Thought of the Day - December 3 2021 - Long-COVID Impact

It has been a couple of months since we talked about Long-COVID ( Thought of the Day - October 4 2021 - Years Into Long-COVID ). As you know Long-COVID or Long Hauling are terms for long-term medical issues arising from COVID. While all Long-COVID cases have significant impairment to normal life they of course do vary greatly in terms of symptoms and their severity.

Problems with Mood and Fatigue

People who have severe symptoms of COVID-19 often have to be treated in a hospital's ICU, with mechanical assistance such as ventilators to breathe. Simply surviving this experience can make a person more likely to later develop post-traumatic stress syndrome, depression and anxiety. In addition, many people who have recovered from severe acute respiratory syndrome have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens with physical or mental activity but doesn't improve with rest.

Lung Transplants

I saw recently that there have been 107 double-lung transplants in BC since the beginning of 2020, with approximately 8 more planned before year-end. So far nine of these were due to lung damage related to COVID-19. Eight of the nine people were aged between 30 and 50 and "healthy". Two of the nine people were long-haul COVID patients. "I've never seen anything like this that affects otherwise completely normal healthy people to knock them down so hard and so severely and end up permanently destroying their lungs," said Dr. John Yee, a lung transplant surgeon with Vancouver Coastal Health. "In terms of the volume of people that we are seeing and the ferocity with which the lung damage occurs — this is quite unprecedented. There are virtually no diseases that can accelerate lung damage as quickly as we've seen with COVID." COVID-diseased lungs become scarred by viral and bacterial pneumonia and filled with fluid. Eventually, the tissue becomes so "leathery" they become unable to inflate normally. "All of the patients we are seeing are very debilitated because they've been bed-bound for months — many unconscious due to the need for sedation," said Yee. "The quality of life would be horrendous." Patients whose lungs are destroyed by COVID have a much longer rehabilitation process than other lung transplant survivors who can recover in weeks. Those who have had COVID are facing a minimum of six months — in part due to the time they have had to spend on life support.

BC leads the country in COVID-related lung transplants. As of October, there had been 12 lung transplants in Canada due to COVID-19, with the nine in BC, three in Ontario and none reported in the other provinces.

Micro-Clots

Although COVID-19 is seen as a disease that primarily affects the lungs, it can also damage many other organs, including the heart, kidneys and the brain. In some people, as well as long-term breathing problems, lasting health effects may include, heart complications, chronic kidney impairment, stroke and Guillain-Barre syndrome — a condition that causes temporary paralysis.

Some experience multisystem inflammatory syndrome after they have had COVID-19. In this condition, some organs and tissues become severely inflamed. Some of the symptoms of Long-COVID, may be caused by inflammatory molecules trapped inside tiny blood clots, according to a scientist at South Africa’s Stellenbosch University. High levels of inflammatory molecules were found in micro blood clots in blood samples from people with Long-COVID.

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.

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

While all this sounds pretty depressing it is good to see we are making progress in recognizing the significance of Long-COVID and starting to understand some of the causes of people's ongoing symptoms.

Cheers

Cliff