From early on in the pandemic, COVID-19 patients were leaving hospital with lung and heart damage that was was found to linger for weeks, prompting doctors to talk about possible long-term consequences.
Months of ongoing lung and heart complications have made plain that some patients will be sick for a long time. But how long?
And is there a pattern emerging of some patients recovering faster than others?
Austrian researchers have reportedly completed the first, prospective follow-up of patients infected with the coronavirus: the patients were released from hospital six months ago.
Two main conclusions:
- Many patients continue to show lung impairment (from scarring) from when they became ill.
- Many patients who have suffered long-term lung or heart damage tend to improve over time, suggesting the lungs have “a mechanism for repairing themselves.”
A French study found that COVID-19 patients that started a pulmonary rehabilitation program after coming off ventilators enjoyed a better and faster recovery, including the ability to walk unaided.
The findings of the two studies were reported to a virtual European Respiratory Society International Congress.
More details please
According to a statement from the European Lung Foundation, the Austrian researchers enrolled 86 patients between 29 April and 9 June. (There are now more than 150 patients participating).
The patients returned for evaluation six, 12 and 24 weeks after their discharge from hospital.
During these visits, clinical examinations, laboratory tests, analysis of the amounts of oxygen and carbon dioxide in arterial blood, lung function tests, computed tomography (CT) scans and echocardiograms were carried out.
After six weeks, more than half the patients “had at least one persistent symptom, predominantly breathlessness and coughing.” CT scans still showed lung damage in 88 per cent of patients.
The echocardiograms showed that nearly 60 per cent of the patients had “dysfunction of the left ventricle of the heart at the point when it is relaxing and dilating”. Biological indicators of heart damage, blood clots and inflammation were “all significantly elevated”.
After 12 weeks after discharge, damage from inflammation and fluid in the lungs caused by the coronavirus, which shows up on CT scans as white patches known as ‘ground glass’, improved. Where it had been present in 74 patients at six weeks, it was found in 48 patients at 12 weeks.
Results from the evaluations at 24 weeks are yet to be evaluated.
“The bad news is that people show lung impairment from COVID-19 weeks after discharge; the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves,” said Dr Sabina Sahanic, a clinical PhD student at the University Clinic in Innsbruck and part of the team that carried out the study.
- The average age of the 86 patients in this study was 61
- 65 per cent of them were male.
- Nearly half of them were current or former smokers.
- 65 per cent of hospitalised COVID-19 patients were overweight or obese.
- 21 per cent had been in an intensive care unit.
- 19 per cent had had invasive mechanical ventilation.
- The average length of stay in hospital was 13 days.
Prompt rehabilitation is key
The French study involved following 19 patients’ recoveries after being on ventilation in ICU and suggests they fared better when promptly transitioned to a pulmonary rehabilitation program.
Those French patients spent an average of 26 days in intensive care, followed by 13 days in a pulmonary ward before their transfer to a rehabilitation centre.
Their weekly progress was evaluated using a six-minute walk test.
Most patients were unable to walk when they arrived for rehabilitation.
After three weeks of rehab, the mean six-minute walk test distance had increased from 120 metres to 337 metres. They were judged to be still seriously impaired.