Health experts are warning about a variety of possible coronavirus after effects — from long-term respiratory ailments to blood clotting to brain damage.
Even though most people experience only moderate symptoms, severe complications of the disease could lead to long-term effects, experts say.
“COVID-19 is not always a benign illness and there are lingering effects that may affect you even if you do not require hospitalization. This is something that people should avoid getting and spreading — we can’t take it lightly,” said Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security. COVID-19 symptoms include fever or chills, cough, difficulty breathing, fatigue, muscle or body aches, new loss of taste or smell, sore throat, runny nose or congestion, nausea or vomiting and diarrhea.
The coronavirus has sickened more than 3 million people in the U.S. and killed more than 132,000 as of Thursday. Of those who have fallen ill, about 953,000 have recovered, a Johns Hopkins University tally shows.
Studies and anecdotes reveal that the coronavirus could lead to conditions such as post-intensive care unit syndrome, diabetes, chronic shortness of breath, blood clotting, damage to organs and neurological problems.
Post-intensive care syndrome
There is a high risk of delirium characterized by confusion, difficulty paying attention, reduced awareness of surroundings and inability to interact with others in patients who are most seriously ill with COVID-19 and who receive care in intensive care units.
While delirium is not a complication specific to COVID-19, it is a common complication of ICU treatment, according to Dr. William Petri, professor of medicine at the University of Virginia.
People who are older and who have existing health conditions are at greater risk of ending up in the ICU. One study found that close to 75% of patients admitted to the ICU experienced delirium, and the confusion lasted months after hospitalization for some. A proportion of patients still experienced delirium and cognitive impairment three and 12 months after their hospitalization.
For example, at three months, 40% of the patients had cognition scores that were lower than those typically seen in patients with moderate traumatic brain injury and 26% of patients had scores that were similar to scores for patients with mild Alzheimer’s disease.
“People with mild illness may also be playing with fatigue, difficulty concentrating, and other various symptoms as part of a post viral syndrome,” said Dr. Adalja.
Diabetes
Physicians warned in a letter published last month in The New England Journal of Medicine that COVID-19 could cause diabetes.
There are other instances of coronaviruses triggering diabetes: During the 2002-2003 SARS (severe acute respiratory syndrome) outbreak in China, some patients with pneumonia caused by the coronavirus developed acute onset diabetes.
Diabetes in most patients went away but remained in 10% of them after three years, according to a 2009 study. Several viruses have been linked to diabetes, including enteroviruses, rotavirus, rubella and the mumps virus.
“We have known for many years that viral infections may be linked to the first time a patient has diabetes symptoms. (Type 1 diabetes presents in a seasonal fashion, a fact often seen with viral infections.) And viral infections may also trigger the destruction of the insulin-producing islet cell ’factories’ in the pancreas, setting up a chronic autoimmune response,” Dr. Julian Hamilton-Shield, professor in diabetes at the University of Bristol, wrote in an article for The Conversation.
Dr. Hamilton-Shield said it is unclear if COVID-19 can cause Type 1 or Type 2 diabetes, speculating that this could be a new form of diabetes, but right now there is not enough data.
Chronic shortness of breath
Patients who are severely ill with COVID-19 often suffer from pneumonia and acute respiratory distress syndrome, or ARDS, said Dr. Petri in an article for The Conversation.
It is unknown if patients who have recovered from the coronavirus will have long-term breathing problems since doctors have not monitored them long enough. If a patient needs a mechanical ventilator, they could have decreased lung capacity and chronic lung issues due to scarring on the lungs, according to Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University. The reduced lung capacity means a patient could become short of breath much quicker.
A study of health care workers in China who contracted severe acute respiratory syndrome (SARS), another type of coronavirus, shows that lung damage mostly healed within two years after the illness.
Blood clotting
Researchers found that more than 30% of critically ill COVID-19 patients in ICUs at Dutch hospitals experienced complications from blood clotting.
If blood clots break loose from blood vessels and travel to the lung, they could cause a pulmonary embolism or a blockage in one of the lung arteries, Dr. Petri said, or they could cause a stroke if they migrate to the brain.
In some cases, blood clotting could lead to the amputation of toes, fingers or even legs. Dr. Schaffner said the linings of blood vessels can become inflamed, causing blotting to occur, cutting off oxygen to body tissues, and leading to gangrene, a life threatening condition.
He said that was undoubtedly the case for Nick Cordero, the 41-year-old Broadway star who died from COVID-19 complications and had to have his leg amputated during his 3-month hospitalization.
“These are the sorts of things that should give everyone pause, and that example of that Broadway star actually is very vivid and sad because he was a young, otherwise healthy person,” Dr. Schaffner said. “And the COVID virus caused terribly severe disease in him, resulting eventually in his passing. Young people are less apt to get sick than older people, but that doesn’t mean they have a suit of armor that will reject the coronavirus entirely. Young people, even if they don’t get that sick, can spread the virus to people who are going to get very sick.”
Organ damage
A study of critically ill COVID-19 patients in Washington state found that 86% of them experienced comorbidities such as congestive heart failure. It also found that a third of the patients had myocarditis, inflammation of the heart muscle. Arrhythmias, an irregular heartbeat, has also been observed in patients, Dr. Petri notes, but it is unknown whether this stems from a direct heart infection or is an indirect effect from the stress caused by the inflammatory response to the infection.
There also have been reports of ill patients suffering kidney or liver damage.
Neurological problems
More research is suggesting that COVID-19 could be linked to brain damage and neurological problems.
British researchers found that some coronavirus patients experienced brain swelling along with delirium and psychosis while others had strokes or developed nervous system disorders like Guillain-Barré syndrome, which can cause paralysis, according to a study published Wednesday in the journal Brain.
The team also discovered a rising number of cases of a life-threatening condition called acute disseminated encephalomyelitis (Adem), a condition where there is a brief widespread attack of inflammation in the brain and spinal cord. Cases rose from about two a month prior to the pandemic to two per week in April and May.
“We’re seeing things in the way COVID-19 affects the brain that we haven’t seen before with other viruses,” Michael Zandi, a senior author on the study and a consultant at the institute and University College London Hospitals NHS foundation trust, told The Guardian. “What we’ve seen with some of these Adem patients, and in other patients, is you can have severe neurology, you can be quite sick, but actually have trivial lung disease.”
Researchers from Johns Hopkins University recently discovered that the coronavirus could infect brain cells using “mini-brain” models made from human stem cells, offering further evidence that COVID-19 could possibly cause serious neurological damage.
Earlier reports from Wuhan, China, where the coronavirus pandemic began, suggest that 36% of infected patients experienced neurological symptoms such as impaired consciousness and dizziness. Yet, it has been unclear whether the virus can infect human brain cells.
Health experts have also expressed concern about the impact of COVID-19 on the developing brain as evidence has shown that the virus can cross the placenta in pregnant women. Researchers from Italy on Thursday said they found the coronavirus and antibodies in the vaginas, placentas, breast milk and umbilical cord blood in 31 pregnant women infected with COVID-19, providing more evidence that the virus can spread to fetuses and newborns, The Associated Press reported.
What about immunity?
The sicker a person is, the more antibodies that person makes. However, how much and how long those antibodies protect against COVID-19 remains unknown, Dr. Schaffner said, noting more research is needed.
Dr. Adalja said immunity, which comes from antibodies but also other “arms of the immune system,” will likely last for at least a year. However, he said those who have recovered from the coronavirus need to be followed for a longer period of time to get a better idea.
“It is unclear how sick someone has to become to get antibodies; there are individuals who have no symptoms yet develop antibodies and those that are symptomatic yet don’t,” he said.
Infectious disease experts estimate that about 70% of the population would have to be infected with coronavirus in order to achieve herd immunity or resistance to the spread of a contagious disease within a population.
However, a recent study of patients in Spain found that just 5% of thousands of participants tested across the country had maintained antibodies.
“Immunity can be incomplete, it can be transitory, it can last for just a short time and then disappear,” Raquel Yotti, the director of Spain’s Carlos III Health Institute, one of the groups that conducted the study, told the Business Insider.
Even if a coronavirus vaccine becomes available, herd immunity might not be achieved if too many people opt out of getting vaccinated, top infectious disease expert Dr. Anthony Fauci said last month.
• This story is based in part on wire service reports.
• Shen Wu Tan can be reached at stan@washingtontimes.com.
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