Doctors are now concerned that the pandemic will lead to a significant surge of people battling lasting illnesses and disabilities. Because the disease is so new, no one knows yet what the long-term impacts will be. Some of the damage is likely to be a side effect of intensive treatments such as intubation, whereas other lingering problems could be caused by the virus itself. However, preliminary studies and existing research into other coronaviruses suggest that the virus can injure multiple organs and cause some surprising symptoms. Prof. Dr. Sundeep Mishra provides reasons for post-COVID complications and advise physicians should dole out to patients.

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Most people with COVID-19 experience only mild symptoms or may even remain asymptomatic but about 10-15% of cases progress to severe disease, and about 5% become critically ill, and may even die. Typically most people recover from COVID-19 after 2 to 6 weeks, but in about 1/3rd of cases some symptoms may linger (or even recur) for weeks to months. Interestingly, this can even happen in people with mild disease and some of them can develop medical complications that may have lasting health effects.

It has been noted that in COVID patients who have been hospitalised, more than 70% were reporting shortness of breath and nearly 1 in 7 were still using oxygen at home even a month after being discharged. However, in patients who have had more severe infections, long-term damage may affect not just in their lungs, even heart, immune system, brain and elsewhere. As a matter of fact, data from previous coronavirus outbreaks, like SARS epidemic also reveals that these effects can last for years. In light of all this, doctors are now concerned that the pandemic will lead to a significant surge of people battling lasting illnesses and disabilities.

Reasons for post-COVID complications

Persisting organ damage

Infection clears away but the damage that occurred during acute COVID disease persists. This happens in cases presenting with lung disease, where about 1 in 10 cases, lung damage may persist at least for intermediate duration. Fortunately, this lung damage decreases with time. One study showed that 88% of participants had visible damage 6 weeks after being discharged from hospital, but by 12 weeks, this number had fallen to 56%.

Immune dysregulation

While COVID-19 often strikes the lungs first, it is not simply a respiratory disease, and in many people, the lungs are not the worst-affected organ. The immune system is one major target of this disease which pervades the whole body. On one hand it can decrease immune-system activity by reducing the production of signaling molecules called interferons, leaving the infected with weakened immune systems.

On the other hand, the virus can also have the opposite effect, causing parts of the immune system to become overactive and trigger harmful inflammation throughout the body. As a matter of fact cytokine storm is the major cause of multi-organ disease like myocarditis and heart failure and even death during active COVID disease but the increased inflammation may persist even after one becomes COVID negative with subsequent organ problems and multi-organ problems later on.

Unmaking of previous disease

During COVID infection patient may present with lung disease but also develop heart disease like myocarditis, which remains unmasked because the focus was on lungs only. After discharge when patient resumes activity, the hidden heart disease becomes unmasked.

Increased thrombotic tendency

Persisting inflammation may contribute to increased thrombotic vascular activity which persists even after the infection goes away. There are cases of patients developing heart attacks and sudden deaths soon after discharge for COVID disease.

Neurological and psychological disorders

Many people who become severely ill experience neurological complications such as delirium and cognitive difficulties such as confusion and memory loss which may persist long after. It may be a consequence of continuing inflammation.

Chronic fatigue

Over half the patients who are discharged continue to have fatigue which persists in 1 out of 6 patients even at 3 months. Again the cause of this seems to be persistent low-level inflammation, possibly triggered by infection.

Side-effect of acute treatment

Some of the damage is likely to be a side effect of intensive treatments such as intubation.

So, what to do about it?

Patients should be advised:

1. To avoid heavy exertion: Since there is persistent inflammation, even after virus goes away, heavy exertion should be avoided for at least 6 months.
2. Continue anti-thrombotic therapy: It may be prudent to continue anti-thrombotic therapy to avoid vascular thrombogenic tendency.
3. Frequent and careful medical follow-up: All organs which can be affected should be carefully examined to ascertain if any disease is present and a healthy attitude of suspicion should be kept during follow-up.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Sundeep Mishra is a Professor of Cardiology.