COVID-19: Recovery & Sequelae
All the things that the media isn't talking about.
I have been asked this so many times, “Milla, you really haven’t gone out in 6 months?”, to which my answer has been “No”. The conversation then goes to “are you afraid?”, “are you living in fear?”, and the answer to both of those is NO. Unlike many of my peers, I’ve had yellow fever, dengue, typhoid... amongst other diseases. I’ve had to be on drip, and I’ve had to go across town just to get respiratory therapy. In all those situations, I’ve had no pre-existing conditions, and I was not immunocompromised. With my previous experiences, I knew Covid-19 was no flu.
And while people are dodging infection, I am dodging sequelae.
I decided to fervently research this virus, reading medical journals, articles, and talking to my friends that are on the front lines. For the sake of argument, I’m not talking about the elderly or the immunocompromised - I am focusing on recovery, severity of symptoms, and sequelae, amongst other things. I’ve compiled all of my research below. This isn’t political or biased - these are just facts:
Let’s talk about sequelae - what is it?
A condition which is the consequence of a previous disease or injury. Meaning: After a chickenpox infection, for instance, the herpes virus that causes the illness hides quietly for decades and often emerges as the painful affliction called shingles. 30% of people who have chickenpox will have shingles later in life. And in the months after the West African Ebola epidemic subsided in 2016, the virus responsible for that illness was found to have taken up residence in the vitreous fluid of some of its victims’ eyes, causing blindness or vision impairment in 40% of those affected. The predicted sequelae of COVID-19 are lung damage, heart damage, neurologic symptoms, kidney damage, and blood clots. These may resurface during treatment or down the road after recovery. (FYI, lung damage from SARS took 15 years to recover from).
One of the most notorious was the influenza virus responsible for the 1918 pandemic, which caused permanent and profound damage to the dopamine neurons of the brain and central nervous system. An estimated five million people worldwide were hobbled by a form of extreme exhaustion known as “sleepy sickness” or “encephalitis lethargica”. “Among those who survived, many remained in a state of suspended animation. They neither conveyed nor felt the feeling of life; they were as insubstantial as ghosts, and as passive as zombies,” wrote Oliver Sacks in his 1973 memoir, Awakenings. He described patients remaining in this stupor for decades until being revived by the drug L-DOPA which replenished levels of the neurotransmitter dopamine.
It’s estimated that many who recover from COVID-19 with moderate to severe symptoms will have physical, cognitive, or psychological disabilities for the rest of their lives.
Asymptomatic
Many people are hiding behind the false security of the possibility that they might be “asymptomatic” - so let’s look at some figures:
A study found that 50% of people who didn’t have symptoms (asymptomatic) had abnormal findings on imaging tests showing damage in the lungs, even without lung symptoms.
In another study, a sample group of 2,088 people who were asymptomatic had CT scans done of their lungs. 57% showed “ground glass opacities” and “stripe shadows” on their CT scans indicating lung inflammation and damage. The study was done in France.
I don’t know why wearing a mask is political or debatable - wear a mask even if you are asymptomatic.
America is confused about mask wearing because hardly any studies on asymptomatic patients have been done here (none that I know of). Doctors are overwhelmed with treatment, prioritizing the sick. Other countries that have done studies are stringent with mask wearing, as it decreases risk of infection by 70-80%. SO WEAR A MASK.
Looking at mild to moderate symptoms
The most mild cases reported by Dr. Owen Tsang Tak-yin, director of infectious diseases at Princess Margaret Hospital in Hong Kong, told reporters that patients “have around a drop of 20 to 30% in lung function” after their “mild” recovery.
And over 80% of cases, according to the World Health Organization, are mild or asymptomatic. Many struggle for months with lingering COVID-19 symptoms that can be debilitating. They exhibit shortness of breath, extreme fatigue, intermittent fevers, cough, concentration issues, chest pressure, headaches, and heart palpitations, among other symptoms. The literature has a name for them: “long-haulers.”
Another study showed 47% of people who had only a mild disease and 61% with a moderate disease had abnormal liver function tests (indicating injury to the liver) during their illness.
In the Netherlands, the Lung Foundation, together with the University of Maastricht and the CIRO group, surveyed 1,622 Covid-19 patients who had reported a number of long-term effects from their illness. 91% of the patients were not hospitalized, which indicates that the vast majority of the surveyed patients would fall under the category of “mildly symptomatic.”
Another study found that patients with mild symptoms reported 88% persistent intense fatigue, while almost three out of four had continued shortness of breath. Other enduring symptoms included chest pressure (45% of patients), headache and muscle ache (40% and 36%, respectively), elevated pulse (30%), and dizziness (29%). Perhaps the most startling finding was that 85% of the surveyed patients considered themselves healthy prior to getting COVID-19. One or more months after getting the disease, only 6% considered themselves healthy.
A study found that more than half of the recovered patients suffered another lung infection since their bout with SARS and also had higher cholesterol levels. Additionally, half the patients had at least five colds in the previous year. This data demonstrated that the recovered SARS patients had a poor quality of life 12 years following recovery, and were susceptible to inflammation, tumors, and glucose and lipid metabolic disorders,” researchers wrote.
An initial study found cardiac damage in as many as 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress.
"In addition, evidence is emerging that some people are prone to developing cardiomyopathy several weeks after recovering from COVID-19," warns Dr. Septimus. "It's one of the biggest things we worry about in people who seemed to have made a full recovery."
Moderate symptoms arise from three common reasons - they are coinfection with another germ; respiratory failure when the lungs are weakened by the disease; and a “cytokine storm” caused by an overwhelming immune system response to the infection. Cytokines are proteins that regulate a wide array of biologic functions, one of them being inflammation and repair.
There is no guarantee that your symptoms will be mild, in some it leads to serious lung inflammation and an excess of immune signalling chemicals, leading to a complication called a cytokine storm. If someone is left with scarring, also known as fibrosis, there is no way to reverse it.
A study of hospitalized patients in Wuhan, China, found that survivors recovered after a host of complications: 42% had sepsis, 36% had respiratory failure, 12% had heart failure, and 7% had blood clotting problems.
TLDR: why so much?
1) infection is really hard on your body, no matter how big or small.
2) medication that is used to treat the virus is harsh on your body, and some of the life long side effects are due to damage from medication.
Moderate to severe infection
This wasn’t a priority, but we all know that moderate to severe infection results in permanent organ damage or death.
In a study from China, published in March, 66 of 70 patients still had some level of lung damage after being discharged from hospital.
Physicians report that patients hospitalized for COVID-19 are experiencing high rates of blood clots that can cause strokes, heart attacks, lung blockages, and other complications, physicians are seeing an uptick in strokes among young patients with COVID-19. The blood clots also can travel to other organs, leading to ongoing health problems.
Governments will have to make social programs, as moderate to severe patients who recover will most likely be on permanent disability for the rest of their lives.
In pregnancy and children
Doctors are also learning that even otherwise healthy young children who may have had only a mild disease or one without symptoms can, weeks after, have a condition similar to Kawasaki disease, now being called pediatric inflammatory multisystem syndrome (PIMS). This condition may be due to a delayed immune system response that inflames multiple organ systems, including blood vessels, and can lead to severe complications. While most children recover from Kawasaki disease, it can cause long-term heart damage, and doctors still don’t know what effects this new syndrome will have.
A hallmark of an autoimmune disease called antiphospholipid syndrome, these antibodies sometimes occur as a passing response to an infection. But sometimes they linger, causing dangerous blood clots in the legs, kidneys, lungs and brain (as seen in COVID-19 infections). In pregnant women, antiphospholipid syndrome also can result in miscarriage and stillbirth.
Hospitals in New York State reported cases of Kawasaki’s disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH.
Mental health
For those that are thinking “I need to go out for mental health” and “I need to meet people for mental health”, your decisions might backfire as patients have reported extreme depression when admitted to the hospital: nurses and doctors dodge COVID-19 patients for risk of infection, and they have no human contact for weeks. Many patients who have recovered and are discharged have been clinically diagnosed with PTSD.
People are (obviously) putting their mental health ahead of the mental health of medical professionals. Medical professionals have reported 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms.
Additionally, people requiring intensive care are at increased risk for mental health issues like post-traumatic stress disorder (PTSD), anxiety, and depression.
Post-intensive care syndrome (PICS) is used to describe patients who have survived a severe critical illness, along with the intensive care required to survive. Patients can have some combination of physical impairment, cognitive impairment, and psychiatric impairment.
A study showed that in asymptomatic, mild, and moderate recoveries resulted in 51.2% of patients had neurosensory dysfunction: hyposmia - reduced smell (34 - 39.5%), hypogeusia - reduced taste (33 - 38.4%), and tinnitus - ringing in ears (3 - 3.5%). Neurosensory dysfunction was significantly more common in patients under 40 years old or in women. Hyposmia and hypogeusia coexisted in 23 (26.7%) patients.
Part of the reason that the brain is heavily affected is because the virus shows resistance to medication, but the higher the doses the more it can induce delirium. A change in the brain that can cause mental or emotional confusion. And it can have a lasting impact on the recovery process, potentially causing PTSD.
If you think your mental health is suffering, wait until you see all the mental health side effects of any/all medications that are being used to treat COVID-19 - everything from anxiety to suicidal thoughts.
“‘She is confused, she cannot walk, and she just wants to die, it’s really awful,‘ says Helms. ‘COVID has killed me’ – meaning it has killed her brain. ‘She just doesn’t want anything more in life.‘“ - quote from a caretaker who’s loved one was neurologically impacted by COVID-19.
More severe outcomes such as aphasia (inability to speak), strokes, and seizures have been recorded. The extent and severity of these neurological issues has flown largely under the radar. Most people, including physicians, may not recognize neurological abnormalities for what they are when they appear – someone experiencing a seizure may simply look dazed, without any trembling or shaking.
Notes on drugs
According to the study, hydroxychloroquine is a treatment option that can interact with medications used to regulate heart rhythm. It could also cause heart damage and worsen cardiomyopathy.
The authors note that remdesivir, an antiviral that’s the only COVID-19 treatment authorized by the FDA, can cause low blood pressure and abnormal heart rhythm.
I couldn’t possibly fit all the side effects of drugs, but the 2 biggest parts of this are:
1. Drugs are hard and are causing abnormal heart rhythms,
2. Most of these drugs are used to treat rheumatoid arthritis. A surge in demand for COVID-19 is stalling the refills of those that have RA, and prescription refills have been on hold in many areas. So please use a mask and social distance, because it’s not fair to take up drugs of those who need them for survival.
The factor that nobody is talking about - obesity
In the case series including 5700 patients hospitalized with COVID-19 in the New York city, a higher prevalence of obesity (41.7%) compared to diabetes (33.8%).
Yes, these can overlap, but obesity is actually the biggest factor in severity of infection and prolonged recovery.
The risk associated with obesity might be particularly relevant in the USA because the prevalence of obesity is approximately 42%, versus a prevalence of 6.2%in China, 20% in Italy, and 24% in Spain.
The retrospective study conducted in French showed that 76% of patients admitted to ICU for COVID-19 were at least overweight.
Researches from China also showed that the presence of obesity increases the risk of COVID-19 approximately threefold with a consequent longer hospital stay.
Obesity is an inflammatory state associated with chronic activation of the immune system, which negatively affects immune functions and host defense mechanisms, resulting in high rates of infectious complications and vaccine failure.
Other miscellaneous tidbits
A pulse oximeter was used on multiple asthmatic people to prove that oxygen levels are going to be at 99% even when you use a cloth masks, K95 masks, and N95 masks. The claim that “I can’t breathe properly” is a false claim. Personally, I have a deviated septum, inflamed inferior turbinates, and I still wear a mask. If I am having difficulty, it is because my breath smells.
“Hospitals are not overrun/it’s a political agenda” - Doctors have spent years of their life pursuing their education, and residency. These claims undermine the medical community and all the work they’ve put in. If you’d like to make uneducated claims, please spend 12 years of your life in medical school, then come back to this thread.
“Hospitals are inflating COVID-19 statististics to get more money” - Hospitals ARE getting paid $8-13K per patient. These are coming from Medicare/Medicaid funds, and are called “bundle payouts” for people that ARE being treated for their COVID-19 symptoms. If you think that $8-13K is a lot of money for a hospital bill, then think again. IT IS NOTHING, compared to all the care and equipment that is used on each patient.
Herd immunity would mean 1,000,000 deaths in America (60% of the population needs to have immunity), antibodies only last for 3 months. Don’t hope for herd immunity, it would be devastating.
An asymptomatic recovery - 7 days. Mild symptoms recover within 14 days. Severe symptoms recover within 3-4 weeks. Deaths happen between 17-19 days after infection. Most people show symptoms day 2 after infection.
Common symptoms :
Fever (83–99%)
Cough (59–82%)
Fatigue (44–70%)
Anorexia (40–84%)
Shortness of breath (31–40%)
Sputum production (28–33%)
Myalgia (11–35%)
Reinfection/reactivation is possible. A woman was cleared, testing negative from COVID-19, just to be in hospital 4 days later with the same early symptoms she had when she first contracted the virus.
So think twice before you roll the dice.
References
https://jamanetwork.com/journals/jamacardiology/fullarticle/2763524
https://khn.org/news/mysterious-heart-damage-not-just-lung-troubles-befalling-covid-19-patients/
https://jamanetwork.com/journals/jamacardiology/fullarticle/2763846
https://www.webmd.com/lung/news/20200513/complications-on-the-road-to-recovery-after-covid
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html#:~:text=The%20signs%20and%20symptoms%20of,and%20respiratory%20symptoms.%20I
https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.317055
https://www.businessinsider.com/heres-what-covid-19-recovery-looks-like-over-time-2020-5
https://www.houstonmethodist.org/blog/articles/2020/apr/recovering-from-coronavirus-what-to-expect-during-and-after-your-recovery/
https://www.newscientist.com/article/2247086-the-coronavirus-is-leaving-some-people-with-permanent-lung-damage/#ixzz6Qo3wOkpN
https://www.advisory.com/daily-briefing/2020/06/02/covid-health-effects
https://www.healthline.com/health-news/what-we-know-about-the-long-term-effects-of-covid-19
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https://www.bbc.com/news/health-53065340
https://www.sciencedirect.com/science/article/pii/S1201971220305191
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https://www.healthline.com/health-news/how-covid-19-may-damage-your-heart#The-bottom-line
https://www.latimes.com/science/story/2020-04-10/coronavirus-infection-can-do-lasting-damage-to-the-heart-liver
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https://www.forbes.com/sites/joshuacohen/2020/06/13/report-suggests-some-mildly-symptomatic-covid-19-patients-endure-serious-long-term-effects/#1585da0e5979
https://www.sciencedirect.com/science/article/pii/S1201971220304094
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https://radiopaedia.org/articles/ground-glass-opacification-3?lang=us
