Sunday, July 12, 2020

Lifelong Lung Damage: A Serious COVID-19 Complication

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Even young people can have serious complications from COVID-19. Getty Images
  • Severe cases of COVID-19 can cause lasting damage to the lungs that may necessitate surgery or even organ transplants.
  • While the majority of COVID-19 deaths have occurred in people who are older, fibrosis cases show that even young people who survive the disease can have lasting complications.
  • A 20-year-old COVID-19 survivor in Chicago had a lung transplant that was necessary to treat a condition now being called post-COVID fibrosis.

More than 3.8 million people worldwide have recovered from COVID-19. However, recent cases are showing that even those who recover may still be at risk for long-term health issues.

Despite the fact that the earliest coronavirus reports indicated that younger people were at a lower risk of serious complications from COVID-19, recent findings are contradicting that belief.

Most recently, a 20-year-old COVID-19 survivor in Chicago was the recipient of a new set of lungs, due to a lung transplant that was necessary to treat a condition now being called post-COVID fibrosis.

There have been two other lung transplants performed on COVID-19 survivors with post-COVID fibrosis: one was in China and the other in Vienna.

While the Chicago patient is expected to make a full recovery, this is another serious long-term effect of the virus that the public needs to be made aware of.

“Holes in the lung likely refers to an entity that has been dubbed ‘post-COVID fibrosis,’ otherwise known as post-ARDS [acute respiratory distress syndrome] fibrosis,” said Dr. Lori Shah, transplant pulmonologist at New York-Presbyterian/Columbia University Irving Medical Center.

ARDS occurs when fluid builds up in tiny air sacs in the lungs called alveoli. This reduces oxygen in the bloodstream and deprives the organs of oxygen which can lead to organ failure.

Post-COVID fibrosis, according to Shah, is defined as lung damage that’s irreversible and can result in severe functional limitations from patients, such as cough, shortness of breath, and need for oxygen.

Sometimes, as in this particular case in Chicago, the damage is so extensive that a patient may require a lung transplant.

A combination of factors may contribute to post-COVID fibrosis.

According to Dr. Zachary Kon, surgical director of lung transplantation at NYU Langone’s Transplant Institute, it could be that the coronavirus causes the immune system to create blood clots, which then prevent blood from going to certain segments of the lung.

Another possibility, he said, is that the body’s immune response to the virus creates inflammatory debris that causes clots in capillary-level vessels.

The result in either case is that portions of the lung die, thus forming holes in the lungs.

Simply put, we don’t know yet.

“There is anecdotal evidence that some groups have a higher risk of a severe version of COVID-19 than others,” said Kon. “Overall, almost everyone who develops COVID-19 will have mild symptoms. In fact, many will be completely asymptotic. Only a few will develop a severe infection.”

Kon added that these are the patients who are admitted to the hospital.

A subset of those hospitalized patietns are placed on ventilators, and a subset of those are placed on what’s known as an ECMO machine (extracorporeal membrane oxygenation), which pumps and oxygenates a patient’s blood outside the body.

“The sicker you are along the subset, the higher the likelihood [of post-COVID fibrosis],” he said.

“We know how COVID-19 affects the lungs and airways,” said Dr. Bushra Mina, chief of pulmonary medicine at Lenox Hill Hospital in New York City. “Most patients recovered completely with some elements like residual cough and shortness of breath. But a certain population has excessive lung damage, and some of them wind up with fibrosis of the lung.”

This particular lung transplant patient from Chicago had previously been on a ventilator and ECMO machine for 2 months prior to her operation.

According to The Lancet, in a piece titled, “Pulmonary fibrosis secondary to COVID-19: A call to arms?,” the first series of hospitalized patients in Wuhan, China showed that 26 percent required intensive care and 61 percent of that subset developed ARDS.

“Pulmonary fibrosis can develop either following chronic inflammation or as a primary, genetically influenced, and age-related fibroproliferative process,” reports The Lancet.

Available data shows that about 40 percent of people with COVID-19 develop ARDS, and of those, 20 percent are severe.

“At this point,” added Mila, “there is no definitive answer why a certain population recovered while others had severe lung damage. It’s too early to say.”

While the majority of COVID-19 deaths have occurred in people who are older, these fibrosis cases show that even those who survive the disease can have lasting complications.

As of June 10, the majority of deaths due to COVID-19 have been for people older than age 85.

According to the Centers for Disease Control and Prevention (CDC), death numbers are still greatly dependent on age. But what the medical community is preparing itself for are the recovered cases that show long-term damage, like post-COVID fibrosis.

Some other effects include:

  • ARDS
  • post-intensive care syndrome
  • a lasting impact on the kidneys, heart, and brain

It’s imperative to take health and safety precautions concerning COVID-19 seriously.

After reopening businesses and public facilities, 21 states are reporting an increase in confirmed COVID-19 cases.

Steps you can take to continue to minimize exposure and risk include:

With these measures in place, the chances of COVID-19 spreading drops dramatically. We all need to do our part to make sure the virus continues to slow its spread.

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