With over 2 million cases in the U.S. since the coronavirus pandemic started in late December, many people have now recovered from COVID-19.
At the same time, there have been reports of people who continue to have long-term side effects of the infection.
I am a professor and doctor and specialize in infectious diseases in adults. I not only care for patients with bacterial, parasitic and viral infections – including COVID-19 – but I also actively teach and research diseases that are caused by infectious agents.
Here I offer a summary of what is known today about the restoration of COVID-19 – and where there are important gaps in knowledge.
Much of this information, which comes from studies that started after the 2003 SARS outbreak, is important for those who are recovering, as well as for their family and friends who should know what to expect.
Confusion or post-intensive syndrome
The most seriously ill patients treated in the intensive care unit are at considerable risk of delirium. Delirium is characterized by confusion, difficulty in watching, decreased awareness of person, place and time, and even the inability to interact with others.
Delirium is not a specific complication of COVID-1
Some studies say that 75 percent of ICU patients have delirium. The problem is not just confusion during the hospital stay, but for months afterwards.
For example, three and nine months after discharge, many of those who had recovered still had difficulty with short-term memory, the ability to understand written and spoken words, and to learn new things.
Some even had difficulty knowing where they were and what today’s date was. And the results of executive functions were significantly worse for those who had delirium.
Doctors are making significant efforts to reduce delirium in ICU patients. Approaches that can help include reducing sedative use, repeatedly reorienting the patient to the date, time and location, early mobilization, noise reduction, and cognitive stimulation.
Lungs – will there be chronic shortness of breath?
The most seriously ill patients with COVID-19 often suffer from pneumonia and acute respiratory distress syndrome (ARDS) during their illness.
Doctors haven’t followed patients who have recovered from the new coronavirus long enough to know if there will be long-term breathing problems.
However, a study of health care workers in China who are infected with SARS and caused by the SARS-CoV coronavirus, which was spread during the 2003 outbreak, is reassuring.
Lung damage (measured by interstitial changes seen in CT scans of the lung and lung function test results) usually healed within two years of the disease.
Smell and taste
Most patients with COVID-19 have a loss of taste and / or smell. Only a quarter of the patients had noticed some improvement in a week, but after 10 days most of the patients had recovered.
Fatigue syndrome after infection
Again, it may be too early to judge. In the case of the original SARS outbreak, almost half of the survivors interviewed more than three years after recovery complained of fatigue.
A quarter of COVID-19 patients met the criteria for disease control and prevention centers used to diagnose chronic fatigue syndrome.
It will likely be important to target mental health interventions to COVID-19 survivors to help them cope with a tired, prolonged recovery.
Blood clots can occur in up to a quarter of seriously ill COVID-19 patients.
Blood clots can cause serious long-term complications if the clots detach from the blood vessels and migrate to the lungs, causing pulmonary embolism or going to the brain and causing a stroke.
To prevent blot clots, doctors are now prophylactically using blood thinners when the concentration of D-dimer, a fragment of fibrin, a protein that forms blood clots, increases.
In one study, inflammation of the heart muscle, known as myocarditis or cardiomyopathy, was observed in a third of seriously ill COVID-19 patients.
Arrhythmias – an irregular heartbeat – can also be seen. It is not known whether this is due to a direct infection of the heart or the stress caused by the inflammatory response to this infection.
Most importantly, the long-term consequences for survivors are not understood.
Diabetics are at increased risk of severe COVID-19, which may be due in part to an overreaction of the immune response to the infection.
However, the interaction between COVID-19 and diabetes can go in the other direction. In some patients without a history of diabetes, an increase in glucose is observed in severe cases of COVID-19.
Since the virus interacts with angiotensin converting enzyme 2 or ACE2 on human cells, it is plausible that changes in ACE2 activity could be a cause of diabetes in patients with the new coronavirus. In any case, it is important to follow up on a long-term basis.
The bottom line is that the new coronavirus infection has profound effects on many different organ systems in the body.
The good news is that we expect the harm caused by COVID-19 to heal in the vast majority of patients.
However, it is important to know that some long-term conditions can be anticipated and prevented or treated for the benefit of the patient.[[[[Expertise in your inbox. Sign up for The Conversation newsletter and get expert updates on today’s news every day.]]
William Petri, professor of medicine, University of Virginia.
This article is republished by The Conversation under a Creative Commons license. Read the original article.