The COVID-19 pandemic has paralyzed much of the world and hundreds of thousands of people are facing this disease caused by the new coronavirus, which has so far killed more than 19,000 people.
As doctors across the planet struggle to detect and treat patients, many manage to recover. So far, more than 100,000 people have managed to overcome the infection worldwide.
But one of the main questions is: do people who recovered, both symptomatic and asymptomatic, have short or medium-term sequelae?
One of the first studies related to the status of a dozen patients recovered from COVID-19 was carried out by the Hong Kong Hospital Authority. Specialists found that some of them had reduced lung function and experienced shortness of breath when walking.
“Some patients might have around a drop of 20 to 30% in lung function after full recovery. […] they gasp if they walk a bit more quickly”, told Owen Tsang Tak-yin, director of the Infectious Disease Center at Princess Margaret Hospital in Hong Kong, to South China Morning Post.
Also, doctors at the Hong Kong Hospital Authority found that patients’ CT scans showed a milky and ground glass substance in their lungs, suggesting there was organ damage.
“It is true [that there may be lung damage], but there are few studies on subsequent lung sequelae. So suggests the cases report of patients who have overcome the disease after severe pneumonia and were under mechanical ventilation. But remember that these studies were coming out three weeks ago and it is not yet known if that lung capacity will recover over time, therefore we cannot assure that it will be maintained”, explains Pulmonologist Pascual Chiarella, Dean of the School of Health Sciences at Universidad Peruana de Ciencias Aplicadas (UPC).
In this sense, he agrees with Eduardo Gotuzzo, Specialist in Infectious and Tropical Diseases at Universidad Peruana Cayetano Heredia, who points out that “we will have to study and follow the cases. More research is needed for patients who recover [from COVID-19].”
Based on the previous evidence of patients who present other viral and bacterial lung infections, the specialists interviewed agree that the new coronavirus can generate sequelae in those patients who develop a serious condition of pneumonia, but it is unknown if it will maintain or disappear over time.
“People who develop pneumonia could be left with lung damage, which recovery is not yet known. Initially, they are going to be left with some pulmonary restriction”, says Gotuzzo.
As COVID-19 primarily affects the lower airways it focuses on the lungs. In this context, experts are concerned that patients who overcome the infection, as happens with other serious respiratory diseases, develop pulmonary fibrosis, which occurs when the affected lung tissue becomes scarred and hardened.
“The problem is the group of infected people who develop the most severe form of the disease, with respiratory failure and require mechanical ventilation to survive. This group, due to the compromise in the lungs, is going to have the effects that have all patients who use mechanical ventilators: the lung capacity will be altered in some way. Discharged patients will have a decline of about 30% in breathing capacity. This is due to pulmonary fibrosis, which will lead to shortness of breath and chronic cough”, explains Dr. Javier Jauregui, Pulmonologist at Clínica Ricardo Palma.
“The longer the patient has mechanical ventilation, the sequelae will be worse”, adds Dr. Jauregui.i
In this sense, Dr. Chiarella affirms that patients who overcome COVID-19 may present the typical sequelae of someone who required mechanical ventilation, but the situation will depend on the age of the patient, considering that the virus is more aggressive in older adults. “You have to be aware of the sequelae to be able to treat them.”
Oscar Gayoso, Pulmonologist and Professor of Medicine at Universidad Peruana Cayetano Heredia (UPCH), affirms that although there is not much data on the effect of the new coronavirus on recovered patients, it is expected that “those who require mechanical ventilation will present more structural damage and, therefore, more sequelae.”
Although the percentage of patients that need intensive care is around 5% of the total infected, this percentage is enough to collapse the health care systems in the country, says Dr. Jauregui.
What about people with mild symptoms?
Both experts consider that in mild and moderate cases of COVID-19, which are 80% of all infected people, the prognosis is much better from what is known so far.
“It is supposed there is not much damage in patients who do not develop a pneumonia condition. It is not yet known [what will be the effect in the medium term]”, says Dr. Gotuzzo.
On the other hand, Dr. Chiarella points out that “in asymptomatic people, the disease happens like a common cold. Those with more symptoms will also have no sequelae.”
“Groups that develop mild symptoms and do not have a lung infection will not have major sequelae. The only thing that could occur is bronchospasm, but this is quite treatable”, adds Dr. Jauregui.
Dr. Javier Jauregui
Pulmonologist at Clínica Ricardo Palma