Coronavirus: survivors could suffer severe health effects for years

Research shows long-term health issues can stem from virus

A police officer wears a headgear mounted with thermal temperature monitor during a nationwide lockdown to slow the spread of the coronavirus, in New Delhi, India. Reuters

Groom Sanjib Mandal, right, and bride Soma Roy wear masks as they perform rituals on their marriage ceremony at a Hindu temple amid the nationwide lockdown against the coronavirus, in Siliguri. AFP

A relative of a patient stands outside the General Hospital in Mexico City during the Covid-19 pandemic. AFP

A man wearing a face mask talks with a shopkeeper in a deserted street with rows of closed shops and restaurants near Gion, in Japan's ancient capital Kyoto. The streets of the tourist city are largely deserted as the number of foreign visitors declined more than 93 per cent from previous year, the local media reported in late April. EPA

Drivers and passengers are screened by healthcare workers from the DeKalb County Board of Health at a free swabbing site at The House of Hope Atlanta church in Decatur, Georgia, US. EPA

An elderly woman holds a French flag as residents of Saint Mande celebrate the end of containment measures and thank medical and health care personnel amid the ongoing coronavirus pandemic in Saint Mande, near Paris, France. France begins a gradual easing of lockdown measures and restrictions although the Covid-19 epidemic remains active. EPA

Health personnel from the Villa Nueva National Hospital stand in front of the entrance of the hospital to address a press conference in Villa Nueva, Guatemala. The health personnel treating coronavirus patients threatened to 'enter a permanent session', in which certain areas of service will receive reduced attention, within 48 hours if they do not receive help from the authorities because of the lack of human resources. EPA

A boy wearing a mask looks at himself in the shop mirrors in Guangzhou, Guangdong province, China. China reported 17 new confirmed Covid-19 cases on May 10 , seven of which were reportedly linked to Inner Mongolia Autonomous Region, according to National Health Commission of China. EPA

A patient affected by the Covid-19 speaks with a family member by a video call at a field hospital set up at a sports gym, in Santo Andre, Sao Paulo state, Brazil. AFP

People wait on a tramway dock as they follow social-distancing rules, in the French Riviera city of Nice, southern France, on the first day of France's easing of lockdown measures against the coronavirus. AFP

Workers of the health ministry prepare to test the employees of the Ciudad de Dios market for Covid-19 in Lima. AFP

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A migrant workers' family desperate to reach their home in neighbouring Madhya Pradesh state hitchhike behind a lorry in India's commercial capital Mumbai that will take them to the outskirts of the city. India’s train network, closed in late March, will gradually restart operations on Tuesday as the country eases its lockdown amid a steep rise in the coronavirus infections. AP Photo

More than one million people around the world have been deemed recovered from the coronavirus, but beating the initial sickness may be just the first of many battles for those who have survived.

Some recovered patients report breathlessness, fatigue and body pain months after first becoming infected.

Small-scale studies conducted in Hong Kong and China's Wuhan show that survivors grapple with poorer functioning in their lungs, heart and liver. And that may be the tip of the iceberg.

The coronavirus is now known to attack many parts of the body beyond the respiratory system, causing damage from the eyeballs to the toes, the gut to the kidneys.

Patients’ immune systems can go into overdrive to fight off the infection, compounding the damage done.

While researchers are only starting to track the long-term health of survivors, past epidemics caused by similar viruses show that the aftermath can last more than a decade.

According to one study, survivors of severe acute respiratory syndrome, or Sars, suffered lung infections, higher cholesterol levels and were falling sick more frequently than others for as long as 12 years after the epidemic coursed through Asia, killing almost 800 people.

What these chronic issues ultimately look like – and how many patients ultimately experience them – will have huge implications for patients, the doctors who treat them, and the health systems around them

Sars infected 8,000 people. With more than 4 million - and more every day - infected by the coronavirus, the long-term damage to health could strain social safety nets and health-care infrastructures for years to come as well as have implications for economies and companies.

The prospect led Nicholas Hart, the British physician who treated Prime Minister Boris Johnson, to call the virus “this generation’s polio” - a disease that could leave many marked by its scars and reshape global health care.

“What these chronic issues ultimately look like – and how many patients ultimately experience them – will have huge implications for patients, the doctors who treat them, and the health systems around them,” said Kimberly Powers, an epidemiologist at the University of North Carolina at Chapel Hill, who is developing models on the virus’s spread to inform public-health efforts.

Hong Kong’s hospital authority has been monitoring a group of Covid-19 patients for up to two months since they were released.

They found about half of the 20 survivors had lung function below the normal range, said Owen Tsang, the medical director of the infectious disease centre at Princess Margaret Hospital.

The diffusing capacity of their lungs - how well oxygen and carbon dioxide transfers between the lungs and blood - remained below healthy levels, Dr Tsang observed.

A study of blood samples from 25 recovered patients in Wuhan, the city where the virus first emerged, found that they had not fully recovered normal functioning regardless of the severity of their coronavirus symptoms, according to a paper published on April 7.

In another study, CT scans taken over a month of 90 Wuhan coronavirus patients found that of the 70 discharged from the hospital, 66 had mild to substantial residual lung abnormalities on their last CT scans, which showed ground-glass opacity, said a March paper published online in Radiology.

Chronic cardiac complications could arise in patients even after recovery as a result of persistent inflammation, according to an April 3 paper by doctors at the Cedars-Sinai Medical Centre in Los Angeles. They based their analysis on patient data from Italy and China.

For clues on how Covid-19 may leave its mark, doctors and researchers are looking to the experience of Sars.

Some survivors suffered long-term effects years after they first succumbed to the disease, which is part of the same family as the new coronavirus.

Researchers in China analysed 25 Sars patients 12 years after they contracted the virus, contrasting their results with a control group who were not infected with Sars.

The study found that more than half of the recovered patients suffered another lung infection since their bout with Sars and also had higher cholesterol levels.

Additionally, half the patients had at least five colds in the previous year – a characteristic no one in the control group shared, said the 2017 paper published online in Scientific Reports.

“These data demonstrated that the recovered Sars patients had a poor quality of life 12 years following recovery, and were susceptible to inflammation, tumors, and glucose and lipid metabolic disorders,” researchers wrote.

Doctors such as Dr Tsang at Hong Kong’s Princess Margaret Hospital said looking at former Sars patients is potentially instructive.

Among survivors of the Sars outbreak of 2003, chronic fatigue and impaired lung function have been found in follow-up studies after two to four years.

People sit in a restaurant in Stockholm on May 8, 2020, amid the coronavirus pandemic. AFP

“This is so new that I don’t think anyone is able to tell what is the percentage of patients who will recover, what is the percentage of patients who will not recover and have long-term sequela,” said Michelle Biehl, a critical care pulmonary doctor at the Cleveland Clinic in Ohio, using the medical term for chronic conditions after a disease.

Tracking and figuring out how Covid-19 affects the body even after recovery could inform governments budgeting for social safety nets, doctors that see patients long term, and businesses as they set policies such as sick and disability leave.

These issues could be even more crucial as public health officials say there’s a possibility the virus may become a seasonal affliction.

Economies and companies looking to get people back to work will need to understand how and if Covid-19 affects human health in the long run and its scope.

“There is such a wide range in the way the illness affects people. The various stakeholders need solid data to help them understand the breadth and duration of long term effects,” said Jessica Justman, a professor of medicine in epidemiology at Columbia University.

White House senior adviser and son-in-law Jared Kushner, centre, looks on as US President Donald Trump holds a news conference on the coronavirus on May 11, 2020. AFP

There is some hope: Early intervention could play a role in longer-term outcomes of coronavirus patients, said Ivan Hung, a professor of medicine at the University of Hong Kong.

Prof Hung said in April that 90 per cent of about 200 discharged patients he oversaw at a clinic at one of the city’s hospitals appear to be making a full recovery a month out.

He attributed the success to Hong Kong’s “early diagnosis and early treatment” of patients, which leaves the virus with less time to wreak havoc on the body.

This may not be possible in many countries like the US and UK where testing is uneven and inadequate, and only those with serious symptoms are getting treatment.

Still, larger-scale studies in virus hot spots are needed to separate the physical legacy of the virus from how patients feel immediately after fighting off the infection.

It will be crucial for scientists to track and quantify how Covid-19 affects such factors as oxygenation and breathing rate, said Roberto Bruzzone, a visiting professor at the University of Hong Kong, whose research focuses on cell biology.

Hospitals and researchers will have begun patient registries to start gathering data to study survivors over time as well.

“We need an epidemiological study that may be feasible in places like Wuhan, New York City, Milan or Paris - where there has been a huge group of infections with a wide variety of symptoms,” Prof Bruzzone said.