Post COVID: Even Mild Cases Of COVID-19 Suffer Long Term Health Consequences. COVID-19 Is Not A Dichotomy Of “You Die, Or You're Fine!"

Post-COVID: A new study by researchers from Saint James's Hospital-Dublin and Trinity College-Dublin shows that even individuals who only experienced mild symptoms of COVID-19 initially upon infection, still continue to suffer a host of health complications even months after ‘recovery’.


 
Much is known about the acute infective process of SARS-CoV-2, the causative virus of the COVID-19 pandemic. The marked inflammatory response and coagulopathic state in acute SARS-CoV-2 may promote pulmonary fibrosis. However, little is known of the incidence and seriousness of post-COVID pulmonary pathology.
 
The study team described respiratory recovery and self-reported health following infection at time of outpatient attendance. Infection severity was graded into three groups: (i) not requiring admission, (ii) requiring hospital admission, and (iii) requiring ICU care.
 
Participants underwent chest radiography and six-minute-walk test (6MWT). Fatigue and subjective return to health were assessed and levels of C-reactive protein (CRP), interleukin-6, soluble CD25 and D-dimer were measured. The association between initial illness and abnormal chest x-ray, 6MWT distance and perception of maximal exertion was investigated.
 
A total of 487 patients were offered an outpatient appointment, of which 153 (31%) attended for assessment at a median of 75 days after diagnosis. 74 (48%) had required hospital admission during acute infection. Persistently abnormal chest x-rays were seen in 4%. The median 6MWT distance covered was 460m. Reduced distance covered was associated with frailty and length of inpatient stay. 95 (62%) felt that they had not returned to full health, while 47% met the case definition for fatigue. Ongoing ill-health and fatigue were associated with increased perception of exertion. None of the measures of persistent respiratory disease were associated with initial disease severity.
 
The study highlights the rates of objective respiratory disease and subjective respiratory symptoms following COVID-19 and the complex multifactorial nature of post-COVID ill-health.
 
The study findings were published in the peer reviewed journal: Annals of the American Thoracic Society. https://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.202009-1175OC
 
The detailed study of patients at this Irish medical center, found that 62% said they had not returned to "full health" when they had a follow-up appointment a few months after their COVID-19 diagnosis. Nearly half complained of ongoing fatigue.
 
Interestingly, the severity of patients' initial COVID-19 infections was not a factor: Individuals who'd managed at home were as likely to feel unwell as those who'd been hospitalized.
 
Importantly a year into the global pandemic, the problem of "long-haul" COVID-19 is getting increasing attention.
 
Besides long term health complications of COVID-19, another area that is also gaining more interest and studies is viral persistence.
 
Recent studies estimate that 10% of COVID-19 patients become long haulers, complaining of stubborn problems like fatigue, insomnia, shortness of breath and "brain fog" (problems with memory, focus and other mental skills).
 
But more than 78% are likely to suffer from other health conditions including myocarditis. https://www.thailandmedical.news/news/guide-to-myocarditis-a-dangerous-heart-condition-affecting-up-to-78-percent-of-covid-19-infected-symptomatic-or-asymptomatic-individuals
 
Many more will suffer from a variety of neurological issues and also strokes.
 
Professor of infectious diseases at McGovern Medical School at UTHealth in Houston, Dr Luis Ostrosky is among the doctors seeing long haulers.
 
Dr Ostrosky told Thailand Medical News, "The number-one complaint we see is fatigue and number-two is brain fog."
 
Dr Ostrosky, who is also a fellow with the Infectious Diseases Society of America, was not involved in the study.
 
Dr Ostrosky said most patients who come to his center's "post-COVID" clinic were sick enough to be hospitalized for the infection.
 
He added, "Individuals who have a more severe, prolonged illness are more likely to have prolonged effects. But you do sometimes see it in patients with milder COVID-19, too."
 
The study showed that a large proportion of patients with mild COVID-19 still felt unwell when they saw their doctor over two months later.
 
However Dr Ostrosky noted, that may be because patients with lingering symptoms are more likely to make a follow-up appointment.
 
Irrespective, Dr Ostrosky saw a basic message in the findings: "COVID-19 is not a dichotomy of you die, or you're fine.”
 
In reality, there can be lasting problems, Dr Ostrosky said, including damage to the heart or kidneys, abnormal lung function and psychiatric symptoms, such as depression.
 
There are even issues of male fertility and liver damage and even eye damage.
 
He stressed, "Death is not the only bad outcome from this disease.”
 
In the study, doctors there assessed 153 patients who were diagnosed with COVID-19 between March and May 2020, then returned for a long-term follow-up appointment ie typically 75 days later.
 
In the study, almost half had been hospitalized, while the rest had recovered at home.
 
The majority of patients felt they had not regained their normal level of health, including two-thirds of those who'd managed at home. And both hospitalized and home-managed patients reported similar levels of fatigue on a standard questionnaire.
 
Dr Liam Townsend Lead researcher agreed that the group may have been particularly likely to feel unwell.
 
However of 487 patients the hospital contacted for follow-up appointments, less than one-third showed up. That included just one-fifth of patients who'd recovered at home.
 
Many patients reported breathlessness during treadmill walking tests, and 4% had abnormal chest X-rays.
 
That suggests the breathing problems were, for the most part, not related to persistent lung damage, Dr Townsend said.
 
More importantly, he added, the culprits might include fatigue and de-conditioning of the cardiovascular system and muscles.
 
However it's unclear exactly what is driving the lasting fatigue and general malaise, particularly among people with milder COVID-19, Townsend said.
 
Dr Townsend added, “What can be done for lingering symptoms? That's the hot topic at the moment."
 
Dr Ostrosky said that at his clinic, doctors try to find an "organic" cause, such as signs of injury to the lungs or heart muscle. For some patients, issues like nutritional deficiencies turn out to be contributors.
 
However sometimes, Dr Ostrosky said, the hunt for causes turns up empty. "In those cases, we have to encourage patients to hang in there," he said.
 
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