follow people for longer and learn more about the virus.’
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Dr Alan Graham MacKenzie   1/08/2020 9:37:30 AM

Wow What a fake news article.
There are at least 30 speculative references to may ,might ,could ,probably,possibly ,I think etc Therefore it is all unscientific ,attention seeking opinion with a sensationalistic headline.
It also makes no reference to the 95+ % who do not end up in intensive care .It is really just a speculative commentary on post intensive care syndrome Medical sites should not peddle unscientific information