Long-Term Illnesses Caused by Covid-19
“With Covid-19 I believe it's God's way of telling us: "Only Humans can Save Humans with Humanity.”
― Somya Kedia
Covid-19, an acronym of coronavirus disease 2019, is a novel disease recognized initially in Wuhan, Hubei Province, China, in December 2019. It is likely caused by the zoonotic spillover of a beta-coronavirus type 2B that is transmitted between humans.
CoVs (Coronaviruses) are positive-stranded RNA viruses with a crown-like appearance under an electron microscope due to the presence of spike glycoproteins on the envelope. Members of this large family of viruses can cause respiratory, enteric, hepatic, and neurological diseases in different animal species, including camels, cattle, cats, and bats. To date, seven human CoVs (HCoVs), capable of infecting humans, have been identified. Some of HCoVs were identified in the mid-1960s, while others were only detected in the new millennium.
Because the first cases of the Covid-19 disease were linked to direct exposure to the Huanan Seafood Wholesale Market of Wuhan, the animal-to-human transmission was presumed as the main mechanism. Nevertheless, subsequent cases were not associated with this exposure mechanism. Therefore, it was concluded that the virus could also be transmitted from human-to-human. The symptomatic people are the most frequent source of Covid-19 spread. Because of the possibility of transmission before symptoms, individuals who remain asymptomatic could also transmit it. Of note, pre- and asymptomatic individuals may contribute to up 80% of Covid-19 transmission.
Covid-19 represents an ongoing global threat as this virus family has the potential to mutate and infect non-immune populations.
This new virus seems to be very contagious and has quickly spread globally. As the number of cases continues to rise and governments are focused on treating patients acutely sick with Covid-19, a disturbing issue of the second crisis of long-term disability is looming large.
Research shows that long-term illnesses and disabilities, enumerated below, can be triggered by it.
Guillain-Barré syndrome –
Guillain-Barre syndrome is a rare disorder in which our body's immune system attacks our nerves. Weakness and tingling in the extremities are usually the first symptoms. These sensations can quickly spread, eventually paralyzing the whole body. In its most severe form, it is a medical emergency. Although most people recover from it, the mortality rate is 4% to 7%.
Some patients in Italy have already developed Guillain-Barré after Covid-19 infection.
Myalgic encephalomyelitis/ chronic fatigue syndrome –
Myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) is a common but less well-understood neurological disease with notable effects on cognitive and muscular function. Up to 80% of cases of ME/CFS are initiated by a viral infection. Viral infections are a very common factor in causing symptom exacerbation and relapse of ME/CFS, sometimes severe and prolonged. If you do catch this infection, the after-effects are likely to be more serious.
Lung scarring –
Experts also suggest that some people, who developed severe acute respiratory syndrome (SARS), can take years to recover.
On CT scans, while normal lungs appear black, Covid-19 patients’ lungs frequently have lighter gray patches, called “ground-glass opacities”, which may not heal.
One study from China found that this ground-glass appearance showed up in scans of 77 percent of Covid-19 patients. In another study from China, published in Radiology, 66 of 70 hospitalized patients had some amount of lung damage in CT scans, and more than half had the kind of lesions that are likely to develop into scars.
A third study from China suggests this is not just for critically ill patients; its authors found that of 58 asymptomatic patients, 95 percent also had evidence of these ground-glass opacities in their lungs. More than a quarter of these individuals went on to develop symptoms within a few days.
While some lung damage may heal or disappear over time, the damage may have a greater impact on some patients. Patients who have recovered from Covid-19 can have some residual fibrosis, scars and there are chances that their lung function and lung anatomy don’t go back to normal.
Stroke, embolisms, and blood clotting –
Many patients, hospitalized for Covid-19, are experiencing unexpectedly high rates of blood clots, likely due to inflammatory responses to the infection. Studies from the Netherlands and France suggest that clots form in 20-30 percent of critically ill Covid-19 patients. These can cause lung blockages, strokes, heart attacks, and other complications with serious lasting effects.
Blood clots that form in or reach the brain can cause a stroke. Although strokes are more typically seen in older people, they are now being reported even in young Covid-19 patients. In Wuhan, China, about 5 percent of hospitalized Covid-19 patients had strokes.
In younger people, who have strokes, mortality rates are relatively low compared to those who are older. And many people recover. However, studies show only between 42 and 53 percent can return to work.
Clots outside organs can be serious, too. For example, deep vein thrombosis occurs when a blood clot forms in a vein, often the legs. This can give rise to serious complications leading to the amputation of the leg.
Cardiovascular complications –
The cardiovascular long-term complications of Covid-19 are still being researched. Experts have warned that the virus could cause angina, arrhythmia, heart failure, and heart attacks. Researchers from the University of Virginia (UVA) found that almost a quarter of Covid-19 patients, 24 percent, were suffering from acute heart failure when they were first diagnosed with Covid-19 infection. It remains unclear if the heart failure was the result of Covid-19 specifically or if the virus was worsening undiagnosed heart failure. Researchers said that out of the patients with heart failure, nearly half were not known to have high blood pressure or cardiovascular disease.
The cardiologists at the Yale School of Medicine and other experts think that there may be a subset of patients, who may suffer long-term damage to the heart.
Psychological complications –
Most people are resilient and do not succumb to psychopathology caused by disasters. Indeed, some people find new strengths. Nevertheless, like all disasters, the Covid-19 pandemic can also cause post-traumatic stress disorder (PTSD). Medical conditions from natural causes such as life-threatening viral infections do not meet the current criteria for trauma required for a diagnosis of PTSD. But other psychopathology such as depressive and anxiety disorders may ensue.
Some may be more vulnerable than others to the psychological effects of pandemics. In particular, people who contract the disease and those who are at a heightened risk for it, including the elderly, people with compromised immune function, and those living or receiving care in congregate settings, are vulnerable to psychological complications.
Simultaneously, people with pre-existing medical, psychiatric, or substance use problems are at an increased risk for adverse psycho-social outcomes.
Complications in children –
According to the WHO, some clusters of children and adolescents with a multi-system inflammatory condition with some features that are similar to those of Kawasaki disease and toxic shock syndrome have been reported from Europe and North America.
Based on initial laboratory testing, the syndrome may be related to Covid-19. Some children tested positive for Covid-19, while others did not. So, what we have is a confused picture right now.
The bottom line –
The new coronavirus and the disease it causes are still just months old. Hence, researchers have not been able to study its long-term effects on people. A smaller percentage of patients, who have a severe infection of Covid-19, can take three to six weeks to recover fully, according to estimates of the WHO.
We are learning more about the novel coronavirus every day. It is becoming clear that the virus can damage many of our body organs, and the effects may be permanent. It causes low oxygen levels, called hypoxia, which can harm our organs. It also causes widespread swelling or inflammation that puts extra stress on our bodies.
As time passes, scientists and doctors would collect more information about Covid-19. Gradually, we will know much more about its long-term effects. However, we are already starting to understand some basics. Older studies about severe pneumonia caused by other similar viruses are also giving us some insight.
- Published Online: Mar 19 2020https://doi.org/10.1148/radiol.2020200843
- Published Online: Apr 23 2020https://doi.org/10.1148/radiol.2020201629
- COVID-19 ARDS: clinical features and differences to “usual” pre-COVID ARDS, MJA Published online: 24 April 2020