A study from National Library of Medicine has dealt more with the post COVID-19 syndrome, its causes and permanent impairments in the recovered people.
Almost all COVID-19-related serious consequences feature pneumonia. In the first large series of hospitalised patients with COVID-19 in Wuhan, China, chest CT showed bilateral ground glass opacities with or without consolidation and with lower lobe predilection in all patients. In this series, 36 (26%) patients required intensive care, of whom 22 (61%) developed acute respiratory distress syndrome (ARDS). The mechanisms through which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes lung damage are only partly known, but plausible contributors include a cytokine release syndrome triggered by the viral antigen, drug-induced pulmonary toxicity, and high airway pressure and hyperoxia-induced acute lung injury secondary to mechanical ventilation. To date, more than 2 million people worldwide have recovered from COVID-19, but there remains concern that some organs, including the lungs, might have long-term impairment following infection.
Other strains of the coronavirus family, namely severe acute respiratory syndrome coronavirus (SARS-CoV; known as SARS) and Middle East respiratory syndrome coronavirus (MERS-CoV; known as MERS), are genetically similar to SARS-CoV-2 and cause pulmonary syndromes similar to COVID-19. The predominant CT abnormalities in patients with SARS/MERS included rapidly progressive ground glass opacities sometimes with consolidation. The same abnormalities continue to occur in the COVID 19 patients even after recovery.
“Would start realizing the development of ARDS symptoms from the period of 45 days to 90 days post recovery”
“The people recovered from COVID-19 mostly asymptomatic, would start realizing the development of ARDS symptoms from the period of 45 days to 90 days post recovery. The reason behind is that the COVID-19 certainly leaves its traces in our body which causes the air sacs and blood vessels in the function of lungs to lose its elasticity and becomes stiff leading to difficulty in breathing.” said Dr. Sri Venkatesh from a Government hospital of Tamilnadu in India. The solution is indeed to be proactive. “The early detection of COVID-19 followed prior diagnosis and treatment from the physician will definitely reduce the chances of ADRS post recovery” he added. This clearly indicates that the lethargy of the people in lack of reporting to physicians quick after the development of symptoms of COVID-19 is witless.
Available data indicate that about 40% of patients with COVID-19 develop ARDS, and 20% of ARDS cases are severe. Although the virus is eradicated in patients who have recovered from COVID-19, the removal of the cause of lung damage does not, in itself, preclude the development of progressive, fibrotic irreversible interstitial lung disease. Furthermore, even a relatively small degree of residual but non-progressive fibrosis could result in considerable morbidity and mortality in an older population of patients who had COVID-19, many of whom will have pre-existing pulmonary conditions.
At present, the long-term pulmonary consequences of COVID-19 remains speculative and should not be assumed without appropriate prospective study. Nonetheless, given the huge numbers of individuals affected by COVID-19, even rare complications will have major health effects at the population level. It is important that plans are made now to rapidly identify whether the development of pulmonary fibrosis occurs in the survivor population. By doing this, we can hope to deliver appropriate clinical care and urgently design interventional trials to prevent a second wave of late mortality associated with this devastating pandemic.
By Vinod Subburaj
