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Young or old, hospitalized or asymptomatic, anyone who had COVID-19 is at risk, doctors say

***EDITORS NOTE: This article is Part 2 of 2. Please read Part 1, "Two weeks then gone? Not even close, say doctors about the lingering effects of COVID-19" by clicking here.

Following is a breakdown of some of the lingering effects of COVID-19 infections, according doctors and public health officials treating and examining cases.

Lungs

Since coronavirus is, at its most simplified, a respiratory virus, the lungs are typically where doctors say they see the most damage.

"I think lung fibrosis is the most worrying," said Dr. Michael Hamblin, associate professor and chemist specializing in Dermatology at Harvard Medical School. "The virus damages the lungs and you get this fibrosis which dramatically decreases your breathing capacity."

Lingering lung problems can affect people of all ages, said Dr. Aileen Marty, infectious disease specialist at Florida International University. She cites international research that shows some young people who report being asymptomatic actually have scar tissue in their lungs of which they are unaware.

"When studies have been done on people who feel great, about 67% of those people have changes on chest x-rays," she said. "CT scans will then refine those images, but changes on the CT scans are worse than the changes on the film."

Young people, in particular, may not realize they have diminished lung capacity until they are older, Marty said. And because the "majority" of COVID-19 hospitalizations in Florida right now are patients in their 30s and below, she said, a significant number of younger patients might be surprised to find themselves with breathing problems down the road.

"A young person may have 150% lung capacity, so if they lose 10-15%, they don't notice it; they feel great," she said. "The problem is, we dont know how much of that tissue gets scarred up. The virus is causing the damage, it's just their youth is not letting them perceive the damage."

Neurological disease

"Patients with COVID-19 are experiencing an array of effects on the brain, ranging in severity from confusion to loss of smell and taste to life-threatening strokes," said Dr. Robert Stevens, associate director of the Johns Hopkins Precision Medicine Center of Excellence for Neurocritical Care at Johns Hopkins Medicine in a June 4 report. "Younger patients in their 30s and 40s are suffering possibly life-changing neurological issues due to strokes."

Researchers at University of Bonn in Germany in a separate June 4 publication found some of these effects might be long lasting.

"Evidence strongly suggests that patients surviving COVID-19 are at high risk for subsequent development of neurological disease and in particular Alzheimers disease," they wrote.

Even those with no prior neurological problems could find themselves with issues, as detrimental effects from the virus put COVID-19 survivors "at risk for developing long-term neurological consequences either by aggravating a pre-existing neurological disorder or by initiating a new disorder," researchers said.

Neurological disease can be evidenced by cognitive decline, in which brain cells lose function or die, resulting in reduced intellectual or motor skills.

This condition affected one-third of hospitalized patients at the time of discharge, the researchers said. They also noted a growing number of "Kawasaki-like multisystem inflammatory syndromes now being recognized in children and teenagers" something they called "clinically striking."

Symptoms of Kawasaki disease include fever, rash, inflammation of the mouth, lips and throat and swelling of the hands and feet.

Blood clots, inflammation, heart

COVID-19-induced blood clots can result in strokes, heart attacks, pulmonary embolisms and kidney failure, as well as prevent oxygen flow to the hands and feet, Hamblin said.

"A lot of people ended up with necrosis of the extremities, so they have fingers and toes amputated because they turn black from COVID," he said. "Your blood inappropriately clots and you get no blood supply to the extremities and they die."

COVID-19-induced hyper-inflammation, which can result in respiratory failure or other severe problems, is also something he said doctors are working to understand.

One cause may be a "cytokine storm," which is when the body releases too many infection-fighting substances into the bloodstream.

"[The body] is trying to limit the infection and overcome the virus; however, it leads to an excessive inflammatory response rather than harming the virus," researchers said in a June 2 paper published in the U.S. National Library of Medicine.

University of Bonn researchers warn that inflammation can result in long-lasting, detrimental effects on the brain.

"The fact that systemic inflammation has been shown to promote cognitive decline and neurodegenerative disease makes it likely that COVID-19 survivors will experience neurodegeneration in the following years," they wrote.

While inflammation is observable, the underlying causes are less so, Hamblin said. And that is something doctors must determine if they hope to treat it effectively.

"The question is, is it the virus affecting the cells of the blood vessels or is it more like a serious infection where the immune cells go into overdrive and create systemic inflammation?" he said. "Local inflammation is not too bad, but systemic inflammation is very bad."

Kidneys

Kidneys act as a filter to eliminate toxins, waste and excess water from the body. Blood clots caused by COVID-19 can impair the kidneys ability function, leading to a host of problems throughout the the body.

"If the kidney function isn't normal, that's going to be a very significant issue over time," said Dr. C. John Sperati, kidney specialist and associate professor of medicine at Johns Hopkins Medicine.

Chronic kidney disease can lead to heart disease, as well as the need for dialysis. High potassium, acid, and protein levels; swelling of the arms and legs; and fluid in the lungs are indicators one might have kidney trouble, he said.

Those with pre-existing conditions are most likely to suffer kidney damage from COVID-19, but people with no previous kidney problems are also at risk, he said.

"In some cases 90% of ventilated patients in the ICU have gone on to develop kidney issues," he said. "If you were in the ICU, there is a 50-70 percent chance of kidney damage. Many of those will get better, but we dont have enough data to see how much recovery they will have."

Sperati said people tend to seek care for lung or heart problems before kidney trouble because the symptoms of the former tend to be more apparent. Unless kidney damage is severe, he said, many people might not know they have a problem until a blood test is performed.

"Its going to be one of those sort of silent killers thats under the surface," he warned. "If it resolves, good, but if it doesnt, that becomes a major health issue that needs to be addressed over time."

Psychological issues

Suffering through a COVID-19 infection, particularly for those who have been hospitalized or intubated, can be emotionally and mentally devastating, said Dr. Jessi Gold, assistant professor of psychiatry at Washington University in St. Louis, Missouri.

"When you leave the ICU, you can end up having dreams and not know if the things happened to you or not," she said. "You might have these really dark visions."

Like physical symptoms, psychological symptoms can persist even after the virus is gone.

"Just because you were in the ICU and lived, doesnt mean you are better," Gold said. "It can take months and months, if not years, and you can end up very different than your previous self."

Anxiety and depression, including Post Traumatic Stress Disorder, or PTSD, can accompany flashbacks, nightmares or a crushing sense of being unable to breathe, she said.

Even the most common stressors reported by ICU patients are exacerbated during COVID-19, she said. Feelings of isolation and worry are heightened because family and friends are typically not allowed to visit and nurses must avoid unnecessary contact with sick patients.

Those who convalesce at home can also be traumatized, she said, because fear of contracting the virus may cause those who would otherwise help out to steer clear, leaving the patient miserable and alone.

One area in need of additional research involves the idea that some psychological implications related to COVID-19 may be caused by factors beyond a persons individual experience while ill, Gold said.

"I wouldn't be surprised if there are things that we will find out over time where well see that the disease itself causes biological problems that affect the brain and your mood and how you are feeling," Gold said. "That it is not the circumstance the experience, stress, anxiety or trauma of it but that it is actually coming from the disease itself."

Click here to read Part 1, "Two weeks then gone? Not even close, say doctors about the lingering effects of COVID-19."

@WendyRhodesFL

wrhodes@pbpost.com

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Lingering effects of COVID-19 on the lungs, heart, brain, kidneys and immune system - Palm Beach Post

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