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Concerns as COVID-19 survivors live with life threatening conditions

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Survivors of COVID-19 who spent time on a ventilator may be at risk of long-term disability and illness<br />CREDIT: Farhad Babaei/Magnus New/SIPA/Newscom

• Medical experts seek establishment of post pandemic recovery plan to regenerate, repair damaged organs
• Healthcare system has to be revamped to guarantee existence of continuous support system, says Okoye

Do you easily get tired nowadays? Do you have shortness of breath or difficulty breathing, cough, joint pain, chest pain, memory loss, concentration or sleep problems, muscle pain or headache, fast or pounding heartbeat, loss of smell or taste, depression or anxiety, fever, dizziness when you stand, and worsened symptoms after physical or mental activities?

You might have survived COVID-19, although you were never tested. Recent studies and medical doctors suggest that you are prone to organ damage caused by COVID-19.

They said although COVID-19 is seen as a disease that primarily affects the lungs, it can damage other organs as well, especially, the heart and brain, and that this organ damage may increase the risk of long-term health problems and sudden death.

It is feared that the situation is associated with recent rise in sudden and unexplained deaths in Nigeria and consequently, shortening of life expectancy of the population.

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Life expectancy is the number of years lived in good health.

A consultant oncologist and radiologist, Prof. Ifeoma Okoye, told The Guardian that most people who have COVID-19 recover completely within a few weeks, but some people, even those who had mild versions of the disease, continue to experience symptoms after their initial recovery.

Okoye said these people sometimes describe themselves as “long haulers” and the conditions have been called post-COVID-19 syndrome or “long COVID-19.” “These health issues are sometimes called post-COVID-19 conditions. They are generally considered to be effects of COVID-19 that persist for more than four weeks after you have been diagnosed with the COVID-19 virus,” she said.

The physician said older people and people with many serious medical conditions are the most likely to experience lingering COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for weeks to months after infection.

Okoye said organs that may be affected by COVID-19 include: heart, lungs, and brain.

She explained: “Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscle, even in people who experienced only mild COVID-19 symptoms. This may increase the risk of heart failure or other heart complications in the future.

“The type of pneumonia often associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to long-term breathing problems.

“Even in young people, COVID-19 can cause strokes, seizures and Guillain-Barre syndrome — a condition that causes temporary paralysis. COVID-19 may also increase the risk of developing Parkinson’s disease and Alzheimer’s disease.

Some adults and children experience multisystem inflammatory syndrome after they have had COVID-19. In this condition, some organs and tissues become severely inflamed.”

The cancer expert said surviving coronavirus is not a victory in itself as the ravages of the disease on the hearts and the lungs can also shorten life expectancy considerably.

On the implications to life expectancy and the healthcare system, Okoye said there is therefore a need for the establishment of a post COVID-19 recovery plan designed to regenerate and repair damaged tissues or organs. She said the healthcare system has to be revamped to guarantee the existence of a continuous support system.

On blood clots and blood vessel problems, she said COVID-19 can make blood cells more likely to clump up and form clots. “While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from very small clots that block tiny blood vessels (capillaries) in the heart muscle,” Okoye said.

The oncologist said other parts of the body affected by blood clots include the lungs, legs, liver and kidneys. She said COVID-19 can also weaken blood vessels and cause them to leak, which contributes to potentially long-lasting problems with the liver and kidneys.

On problems with mood and fatigue, Okoye said people who have severe symptoms of COVID-19 often have to be treated in a hospital’s intensive care unit, with mechanical assistance such as ventilators to breathe. She said simply surviving this experience can make a person more likely to later develop post-traumatic stress syndrome, depression and anxiety.

Okoye said because it is difficult to predict long-term outcomes from the new COVID-19 virus, scientists are looking at the long-term effects seen in related viruses, such as the virus that causes severe acute respiratory syndrome (SARS).

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She said many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterised by extreme fatigue that worsens with physical or mental activity, but does not improve with rest. “The same may be true for people who have had COVID-19,” Okoye said.

She, however, said many long-term COVID-19 effects still unknown. Okoye said much is still unknown about how COVID-19 will affect people over time, but research is ongoing. Researchers recommend that doctors closely monitor people who have had COVID-19 to see how their organs are functioning after recovery.

Okoye said many large medical centres are opening specialised clinics to provide care for people who have persistent symptoms or related illnesses after they recover from COVID-19. Support groups are available as well.

“It is important to remember that most people who have COVID-19 recover quickly. But the potentially long-lasting problems from COVID-19 make it even more important to reduce the spread of COVID-19 by following precautions. Precautions include wearing masks, social distancing, avoiding crowds, getting a vaccine when available and keeping hands clean,” she said.

A consultant cardiologist and executive secretary, Nigerian Heart Foundation (NHF), Dr. Kinsley Kola Akinroye, confirmed to The Guardian that there is a rise in sudden death in COVID-19 survivors. Akinroye said “Long COVID” is defined as “not recovery for several weeks or months following the start of symptoms that were suggestive of COVID, whether you were tested or not”.

The cardiologist said: “Profound fatigue” is the common symptom in most people with long COVID and others include cough, breathlessness, muscle and body aches, chest heaviness/ pressure, skin rashes, fever, headache, diarrhoea.

Akinroye said Long COVID was about two times as common in women as in men. “It appears there is a different type in younger people compared with the over 65,” he said.

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On cardiovascular effects of COVID-19, Akinroye said a study published in JAMA Cardiology showed relatively high frequency of post viral or inflammatory myocarditis in people who have had COVID-19.

He explained: “The virus attacks same receptor in the lungs, respiratory tract, heart. Lots of people who had heart failure in the past who have now been very unwell with COVID-19 symptoms have sustained arrhythmias, meaning their hearts were beating very fast while they were ill and then they went on to develop heart failure.

“So, if you have pre- existing cardiac conditions and cardiomyocytes express the ACE2 receptor that the COVID-19 virus likes, you are more likely to develop the cardiac symptoms. Therefore, taking ACE inhibitors can be used as a preventive measure”.

Akinroye said that the illness was “obviously a huge stress on the heart particularly for those with pre-existing conditions which can lead to hypoxic and ischaemia of the heart. The clinical course of COVID-19 is also much more in individuals with a troponin leak.”

On how to manage long COVID, Akinroye recommends:
•Learn your patterns, learn what brings on utter exhaustion or other symptoms about and try to avoid those things.
•Always recognise that post- COVID. You are different person, drop your baseline activities by about 90 per cent, accept it and life becomes easier, you become a different person.
•Get early referral from Primary Care to Long COVID clinics would lead to gradual improvement.

Akinroye said the medical practitioner have the clinical skill to manage these post-acute COVID- 19, such as listening to the patient documenting what the symptoms are, how they change and how they fluctuate and being alert to symptoms that might suggest they need referring.

The cardiologist said a register should be for statistics for: Long COVID cases, positive tests, and deaths. “Long COVID is the collective term to denote persistence of symptoms in those who have recovered from COVID-19.”

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He said symptoms of Long COVID include: fatigue, cough, chest tightness, breathlessness, palpitation, myalgia, and difficulty to focus.

Akinroye said common cardiac issues in patients from COVID-19 include labile heart rate and blood pressure responses to activity, myocarditis, pericarditis, unpaired myocardial infarction, cardiac failure, life threatening arrhythmias and sudden cardiac death. He said coronary artery aneurysm, aortic aneurysm, accelerates atherosclerosis venous and arterial thromboembolic disease can occur and several of these may manifest as Long- COVID after recovery from acute illness.

Indeed, COVID-19 is a disease that usually causes mild respiratory symptoms in most people. However, some individuals with certain underlying medical conditions and older adults may be at greater risk for severe illness.

In severe cases of COVID-19, an overactive immune response to the presence of the Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-Co-V2) may occur, which may also cause damage to other organs of the body.

Complications related to damage of the blood vessels, kidneys, eyes, brain, skin, heart, and gastrointestinal organs might result from severe SARS-CoV-2 infection.

Current data focusing on mortality outcomes from COVI-19 in the United Kingdom (U.K.) demonstrated that 26 per cent of patients admitted to the hospital with SARS-Co-V2 infection die from their illness.

However, there is a lack of data regarding morbidity related to in-hospital complications and the long-term physical and mental health burdens of patients who survive COVID-19.

A collaboration of researchers from the Department of Health and Social Care, Imperial College London, Public Health England, University of Edinburgh, University of Glasgow, University of Liverpool, University of Nottingham, University of Oxford, and the University of Sheffield — all based in the U.K. — studied the incidence of short-term complications and association with sex, ethnicity, age, and patient outcomes.

Their findings were published in the journal The Lancet.

The study took place in 302 U.K. healthcare facilities between January 17 and August 4, 2020. It enrolled 80,388 patients 19 years or older hospitalised with highly suspected or confirmed SARS-CoV-2 infection. Of these, the researchers included 73,197 patients in the analysis.

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The average age of patients included in the study was 71 years, with the majority being male (56 per cent) and white (74 per cent). Eighty-one percent of the patients had underlying conditions at baseline.

The study measured the incidence of in-hospital neurological, cardiovascular, gastrointestinal, complex respiratory, acute kidney injury, and other systemic complications. The trial also examined the patient’s ability for self-care.

Nurses and medical students collected data at specified intervals: on admission, on days one, three, nine of the hospital stay, and at discharge (or at 28 days if not discharged).

Of the patients included in the final analysis, the study reported that about 32 per cent died during the trial and 50 per cent experienced at least one complication. Approximately 44 per cent of those that survived had at least one complication.

The rate of having at least one complication ranged from 27 per cent in patients aged 19–29 years with no comorbidities up to 58 per cent in patients 60–69 years with two or more underlying conditions. The complication rates tended to increase with age and be higher in patients with preexisting medical conditions and in patients designated male at birth.

A co-author of the study from the University of Edinburgh, U.K., Dr. Thomas Drake, commented for Medical News Today (MNT) on the findings: “Complications from COVID-19 affect nearly all groups admitted to hospital with severe disease. Although people over 50 years were at the highest risk of developing complications, people under the age of 50 years were also very likely to develop complications, which was a real surprise.”

The incidence of complications was similar amongst white, East Asian, and South-Asian racial and ethnic groups. However, complication rates were highest in Black (58 per cent) versus white patients (49 per cent).

Kidney, complex respiratory, systemic complications occurred most frequently. However, patients also developed cardiovascular, liver or gastrointestinal, and neurological complications.

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Patients with complications were 2.4 times as likely to have an increased risk for poorer self-care after discharge, with neurological complications most strongly linked to the worst functional outcomes. In survivors with a complication, about 27 per cent had a decreased ability to care for themselves.

Critical care medicine specialist, pulmonologist, and medical director of the Intensive Care Unit (ICU) at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, CA, an expert not involved in the study, Dr. Shahyar Yadegar, commented to MNT on the strengths and weaknesses of the study.

He said, “Over 80,000 patients were included in this study, which aids in giving a more representative view of what truly happens within the population.”

“However, data were collected during the early days of the pandemic, which does not reflect the spread of variants that have since emerged. Ongoing data reports that variants are even more severe than the original strain studied in this article, which suggests that complications from a variant are even more severe than detailed.”

Drake elaborated on the study implications and the need for further research: “Large numbers of patients with COVID-19 will develop complications. Therefore we need to make sure healthcare systems have enough resources to care for patients and monitor their complications in the long-term.”

“We don’t know whether these complications get better or whether they lead to long-term problems,” he added. “We are currently following these people up to try and work out what this means for these patients and society going forwards in the longer term.”

Meanwhile, according to a new large-scale study from the United Kingdom, infection from COVID-19 may have a substantial negative effect on intelligence, findings that are consistent with reports of “brain fog” among long-haul COVID-19 patients.

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Researchers analysed data from 81,337 people who took the Great British Intelligence Test in 2020. Of those, about 13,000 reported they had contracted COVID-19, and 275 of those had completed the test before and after infection.

Those who had previously had the coronavirus found it harder to complete tasks related to reasoning, problem-solving, and spatial planning, the authors said. Researchers controlled for age, education, and overall mood.

“These results accord with reports of long-COVID, where ‘brain fog,’ trouble concentrating, and difficulty finding the correct words are common,” the authors wrote. “Recovery from COVID-19 infection may be associated with particularly pronounced problems in aspects of higher cognitive or ‘executive’ function.”

Working memory span and emotional processing did not seem to be affected.

How bad the cognitive decline was appeared to be linked to how serious the infection was. Researchers said those who had been placed on a ventilator while ill showed the most substantial effects. On average, their score dropped 7 IQ points.

“The scale of the observed deficit was not insubstantial,” the authors wrote. But they said brain imaging is needed before firm conclusions can be drawn.

“It is important to be cautious in inferring a neurobiological or psychological basis of the observed deficits without brain imaging data, although the assessment tasks used here have been shown to map to different networks within the human brain in terms of normal functional activity and connectivity as well as structural network damage,” they wrote.

The researchers speculate that high fever and respiratory problems could have contributed to the cognitive decline. But those symptoms had long dissipated for most people in the study — the authors noted only 4.8 per cent of them reported lingering symptoms.

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The study provides insight into one part of post-COVID — a condition that has been closely tracked by the United States Centre for Disease Control (CDC). According to the agency, long-haul COVID-19 can include a range of lingering symptoms several months after infection, including shortness of breath, headache, joint or muscle pain, dizziness, and a hard time thinking or concentrating, otherwise known as “brain fog.”

Also, scientists are now concerned that these long-term neurological symptoms could lead to worse conditions later in life.

New research from the University of Texas (UT) Health Science Center in San Antonio, United States, indicates that long COVID patients with neurological issues are at risk of Alzheimer’s.

The researchers followed COVID patients with these symptoms for about a year, with the study including more than 50 centers across 30 countries.

The researchers found that loss of smell may be an early indicator of this risk, because the parts of the brain involved in smell are also connected to memory, thinking, planning, and mood.

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