At this stage of the pandemic, many are aware of the acute dangers of COVID-19. But are patients truly in the clear after recovery?
We asked Dr. R. Taylor Ripley, director of the Mesothelioma Treatment Center at Baylor St. Luke’s Medical Center’s Lung Institute, to provide insight into the long-term consequences of COVID-19.
How does COVID-19 damage organs?
Dr. Ripley: The virus, SARS-Cov-2, attaches to the body’s cells and enters those cells — called “hosts.” The virus cannot grow on its own, so it takes over the host’s machinery to produce more virus and spread to additional cells and other organs. This virus damages the organs directly by infecting the cells of the organs, but it also causes severe inflammation that affects the whole body. Many of the effects of this virus in patients with critical illness may actually be secondary to the severe inflammation.
Which organs are most affected by COVID-19?
Dr. Ripley: The lungs are the most affected. For patients with mild symptoms, shortness of breath and cough are common. As the disease gets worse, shortness of breath and decrease in oxygen in the blood occurs. Once patients experience these more moderate symptoms, they are more likely to come to the hospital or doctor’s office.
The other organs are more affected as the disease progresses to severe symptoms. Our patients have experienced heart and kidney failure as well as lung failure. Once major organs are severely affected, these patients are critically ill and often in the ICU.
Can damage to one organ cause the failure of other organs?
Dr. Ripley: Absolutely. When organs such as the lungs, heart, kidneys, brain, and liver start to fail, they affect one another. For example, if the heart does not pump blood well, then the blood with oxygen and nutrients is not delivered well enough to other organs.
Additionally, if the lungs do not absorb enough oxygen from the air, then that’ll affect all organs. The kidneys clear toxins, so if they do not work, the toxins in blood build up, causing damage to other organs.
Who is most vulnerable to lung damage due to the virus?
Dr. Ripley: Patients who are most vulnerable to the severe effects of COVID-19 have underlying medical conditions, such as severe heart disease, chronic kidney disease, emphysema or COPD, both type I and type II diabetes.
Additionally, patients with cancer, sickle cell disease, and organ transplantation are at high risk. Evidence for other conditions, such as high blood pressure, smoking, and asthma, is more limited, but patients with these conditions may also be at risk.
Doctors have witnessed an increase in blood clots in COVID-19 patients. How do these clots affect patients?
Dr. Ripley: Infection with the novel coronavirus has been associated with increased inflammatory states that likely causes increased clots. The components of blood are dynamic and respond to injury by clotting to prevent bleeding. When this response is not appropriate, those clots can block vessels that need to supply blood to the body.
When blood flow to the lungs is blocked, which is called a pulmonary embolism, the lungs are unable to transfer oxygen from the air to the blood and the body. This situation causes extreme difficulty breathing and is treated by ventilators. Ventilators are a limited resource, which is why flattening the curve is so critical, to make sure that enough ventilators are available for patients.
Every part of the body needs blood because blood supplies oxygen and nutrients to all organs, therefore, lack of blood flow can really affect every part of the body.
Can these blood clots be prevented?
Dr. Ripley: Doctors have become much more experienced with patients with COVID-19. We are particularly grateful to our colleagues, especially in New York, who dealt with this disease first. They communicated with many of us around the country about their experiences, which has helped us tremendously. From that experience, we have learned to be proactive about anticoagulation medicine for patients in the hospital and especially in the ICU.
For patients who are not hospitalized or not sick at all, preventing blood clots with medication is uncertain and normal recommendations should be followed. First, I would not recommend taking medication to prevent clots unless prescribed by your doctor.
Second, I tell all my patients, especially with cancers such as mesothelioma, lung cancer, and esophageal cancer, that mild, daily aerobic exercise is the best prevention of clots. Walking, swimming, or the exercise bike five days per week may have more health benefits than most medications. The blood pools in the legs and pumps back up the body by moving the muscles of the legs. Walking helps prevent clots from forming in the lower legs.
Are there any other long-term complications of the virus?
Dr. Ripley: Right now, the long-term damage is unknown, but we are certainly concerned that this disease could have chronic effects for patients. Given the little information on this topic, the best method to deal with these issues is to avoid infection if at all possible. That is why social distancing and masks are so important. Eventually, a vaccine that prevents the disease will be the best management to avoid ever dealing with these complications.
Do you think our nation will witness an increase in future health concerns due to this pandemic?
Dr. Ripley: My suspicion is that we will both directly and indirectly deal with health consequences from COVID-19. As discussed above, recovery from illness may have chronic effects from the damage.
Indirectly, we have seen a significant decrease in patients presenting to the hospitals or clinics with routine diseases such as cancer or heart disease. If patients stay home with mild symptoms, such as chest pain in which they would normally come for care, they may have heart disease that progresses. In this situation, when they eventually do seek care, their disease may be worse and harder to manage.
Similarly, patients should still seek care for mild symptoms or undergo routine screening, such as colonoscopy, mammograms, and possible CT tests to look for colon cancer, breast cancer, and lung cancer, based on normal recommendations. If the screening is delayed, these cancers may progress.
We encourage you to continue practicing the proper precautions to prevent the spread of COVID-19 while also maintaining your health through regular checkups and screenings. Now is the time to take care of your future health. We’re open for you, safely.