MUST READ! COVID-19 Long Term Effects: COVID-19 Survivors Could Suffer Chronic Medical Conditions For Years

COVID-19 Long Term Effects: As of 4am, California, Sunday 7^th June 2020, the total official number of infected COVID-19 cases in the world has reached more than 7 million (7,001,2180) and total number of individuals who have died have reached 402,578.


 
These are only conservative figures as the real figures could actually be much more due to under reporting and concealments by government authorities all over the world especially in countries like Iran, Pakistan, Russia, Afghanistan, Myanmar, Cambodia, Nigeria, Brazil, and even in countries like US, China and India.
 
As the number of cases continues to rise and governments are focused on treating patients acutely sick with COVID-19, a disturbing issue arising in that a second crisis of long-term disability is looming. 
 
Past research shows that long-term illness and disability can be triggered by viral infections. 
 
Among some of these illnesses include postural orthostatic tachycardia syndrome (POTS), myasthenia gravis, multiple sclerosis, Guillain-Barré syndrome, and type I diabetes. Some patients in Italy have already developed Guillain-Barré after COVID-19.
https://www.nejm.org/doi/full/10.1056/NEJMc2009191
 
- Myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS)
 
Myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) is a common but less well-understood neurological disease with notable effects on cognitive and muscular function. Up to 80% of cases of ME/CFS are initiated by viral infection but may also arise in the wake of a surgery or traumatic injury, similar to Guillain-Barré. https://www.ncbi.nlm.nih.gov/books/NBK274235/
 
Medical researchers and clinician are deeply concerned about the potential for COVID-19 to develop into ME/CFS and other post-infectious diseases and disorders. With an estimated 25% of people with ME/CFS housebound or bedbound, patients suffering from the lowest quality of life of any disease to which it has been compared, including multiple sclerosis, and only about 13% of patients are able to return to full-time work, the potential for many new cases of ME/CFS in the wake of COVID-19 is no small matter. https://pubmed.ncbi.nlm.nih.gov/26147503/
 
At times a precursor to ME/CFS post-viral fatigue syndrome can occur after virtually any viral infection. Symptoms wax and wane; a person can feel fine one day and terrible the next. Exercise or other usual activities can bring fever and often symptoms rushing back. Although there is no known treatment, these problems often resolve on their own.
 
Many patients who have experienced post-viral fatigue syndrome advise the newly ill to rest, rest and rest some more, as returning to normal activities can trigger relapses. If symptoms continue for six months or longer, post-viral fa tigue syndrome can convert to a diagnosis of ME/CFS, which is usually lifelong and often devastating. Up to 25 percent of ME/CFS patients are housebound or bedbound for years. There are no treatments approved by the Food and Drug Administration.
 
Even the National Institutes of Health is concerned. Dr Walter Koroshetz, Director of the National Institute for Neurological Disorders and Stroke (NINDS) at NIH, stated that “this idea of a viral infection triggering an immune response that then goes on to initiate] ME/CFS is front and center in researcher’s minds.” The NIH is currently studying post-infectious ME/CFS at their Clinical Center in Maryland. https://www.nih.gov/research-training/medical-research-initiatives/mecfs/nih-me/cfs-advocacy-call-march-17-2020 and https://www.nih.gov/mecfs/nih-me-cfs-clinical-study
 
Already there is a lot of evidence that when a severe viral infection sweeps through the population, ME/CFS will often follow. The Institute of Medicine’s (NAM) 2015 report concluded that ME/CFS may be triggered by a number of acute viral infections, including herpesviruses such as EBV or HHV-6, enteroviruses, and echoviruses. https://www.ncbi.nlm.nih.gov/books/NBK274235/

A research on Epstein-Barr virus, Q fever, and Ross River virus showed that about 12% of subjects across the board met ME/CFS criteria at 6 months after clearing the infection; and another study of people with mononucleosis (Epstein-Barr virus) produced identical numbers. 20% of patients with West Nile Virus (n=140) met the criteria for CFS six months after tests first returned negative for West Nile. There are also a handful of highly-publicized outbreaks leading to ME/CFS: some of the biggest ones include the Epstein-Barr Viral outbreaks in New York; the Lake Tahoe outbreak in Nevada; and the Royal Free Outbreak in London. https://pubmed.ncbi.nlm.nih.gov/16950834/ and https://pubmed.ncbi.nlm.nih.gov/11063953/ and https://pubmed.ncbi.nlm.nih.gov/25062274/

COVID-19 and SARS-C0V-2 would not be the first coronavirus to result in documented ME/CFS. Studies have shown that long-lasting disabling symptoms commonly occur in people who contracted two other coronaviruses that cause SARS and Middle East Respiratory Syndrome (MERS). In one study, 27% of SARS survivors were found to meet CFS criteria several years after developing SARS. https://www.koreabiomed.com/news/articleView.html?idxno=1731 and https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378

Although that a wide variety of different infectious organisms can lead to the same disease-state may seem surprising, ME/CFS may be caused by the body’s unexpectedly uniform reaction to any number of assaults. 
 
The Director of the Center for Infection and Immunity and a coronavirus and ME/CFS expert, Dr Ian Lipkin, commented. “I would not suggest that coronavirus is the cause of ME; rather, innate immune mechanisms in response to a virus may cause it, meaning that many viruses can probably initiate ME/CFS.” 
 
One research that he was a co-author of found that getting H1N1 doubles a person’s risk of developing ME/CFS. https://pubmed.ncbi.nlm.nih.gov/26475444/
 
Physicians are starting to see many emerging long-term effects of COVID-19 and in Italy, neurologists have already created a separate neuro unit for COVID-19 patients, who are being treated for “stroke, delirium, epileptic seizures, and non-specific neurologic syndromes that look very much like encephalitis.”.
 
Dr Alain Moreau of Université de Montréal, Montréal, Québec added, “Coronavirus leading to more cases of ME will happen for sure, unfortunately.  A previous study in which about 200 people who survived the ICU in a previous outbreak of a coronavirus infection, close to 1/3 developed ME/CFS-like symptoms and were unable to get back to work over a year later… there are some preliminary reports of the same from COVID-19.  This should not be a surprise, given that other cases [of ME/CFS] are reported to be post-viral, the classic being EBV.  The question is not ‘will this happen’ but how many will suffer.”
 
Dr Marc Lipsitch Infectious Diseases and Epidemiology professor at Harvard University predicted in February that 40-70% of the world’s population will contract SARS-CoV-2 within a year. Using his most conservative estimate of 40%, over 3.12 billion people world-wide may contract SARS-CoV-2 by March of next year. Based on the myriad studies showing that a wide range of infections can trigger ME/CFS and the many early case reports of people continuing to have neurological symptoms months after first getting COVID-19, it is likely that there will soon be a flood of new ME/CFS patients that medical systems around the world are woefully unprepared to treat.
 
The UK National Health Service assumes that of Covid-19 patients, who have required hospitalization, 45 percent will need ongoing medical care, 4 percent will require inpatient rehabilitation, and 1 percent will permanently require acute care. Other preliminary evidence, as well as historical research on other coronaviruses like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), suggests that for some people, a full recovery might still be years off. For others, there may be no returning to normal. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/880288/COVID-19_hospital_discharge_service_requirements.pdf
 
There’s a lot we still don’t know, but here are a few of the most notable potential long-term impacts that are already showing up in some Covid-19 patients.
 
-Lung Scarring
 
One small longitudinal study published in Nature followed 71 SARS patients from 2003 until 2018 and found that more than a third had residual scarring, which can mean reduced lung capacity. MERS is a little harder to extrapolate from, since fewer than 2,500 people were infected, and somewhere between 30 and 40 percent died. But one study found that about a third of 36 MERS survivors also had long-term lung damage. https://www.nature.com/articles/s41413-020-0084-5 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644332/
 
Dr Ali Gholamrezanezhad, a radiologist at the Keck School of Medicine at the University of Southern California has recently done a literature review of SARS and MERS and says that for this subset of people, “The pulmonary function never comes back; their ability to do normal activities never goes back to baseline.”
 
Furthermore Covid-19 scarring rates may end up being higher than SARS and MERS patients because those illnesses often attacked only one lung. But Covid-19 appears to often affect both lungs, which Dr Gholamrezanezhad says escalates the risks of lung scarring. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs
 
Dr Gholamrezanezhad has already seen residual scarring in Covid-19 patients and is now designing a study to identify what factors might make some people at higher risk of permanent damage. He suspects having any type of underlying lung disease, like asthma, or other health conditions, like hypertension, might increase the risk of having longer-term lung issues. Additionally, “the older you are, probably the higher your chance of scarring,” he says.
 
For individuals with this kind of lung scarring, normal activities may become more challenging. Routine things, like running up a flight of stairs, would leave these individuals gasping for air.
 
- Stroke, embolisms, and blood clotting
 
It was observed that abnormal blood clotting even seems to be happening in people after they’ve appeared to recover. One 32-year-old woman in Chicago, for example, had been discharged from the hospital for a week when she died suddenly with a severely swollen leg, a sign of deep vein thrombosis. Or take Troy Randle, a 49-year-old cardiologist in New Jersey, who was declared safe to go back to work after recovering from Covid-19 when he developed a vicious headache. A CT scan confirmed he’d had a stroke. https://wgntv.com/news/coronavirus/as-doctors-study-connection-between-coronavirus-and-blood-clots-family-mourns-loss-of-woman-who-was-recovering-from-virus/ and https://www.inquirer.com/health/coronavirus/covid-coronavirus-stroke-doctor-clot-blood-infection-20200501.html
 
Although there’s still a shortage of data, one study found that as many as 31 percent of ICU patients with Covid-19 infections had these kinds of clotting problems. In the meantime, the International Society on Thrombosis and Haemostasis has issued guidelines that recovered Covid-19 patients should continue taking anticoagulants even after being discharged from the hospital. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146714/ and https://www.medpagetoday.com/infectiousdisease/covid19/86230
 
- Heart damage
 
A research from Wuhan in January found 12 percent of Covid-19 patients had signs of cardiovascular damage. These patients had higher levels of troponin, a protein released in the blood by an injured heart muscle. Since then, other reports suggest the virus may directly cause acute myocarditis and heart failure. (Heart failure was also seen with MERS and is known to be correlated with even the seasonal flu.) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext and https://www.nature.com/articles/s41569-020-0360-5#ref-CR1 and
 
Another study looked at 416 hospitalized Covid-19 patients and found 19 percent showed signs of heart damage. University of Texas Health Science Center researchers warn that in survivors, Covid-19 may cause lingering cardiac damage, as well as making existing cardiovascular problems worse, further increasing the risk for heart attack and stroke. https://jamanetwork.com/journals/jamacardiology/fullarticle/2763524?resultClick=1 and https://jamanetwork.com/journals/jamacardiology/fullarticle/2763846?guestAccessKey=150724fb-8146-4fc2-a60c-b78955728d41&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=032720
 
 An ICU and pulmonary critical care doctor at Mount Sinai Hospital in New York City, for example, recovered from Covid-19, only to learn she had developed cardiomyopathy, a condition where your heart has trouble delivering blood around your body. Although previously healthy, when she returned to work, she told media “I couldn’t run around like I always do.” https://www.nbcnewyork.com/news/coronavirus/coronavirus-after-effects-ny-doctor-develops-heart-disease-after-recovery/2397699/
 
The actual consequences may vary depending on how the heart is affected. For example, Covid-19 has been linked to myocarditis, a condition where inflammation weakens the heart, creates scar tissue, and makes it work harder to circulate the body’s oxygen. The Myocarditis Foundation recommends these patients avoid cigarettes and alcohol, and stay away from rigorous exercise until approved by their doctor.
 
-Neurocognitive and mental health impacts
 
Interestingly Covid-19 also seems to affect the central nervous system, with potentially long-lasting consequences. In one study from China, more than a third of 214 people hospitalized with confirmed Covid-19 had neurological symptoms, including dizziness, headaches, impaired consciousness, vision, taste/smell impairment, and nerve pain while they were ill. These symptoms were more common in patients with severe cases, where the incidence increased to 46.5 percent. Another study in France found neurologic features in 58 of 64 critically ill Covid-19 patients. https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549 and https://www.nejm.org/doi/full/10.1056/NEJMc2008597
 
Reviewing past SARS and MERS suggests that Covid-19 patients may have slightly delayed onset of neurological impacts. Andrew Josephson, a doctor at the University of California San Francisco, wrote in JAMA, “Although the SARS epidemic was limited to about 8,000 patients worldwide, there were some limited reports of neurologic complications of SARS that appeared in patients 2 to 3 weeks into the course of the illness.” These included muscular weakness, burning or prickling, and numbness, and the breakdown of muscle tissue into the blood. Neurological injuries, including impaired balance and coordination, confusion, and coma, were also found with MERS. https://jamanetwork.com/journals/jamaneurology/fullarticle/2764548 and https://jamanetwork.com/journals/jamaneurology/fullarticle/787110 and https://pubmed.ncbi.nlm.nih.gov/16252612/
 
Long-term complications of Covid-19  whether caused by the virus itself or the inflammation it triggers could include decreased attention, concentration, and memory, as well as dysfunction in peripheral nerves ie the ones that go to your arms, legs, fingers, and toes.
 
In addition, there are also other cognitive implications for people who receive intensive treatment in hospitals. For example, delirium which is an acutely disturbed state of mind that can result in confusion and seeing or hearing things that aren’t there, affects a third or more of ICU patients, and research suggests the presence of delirium during severe illness predicts future long-term cognitive decline. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539890/ and https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2626-z
 
Past research on acute respiratory distress syndrome (ARDS) more generally may also provide clues to what neurological issues critically ill Covid-19 patients might see after leaving the hospital.
 
Studies shows one in five ARDS survivors experiences long-term cognitive impairment, even five years after being discharged. Continuing impairments can include short-term memory problems and difficulty with learning and executive function. These can lead to challenges like difficulty working, impaired money management, or struggling to perform daily tasks. https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2626-z
 
Also many ARDS survivors frequently have increased rates of depression and anxiety, and many experience post-traumatic stress. Although it’s still too early to have much data on Covid-19, during the SARS outbreak, former patients struggled with psychological distress and stress for at least a year after the outbreak. https://pubmed.ncbi.nlm.nih.gov/14702249/?dopt=Abstract
 
-Childhood inflammation, male infertility, and other possible lasting effects
 
The SARS-CoV-2 coronavirus continues to frustrate scientists and patients alike with its mysteries. One of these is a small but growing number of children who recently began showing up at doctors’ offices in Britain, Italy, and Spain with strange symptoms, including a rash, a high fever, and heart inflammation.
 
In May, the New York City Health Department noted that at least 15 children with these symptoms had been hospitalized there, too with COVID-19. These cases present like a severe immune response called Kawasaki disease, where blood vessels can begin to leak, and fluid builds up in the lungs and other major organs.
 
Children who survive Kawasaki-like conditions can suffer myocardial and vascular complications in adulthood. But it’s too early to know how Covid-19 related cases will develop. Many of the small number of reported cases appear to be responding well to treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870533/
 
Medical experts are suggesting that Covid-19 may pose particular problems for men beyond their disproportionate mortality from the illness. The testicles contain a high number of ACE2 receptors, explained researcher Dr Ali Raba, in a recent letter to the World Journal of Urology. “There is a theoretical possibility of testicular damage and subsequent infertility following COVID-19 infection,” he wrote. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171435/#
 
Another research, looking at 38 patients in China who had been severely ill with Covid-19, found that during their illness, 15 had virus RNA in their semen samples, as did two of 23 recovering patients. (The presence of viral RNA doesn’t necessarily indicate infectious capacity.) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765654?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=050720
 
Yet another recent study also showed that in 81 men with Covid-19, male hormone ratios were off, which could signal trouble for fertility down the line. The authors called for more attention to be paid, particularly on “reproductive-aged men.” An April 20 paper published in Nature went so far as to suggest, “After recovery from COVID-19, young men who are interested in having children should receive a consultation regarding their fertility.” https://www.medrxiv.org/content/10.1101/2020.03.21.20037267v2 and https://www.nature.com/articles/s41585-020-0319-7
 
Researchers are just at the beginning of figuring out what this complex infection means for other organ systems and their recovery. For example, a recent preprint from Chinese doctors looked at 34 Covid-19 survivors’ blood. While they saw a difference between severe and mild cases, the researchers found that regardless of the severity of the disease, after recovered patients were discharged from the hospital, many biological measures “failed to return to normal.” The most concerning measures suggested ongoing impaired liver function. https://www.medrxiv.org/content/10.1101/2020.04.05.20053819v3
 
So far too many discussions and research of covid-19 focus on the disease’s death rate while neglecting the risk of long-term health problems. Called morbidity, this measure of the burden of long-term disease is so important that the Centers for Disease Control and Prevention’s most read publication is “Morbidity and Mortality Weekly Report.”
 
To really effectively plan for a post-covid future, the world must fund long-term research on survivors and account for the morbidity associated with the novel coronavirus. Instead, there are states such as Pennsylvania categorizing every covid-19 patient in its borders still alive after 30 days as “recovered.” That oversimplification will underestimate the true human and financial costs of the U.S. epidemic. Some covid-19 patients with kidney damage will need expensive dialysis for a lifetime; some will have lung damage; others will be disabled by post-viral ME/CFS.
 
Considering the historical neglect of ME/CFS very few medical students even learn about it and many physicians and researchers who follow covid-19 patients may think they’re discovering a new phenomenon in the patients who are slow to recover. Instead, they’ll be rediscovering a common illness that’s been known, and neglected and afflicting many people for decades.
 
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