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Here’s what doctors know so far about the persistent effects of coronavirus



With over 2 million cases in the U.S. since the coronavirus pandemic began in late December, there are now many people who have recovered from COVID-19.

Likewise, there have been reports of people continuing to have long-term side effects from the infection.

I am a professor and doctor and specialize in infectious diseases of adults. I am not only concerned with patients with bacterial, parasitic and viral infections – including COVID-19 – but I actively teach and research on diseases caused by infectious pathogens.

Here I offer a summary of what is known today about recovery from COVID-19 – and where there are important gaps in our knowledge.

Much of this information, which was gathered from studies that started after the 2003 SARS epidemic, is important to those who are recovering, their family and friends who should know what to expect.

Confusion or post-intensive care syndrome

In the most severely ill patients receiving intensive care, there is a substantial risk of delirium. Delusion is characterized by confusion, difficulty paying attention, reduced awareness of the person, of the place and of time and even by the inability to interact with others.

Delirium is not a specific complication of COVID-1

9 but unfortunately it is a common complication of intensive care care. Risk factors besides being in intensive care include advanced age and pre-existing disease.

Some studies claim that up to 75% of ICU-treated patients experience delirium. The problem is not just about confusion during hospitalization, but for months later.

For example, three and nine months after discharge, many of those who recovered still had difficulties with short-term memory, the ability to understand written and spoken words and to learn new things.

Some even had difficulty knowing where they were and what the date was today. And executive function scores were significantly worse in those who suffered from delirium.

Doctors are dedicating significant efforts to reduce delirium in ICU patients. Approaches that can help include reducing the use of sedatives, repeatedly reorienting the patient to date, time and place, early mobilization, noise reduction and cognitive stimulation.

Lungs: Will there be chronic shortness of breath?

The most severely ill patients with COVID-19 often suffer from pneumonia and acute respiratory distress syndrome, or ARDS, while they are ill.

Doctors did not follow up on patients who recovered from the new coronavirus long enough to know if there will be long-term breathing problems.

However, a study of health workers in China who contracted SARS, caused by the circulating SARS-CoV coronavirus during the 2003 outbreak, is reassuring.

Lung damage (measured by the interstitial changes observed in CT scans of lung and lung function test results) healed mainly within two years of the disease.

Smell and taste

Most patients with COVID-19 experience a loss of taste and / or smell. Only a quarter of the patients had noticed an improvement in a week, but within 10 days most of the patients had recovered.

Post-infection fatigue syndrome

Although it may be too early to say, in the case of the original SARS epidemic, almost half of the survivors interviewed more than three years after recovery complained of fatigue.

The Centers for Disease Control and Prevention criteria for the diagnosis of chronic fatigue syndrome were met in a quarter of patients with COVID-19.

It will probably be important to target mental health interventions to COVID-19 survivors to help them cope with prolonged convalescence characterized by fatigue.

Blood clots

Blood clots can occur in a quarter of critically ill COVID-19 patients.

Blood clots can cause serious long-term complications if the clots detach from the blood vessels and migrate to the lung and cause pulmonary embolism or go to the brain and cause a stroke.

To prevent blood clots from forming, doctors are now instituting blood thinners prophylactically when there is an increase in the concentration of D-dimer, which is a fragment of fibrin, a protein that produces the blood clot.

Heart

In one study, inflammation of the heart muscle, called myocarditis or cardiomyopathy, was observed in one third of seriously ill patients with COVID-19.

Arrhythmias are also seen – an irregular heartbeat. It is not known whether this is due to a direct heart infection or secondary to the stress caused by the inflammatory response to this infection.

More importantly, the long-term consequences of survivors are not understood.

Diabetes

Diabetics are at an increased risk of severe COVID-19, which may in part be attributable to an overreaction from the immune response to infection.

But the interaction between COVID-19 and diabetes could also go in the opposite direction. Glucose elevations have been observed in severe cases of COVID-19 in some patients who have no history of diabetes.

Since the virus interacts with angiotensin converting enzyme 2, or ACE2, on human cells, it is plausible that changes in ACE2 activity may be a cause of diabetes in patients with the new coronavirus. In any case, it will be important to follow in the long term.

The bottom line is that the new coronavirus infection has profound effects on many different organ systems in the body.

The good news is that we expect the damage caused by COVID-19 to heal in the vast majority of patients.

However, it is important to understand that some long-term conditions can be anticipated and prevented or managed for the benefit of patients.

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William Petri, professor of medicine, University of Virginia.

This article was republished by The Conversation with a Creative Commons license. Read the original article


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