I’ve heard many unconfirmed reports of COVID-19 patients suffering widespread, permanent damage to various internal organs. Mainly I seem to be hearing about kidney damage although heart and brain damage seems to be possibilities.
What do we actually know about this facet of the COVID-19 progression? How strong is the evidence and how do the actual statistical numbers add up?
I don’t know what the current state of our knowledge actually is and I’m desperately hoping for help in separating the facts from the tentatively evidenced from the scaremongering. I’ve seen estimates (unsupported by any actual data) that as many of 5% of all infected suffer some form of permanent impairment. This number seems suspect at best to me and until I can see some hard numbers then It’s difficult for me to take that estimate seriously.
Trust me, I’m not trying to defend a position here and I’m certainly not claiming knowledge on the subject. Telling me “We just don’t know, …yet.” is a perfectly valid answer. Providing me with the expert’s best guess as well as their explanation about why the evidence supports that conclusion is wonderful. I just want to know what the KNOWN risks are.
It should be first noted that many respiratory infections can cause permanent heart and lung damage. Any medical researcher looking at long term effects would not be shocked that covid-19 does as well. Acute respiratory distress syndrome (ARDS) can be caused by a number of conditions, including covid-19. An example:
Anecdotally, one person I know who had a kidney transplant last year got COVID-19 and is now back on dialysis. Another person I know seems to have permanent or semi-permanent damage to her heart.
I think there was a NY Times article on lasting damage that I can track down if you’d like.
It may be far too soon to accumulate date on the long term effects, although there are numerous reports available pertaining to kidney, liver and lung damage when it comes to Covid-19.
Covid appears to cause blood clots in addition to affecting the lung, heart and kidneys. Long term effects might include:
Lungs: decreased oxygen exchange due to scarring, atelectasis, shunting, inflammatory changes and ischemic areas
Heart: increased risk of ischemia, possible viral valve dysfunction, inflammatory changes such as myocarditis or pericarditis
Kidney: decreased filtration secondary to ischemic disease, nephritis, etc. Possible glomerular and interstial pathology. Hematuria, proteinuria.
Brain: increased risk of stroke and smaller vascular events
Other: skin and blood vessel inflammation, bowel ischemia, neuropathy, immune system changes, ICU psychosis, etc.
And what supporting data is available for these (possibly speculative) claims? What percentage of COVID-19 patients are likely to see these complications?
What in the world? No, I’m saying covid-19 will probably cause long term damage to some people because it causes somewhat similar problems as other diseases which we know cause long term damage.
I don’t think they’ve confirmed much of anything. Long-term respiratory damage was seen in patients who had to go on respirators but apparently this is caused by the respirator itself and is common in patients who have to go on respirators.
I don’t have an online cite just word of mouth from one of the ED docs at the hospital I work at.
Its simply too early to know how prevalent this is. Long term damage is long term. There isn’t a long term Covid survivor yet because its only been around eight or so months. Nor is there good data yet, because the studies are really only getting started. Data takes time to collect and analyze.
It is known that survivors of ARDS from influenza can sometimes take years to recover, and a few never do. There is an expectation that COVID-19 ARDS survivors will behave somewhat comparably. There is reasonable concern it might be worse given apparent greater multisystem involvement at lower levels of illness. And given that little expectation that it will be less. But this disease has defied expectations before.
I’ve not yet been able to find anything that compares the recovery courses of similar degree of illness involvement between influenza and COVID-19 followed to date. Faster, slower, more frequent disability, less?
Not sure I could give percentages, which in any case would vary by age and comorbidities, and lots of other things such as treatment with blood thinners. But it’s a pretty reasonable list based on my opinion considering other viruses, current reports and other diseases which cause blood clotting.
While more will be known about long-term effects as time goes on–after all, we’re not AT long-term yet, preliminary data gives us some idea.
Patients with mild cases of COVID can have debilitating long-term symptoms. (Bear in mind “mild” simply means not immediately life-threatening. You could have a temp of 104º, but if you’re not in imminent danger, the ER will send you home.) Even now, few of those cases have been tracked, though there’s a giant new study that started this month.
There’s evidence COVID crosses the blood-brain barrier and could remain in the brain, reactivating the virus at any point, though there’s also speculation the virus leaves the immune system in permanent hyperdrive. Patients with severe COVID sometimes have to relearn how to walk, eat, and talk, but there’s some evidence even mild cases can experience long-term confusion, depression, and other seizures.
A Netherlands study of 1,622 people who’d reported long-term effects of COVID found that 91% had not been hospitalized, meaning they’d had “mild” cases. The average age of patients was 53. (So much for the theory only the very elderly have long-term effects.) Debilitating fatigue (88%), shortness of breath (about 75%), were the most common long-term symptoms, though there were others. 85% had had no underlying health conditions before COVID.
But what percentage of COVID patients GET long-term symptoms? That’s hard to say because: 1) Not all patients get tested, so they’re not counted. 2) Not all neurological symptoms are counted as a result of COVID. If a person is diagnosed with COVID on Day 8 of symptoms and doesn’t develop discernible neurological issues until Day 30, those issues may not be considered a long-term effect of COVID, even if they are.
I am only asking for cite please because I cannot find it myself. I found this article discussing the neurologic side of COVID-19, that there is some evidence that SARS-CoV2 can cross the blood brain barrier, discussing a study that found roughly 50% of COVID-19 patients have neurological involvement, and that shares speculation that maybe reactivation could occur, as it does for members of the herpes family. That is all interesting, important, and scary. But it provides no evidence that such reactivation does occur and to my knowledge such has not been described to occur with any other HCoV. There is an important difference between someone saying maybe this could happen and saying there is evidence that it does.
“If you had asked me a month ago if there was any published evidence that Sars-CoV-2 could cross the blood-brain barrier, I would have said no – but there are now many reports showing that it absolutely can,” says Stevens.
In Japan, researchers reported the case of a 24-year-old man who was found unconscious on the floor in a pool of his own vomit. He experienced generalised seizures while being rushed to hospital. An MRI scan of his brain revealed acute signs of viral meningitis (inflammation of the brain), and a lumbar puncture detected Sars-CoV-2 in his cerebrospinal fluid. Chinese researchers also found traces of the virus in the cerebrospinal fluid of a 56-year-old male patient suffering from severe encephalitis. And in a post-mortem examination of a Covid-19 patient in Italy, researchers detected viral particles in the endothelial cells lining the blood vessels of the brain itself. In some countries such as France, autopsies of Covid-19 patients are highly restricted (or outright banned), making the Italian finding all the more important – and concerning.
In fact, some scientists now suspect that the virus causes respiratory failure and death not through damage to the lungs but through damage to the brainstem, the command centre that ensures we continue to breathe even when unconscious.
Where do you see discussion of evidence of the virus going dormant in the brain and becoming reactivated? Again some speculation that maybe it possibly could … not the same thing.
The cytokine storm in the blood vessels is so severe that it causes an “explosive inflammatory response” and penetrates the blood–brain barrier, leading to the entry of cytokines, blood components, and viral particles into the brain parenchyma and causing neuronal cell death and encephalitis.
“Patients in stage 3 are more likely to have long-term consequences, because there is evidence that the virus particles have actually penetrated the brain, and we know that SARS-CoV-2 can remain dormant in neurons for many years,” said Fotuhi.