Local Doctors Continue Learning About Long Term Effects in Some COVID-19 Patients

[UPDATED] While COVID-19 generally runs its course through patients in a matter of weeks, doctors and researchers are continuing to expand their knowledge of rare but potentially serious long-term effects that can linger weeks or months.

Medical professionals have been tracking a growing list of complications that can arise from COVID-19, from organ damage to neurological problems. But as the virus is new, there is still much to be learned, according to Huntington Hospital infectious disease expert Dr. Kimberly Shriner.

“Although most people who acquire COVID recover without long term effects, we are seeing some individuals who have survived a serious case of SARS CoV 2 infection with long term medical issues,” she said.

“These include neurological, cardiac and pulmonary issues,” Shriner said. “They vary widely from mild brain fog to possibly permanent neurological damage; from mild persistent fatigue to serious heart and lung disease. Although rare, our understanding of the potential long term effects of COVID 19 is still evolving.”

Some of the most serious complications of COVID-19 appear to involve the heart,  said Chief Medical Officer at the USC Verdugo Hills Hospital and Keck School of Medicine of USC Associate Clinical Professor of Emergency Medicine Dr. Armand Dorian.

“There’s a lot of long term consequences, but of course, because the virus is new to us — it’s not a year old yet — we don’t know all the long term effects,” he said.

“We are learning a lot. We’re understanding for some people there are none, and for some there are some really serious consequences,” according to Dorian.” The most common, serious consequences are cardiac. The virus tends to, for some reason, be attracted to the heart and it does cause a few problems like mild carditis, which is an inflammation of the heart.

“It can cause cardiomyopathy, which means the heart basically stops functioning appropriately and it can actually even also make it beat irregularly or create arrhythmias. All of those can create long term effects and become a big problem for that individual long after the infection,” he said.

Long-term lung problems are also being noticed by doctors, he said.

“There’s a lot of lung scarring or pulmonary fibrosis or pulmonary scarring that can occur from people who have significant illness from the COVID infection,” Dorian explained. “And  one other interesting one that we’re seeing that happens both in the acute and long term phases:  There’s some blood coagulation or clotting abnormalities that are occurring both in small and large vessels, which can cause blood clots.”

Some patients, especially older ones, have reported difficulty in thinking, or “brain fog,” long after contracting COVID-19, according to the U.S. Centers for Disease Control.

“There are people who are mentioning feeling foggy or having memory issues, so all of those things are there and they’re all real. And it’s something unfortunate we’re going to have to deal with it as a medical community,” Dorian said.

Dr. Daisy Dodd, an infectious disease specialist with Kaiser Permanente in Orange County, divided lingering COVID-19 symptoms into two categories: Mild and severe.

Among the more mild symptoms, fatigue and muscle weakness seem to be the primary complaints among patients, she said. Many of those with the issues had no underlying health conditions and were otherwise healthy.

“Some people have referred gastrointestinal symptoms, particularly diarrhea, and ongoing cough,” she said. “It’s probably 5%, 10% of the people that have had COVID refer this fatigue and mental fog.”

In more severe infections, doctors have noticed more severe long-term effects, “particularly individuals who have been hospitalized,” Dodd said. Such cases are more common among the elderly and those with already-compromised health.

She estimated about 5% of patients who had severe COVID-19 infections ended up with severe long-term symptoms, including lasting heart and lung damage.

Keeping healthy with proper diet and exercise will help keep patients’ bodies better-able to fight off both COVID-19 infections and long-term side-effects, Dodd said.

But UCLA Critical Care Physician and Co-Director of UCLA’s Post-ICU Recovery Clinic Dr. Kristin Schwab said in her experience, even those who were not hospitalized for their original infection end up displaying long-term issues.

“Oftentimes, it’s the people it’s not even the people who were hospitalized with the most severe form of acute lung injury and a hypoxic respiratory failure that ended up having these long-term effects,” she explained. “Oftentimes it’s people who were previously healthy, maybe not even hospitalized with COVID, but find that the effects seem to linger.”

“Knowing that it can really affect anyone and have long-term effects, in kind of a rather indiscriminate fashion, I think protecting yourself from getting COVID — wearing a mask, social distancing, washing your hands. — are so important now, more than ever.”

It was still unclear how long the long-term symptoms might persist, Schwab said.

“It’s much too early to tell the long-term permanent effects of this. Given the kind of general trajectory of many of my patients, where it takes months, but they seem to be kind of slowly improving, a lot of these manifestations I’m hopeful will not be permanent,” she said.  “Based on evidence we have from similar conditions, I’m hopeful, it’s not going to be permanent.”