As the United States fends off another wave of increasing COVID-19 cases it is important for Americans to understand the potential for long-term health issues related to having contracted the virus. As the numbers of new cases are sweeping upward throughout the country this fall and winter, evidence of long-term or lasting effects of the virus are coming to light. Many parts of the body can be affected by post-infective inflammatory changes, including the cardiovascular, respiratory, neurologic and gastrointestinal systems. Many of the large accredited medical journals are reporting studies on these issues.
One of the more pronounced phenomenon to be observed is post-infective cardiac disease. The American Heart Association cites two recent studies on their website:
But two recent studies suggest heart damage among those infected may be more widespread. In JAMA Cardiology, an analysis of autopsies done on 39 COVID-19 patients identified infections in the hearts of patients who had not been diagnosed with cardiovascular issues while they were ill.
Another JAMA Cardiology study used cardiac MRIs on 100 people who had recovered from COVID-19 within the past two to three months. Researchers found abnormalities in the hearts of 78% recovered patients and “ongoing myocardial inflammation” in 60%. The same study found high levels of the blood enzyme troponin, an indicator of heart damage, in 76% of patients tested, although heart function appeared to be generally preserved. Most patients in the study had not required hospitalization.
The article goes on to state that approximately one quarter of all hospitalized COVID-19 patients have obvious cardiac illness related to the virus and this may contribute to upwards of 40% of the hospital reported deaths from the disease. Much of this is not obvious however. Many patients, hospitalized or not, report protracted periods of fatigue after having “recovered” from the typical viral symptoms. It is unclear at this point whether screenings, such as blood tests or imaging, are of value.
Health experts are only just starting to put together observational data regarding long term-effects of this novel coronavirus. Former head of the FDA, Scott Gottlieb, recently was quoted as saying, “I don’t think we fully understand what these syndromes are. We’ve infected millions, tens of millions of people now with COVID in the United States. So, we don’t know the answers to these questions. It does appear that there is a higher incidence of the serious post-viral syndromes associated with this virus, but we don’t know that for sure. I think we’re not going to know that for some time, because, quite frankly, we haven’t even really accurately characterized what these post-viral syndromes are at this point.”
The Centers for Disease Control (CDC) has several investigations currently underway to investigate long and short-term effects possible after having contracted the COVID-19 virus. They have a dedicated web site to outline and update their progress: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html. Other studies are ongoing at other private and publically-funded organizations as well.
Not everyone will suffer long or short-term effects of the virus. The challenging question is why some people do and some do not. Certainly contributing to the likelihood of post-viral health issues is a patient’s underlying health status. Age and underlying medical disease appear to make these issues more likely. The journal Annals of Internal Medicine published an article this week strongly linking obesity to death in COVID-19 cases. Over 40% of the US population is obese. This study found a strong link to obesity and death, stating:
“We found a striking association between BMI and risk for death among patients with a diagnosis of COVID-19 in an integrated health care system: this association was independent of obesity-related co-morbidities and other potential confounders.”
What does all this mean for you? Several things. First and foremost is to avoid contracting the virus at all costs. The simple guidelines put out by the CDC have proven effective over and over again:
- Wash your hands regularly with soap and water, or clean them with alcohol-based hand rub.
- Cover your mouth and nose with a mask when in public settings or around others.
- Maintain at least six feet distance between you and people coughing or sneezing.
- Avoid touching your face.
- Cover your mouth and nose when coughing or sneezing.
- Stay home if you feel unwell.
- Refrain from smoking and other activities that weaken the lungs.
- Practice physical distancing by avoiding unnecessary travel and staying away from large groups of people.
If you do not feel well, in any way, contact your doctor. Have a discussion with them. See if some further investigation may be warranted. As your physicians, it is not our job to scare you with these emerging fact, but rather to inform you. Well-informed patients can make the proper adjustments in their lives to avoid such long term sequelae of the virus. Your physician is there to help guide you through the pandemic is a safe and plausible fashion. Together we can defeat COVID-19.
Dr. Michael J. Gaesser is board certified in Internal Medicine and sees patients at Premier’s Poughkeepsie – Internal Medicine office located at the Atrium at MidHudson Regional Hospital, 1 Webster Avenue, Suite 301, Poughkeepsie, NY 12601
To schedule an appointment with Dr. Gaesser, please call #845.790.6100
Citations:
- https://www.heart.org/en/news/2020/09/03/what-covid-19-is-doing-to-the-heart-even-after-recovery
- https://www.msn.com/en-us/news/politics/gottlieb-warns-that-long-term-effects-of-covid-still-unknown/ar-BB1bi8Fv?ocid=uxbndlbing
- https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html
- https://www.bing.com/search?q=cdc+guidelines+for+coronavirus&qs=FT&pq=cdc&sk=HS1&sc=8-3&cvid=B6AFEFC8AD854B3B98DC941BE8DF016F&FORM=CHRDEF&sp=2
- https://www.acpjournals.org/doi/10.7326/M20-3742