Doctors treating coronavirus patients have begun to worry that survivors may sustain lasting damage to several organs - not just the lungs, according to the Los Angeles Times.
For the sickest patients, infection with the new coronavirus is proving to be a full-body assault, causing damage well beyond the lungs. And even after patients who become severely ill have recovered and cleared the virus, physicians have begun seeing evidence of the infection’s lingering effects.
In a study posted this week, scientists in China examined the blood test results of 34 COVID-19 patients over the course of their hospitalization. In those who survived mild and severe disease alike, the researchers found that many of the biological measures had “failed to return to normal.” -Los Angeles Times
One alarming observation have been test results indicating that recovered patients continue to have impaired liver function after patients had been cleared for discharge.
Another concern from cardiologists are the immediate effects of COVID-19 on the heart, raising questions over how long the damage may last. As the Times notes, "In an early study of COVID-19 patients in China, heart failure was seen in nearly 12% of those who survived, including in some who had shown no signs of respiratory distress."
Heart damage can easily occur when the lungs cannot deliver sufficient oxygen to the body, however when this happens without respiratory distress, "doctors have to wonder whether they have underestimated COVID-19's ability to wreak lasting havoc," according to the report.
"COVID-19 is not just a respiratory disorder," according to Yale cardiologist Dr. Harlan Krumholtz, who added "It can affect the heart, the liver, the kidneys, the brain, the endocrine system and the blood system."
Of course, there are no long-term survivors of the disease - which was unknown to mainstream science less than five months ago. Even its first victims in China are just over three months removed from their ordeal, while physicians swamped with the ongoing pandemic have been too busy treating critical patients to closely monitor the some 370,000 patients classified as 'recovered.'
Still, doctors are worried that in its wake, some organs whose function has been knocked off kilter will not recover quickly, or completely. That could leave patients more vulnerable for months or years to come.
“I don’t know that for real,” he cautioned. “But this disease is so overwhelming” that some of the recovered are likely to face ongoing health concerns, he said. -Los Angeles Times
Meanwhile, questions have emerged over whether COVID-19 actually leaves the body - possibly lying dormant for years only to re-emerge later in a different form.
Several viruses already do this such as chicken pox - which can come back as shingles, and hepatitis B, which can cause liver cancer years after the primary infection clears up. Ebola is another example - hiding in the vitreous fluid of victims' eyeballs in some cases, causing blindness or impaired vision in 40% of survivors.
Of course, then there's the lungs - which the novel coronavirus tends to target first. In another closely related coronavirus, severe acute respiratory syndrome (SARS), around 1/3 of recovered patients had impaired lung function after three years - though they largely resolved over the next 15 years. And, 1/3 of those who survived Middle East Respiratory Syndrome (MERS) had permanent scarring of the lungs known as fibrosis.
According to a mid-March publication which tracked a dozen COVID-19 patients discharged from a Hong Kong hospital, two or three reported having difficulties with activities they had no problem performing in the past.
Dr. Owen Tsang Tak-yin, director of infectious diseases at Princess Margaret Hospital in Hong Kong, told reporters that some patients “might have around a drop of 20 to 30% in lung function” after their recovery.
Citing the history of lasting lung damage in SARS and MERS patients, a team led by UCLA radiologist Melina Hosseiny is recommending that patients who have recovered from COVID-19 get follow-up lung scans “to evaluate long-term or permanent lung damage including fibrosis.”
As doctors try to assess organ damage after COVID-19 recovery, there’s a key complication: Patients with disorders that affect the heart, liver, blood and lungs face a higher risk of becoming very sick with COVID-19 in the first place. That makes it difficult to distinguish COVID-19 after-effects from the problems that made patients vulnerable to begin with — especially so early in the game. -Los Angeles Times
And while doctors and researchers are still discovering COVID-19's secrets, what they do know is that when patients show signs of infection, several organ systems are affected - and that when one begins to fail, others often follow. This is all wrapped in an inflammatory response, which can pry "plaques and clots from the walls of blood vessels and causing strokes, heart attacks and venous embolisms," according to the report.
Dr. Krumholtz, the cardiologist, says the infection can cause damage to the heart and the sac which encases it, causing heart failure and arrhythmias in some patients during the acute phase. This means that former COVID-19 patients can become lifelong cardiology patients after they 'recover' from the primary illness.
What's worse, blood abnormalities that can make clots more likely can persist as well.
In a case report published this week in the New England Journal of Medicine, Chinese doctors described a patient with severe COVID-19, clots evident in several parts of his body, and immune proteins called antiphospholipid antibodies.
A hallmark of an autoimmune disease called antiphospholipid syndrome, these antibodies sometimes occur as a passing response to an infection. But sometimes they linger, causing dangerous blood clots in the legs, kidneys, lungs and brain. In pregnant women, antiphospholipid syndrome also can result in miscarriage and stillbirth. -Los Angeles Times
Yale's Dr. Brennan says that at the end of the day, we just don't have enough data to make a long term prognosis for coronavirus patients.