Sunday, July 12, 2020

Patients already presenting in need of lung transplants after surviving Covid

Transplant News Sharing // News from Source

A CORK respiratory consultant has said patients are already presenting in need of lung transplants as a result of permanent damage inflicted by Covid-19.

Dr Oisin O’Connell, a respiratory consultant at the Bon Secours in Cork, voiced concern about the long road ahead for patients suffering permanent damage from the virus.

“I was speaking to two of my lung transplant colleagues, one of the doctors and one of the surgeons, and they said they’ve already got people who had Covid-19 referred to them for lung transplantation,” he said. 

“The disease has left them with such permanent scarring they can no longer have a quality of life. 

“These patients are persistently on high oxygen. They have already been treated but are left with this residual scarring.

“There is a misinterpretation among people that Covid causes a very bad flu-like illness that people get over. Unfortunately, that’s not always the case.”

The severity of side-effects are still unknown due to the recent introduction of the virus.

“It’s now going to be a lot more complex figuring out what causes inflammation in the lungs,” Dr O’Connell said. 

“Normally, what we do is regular CT scans and if the inflammation is persistent, biopsies. We have to bear in mind that there are waiting lists for months and years in some centres to see a respiratory consultant with these new forms of post-Covid pneumonitis. 

“The difficulty is there is not a long enough duration of knowledge to determine if there is going to be a consequence, but we know that one in 20 people who get over forms of clotting conditions in the lung go on to develop this one to three years later. 

“With this in mind, there is a realistic possibility that in addition to a subset of patients developing pulmonary fibrosis after Covid, a subset of patients may develop pulmonary hypertension secondary to Covid — a type of high blood pressure affecting arteries in the lungs and heart. 

“However, we don’t have that data yet as Covid’s only around since December.

“It’s not going to be seen for a year or two whether some patients do get this, but we are certainly seeing patients that have been permanently left with advanced pulmonary fibrosis who are meeting the criteria for lung transplants already.”

He pointed out the difficult challenges facing consultants adapting to a post-Covid world.

“We know for a fact that some people are ending up with permanent scarring of the lungs and they have been referred for lung transplantation. 

“As a result, we have to completely refashion the way we assess patients to avoid them coming into hospital. 

“The second way this is going to affect us is with diagnostic uncertainty. 

“Your job as a doctor is to exclude the rare and serious possibilities.

“Whenever you see inflammation and scarring there is a possibility for a type of lymphoma or pulmonary lymphoma. 

“The difficulty with that is if you assumed every lung is related to a post-Covid syndrome, every now and then, there is the risk of missing a serious condition.

“Ireland has become a very litigious country and I think we are all scared that there is going to be a new wave of misdiagnoses from a respiratory perspective because, (1) we don’t have ready access to CT scans and (2) there will be a reduction in the number of pulmonary tests.”

He spoke of patients with permanent Covid-19 damage who never tested positive for the disease.

“There is going to be a huge number of referrals. 

“When a patient visits their GP and says I’m very breathless and tired it’s very difficult for that GP to quantify if this is a mild or severe form of inflammation. 

“I’ve seen patients who clearly had Covid-19 but never tested positive. 

“They are coming in with really bad inflammation of the lungs and if you didn’t have a CT scan you wouldn’t have understood the need to treat this aggressively with medications like antibiotics, steroids and other blood-thinning medications we now know help a number of Covid-19 patients.”

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