Long Covid’s Effects Go Beyond Respiratory Issues

(Bloomberg Businessweek) -- When Covid-19 struck Jerry Guerinot in January 2021, the stocky 77-year-old defense attorney, who already had diabetes and heart disease, developed double pneumonia and was given a 5% chance of survival. After three months in a Houston hospital, he beat those grim odds. But Guerinot’s scarred lungs and weakened immune system set him up for new infections requiring further hospitalization and rounds of physical therapy. Almost two years after getting Covid and more than $1 million in medical bills later, Guerinot says he still suffers from the virus’s devastating aftereffects. “Covid damn near killed me,” he says. “It did everything it could do to me and then some.”.Covid's Long-Term Impacts" />Virus-damaged organs and compromised immune systems are just part of Covid’s public-health legacy; there’s also a litany of secondary effects still being measured, ranging from increases in mental illness to delays in getting cancer treatment. Some doctors also blame Covid for worsening the effects of other diseases, as with the cases of flu and respiratory syncytial virus now mobbing children’s hospitals. Weekly deaths from Covid reported to the World Health Organization have dipped to levels last seen in March 2020, as the number of severe cases is cut by vaccines, antivirals and the circulation of milder virus variants. But global excess deaths have remained stubbornly high in the pandemic era.Long Covid, shorthand for what the WHO calls post-Covid-19 condition, is far more pernicious than an extended-play version of the initial respiratory disease. Unlike influenza, which attacks the lining of the airways, SARS-CoV-2 resembles a multisystem cluster bomb. “That’s a total game changer, because it’s not just your lungs,” says Sonia Sharma, an associate professor at the Center for Autoimmunity and Inflammation at the La Jolla Institute for Immunology, near San Diego. “You’ve got a battle going on between the virus and your immune system, and that battle can happen in almost any organ.”.Multiple studies show this can impair patients’ immune defenses, potentially reactivating viruses that linger in the body, such as those that cause mononucleosis and shingles. Long Covid patients whose initial illnesses were mild can sustain immune changes that slow the response to infections and exacerbate chronic conditions for as long as six months, researchers say. Alterations in immune-cell populations, persistent activation of certain white blood cells and other immune disturbances have been observed up to a year after severe cases.Even if immune dysfunction occurs in just 5% of Covid patients, the effect across populations could raise the threat posed by many other infections, says microbiologist Brendan Crabb, director of the Burnet Institute, a nonprofit medical research organization in Melbourne. “Under this circumstance, you would expect non-Covid infections to have a greater chance to get a foothold, amplify and evolve in people with immune dysfunction,” he says. “These infections are then free to transmit to the wider community more readily than they otherwise would.”Delayed ComplicationsIn the most insidious cases, Covid silently inflames and damages tissues or causes clotting abnormalities before manifesting as cardiovascular disease, diabetes, kidney impairment or brain damage. Multiple studies show former Covid patients who had disease at all levels of severity have an increased risk of dying or being hospitalized for complications 6 to 12 months later. An estimated 7.7 million to 23 million Americans are affected by long Covid, the Department of Health and Human Services said in a report in November.While vaccination has been shown to attenuate the disease initially caused by SARS-CoV-2, repeated infections appear to compound the risk of harm, a study published in November in the journal showed. Three in five Americans had been infected with the coronavirus at least once as of February, up from 33% a year ago. “You’re talking really large numbers and lots of people who were exposed, but may not even know they were affected,” says Harlan Krumholz, director of Yale University’s Center for Outcomes Research and Evaluation. A proportion of patients may develop complications much later. “That’s going to also take a major toll—maybe a bigger toll than even the pandemic itself,” he says.In the US, life expectancy fell in 2021 to its lowest since 1996, extending the biggest two-year decline in a century. Covid’s delayed effects may stymie a rebound. In the year after a Covid infection, patients experienced a decline in kidney function equivalent to that from four years of normal aging, according to research by epidemiologist Ziyad Al-Aly, director of the Clinical Epidemiology Center at the Veterans Affairs St. Louis Health Care System in Missouri. Even nonhospitalized Covid patients with no preexisting renal problems have almost a twofold higher risk of developing end-stage kidney disease, compared with someone who’s never had Covid.Similar effects may be occurring in other organs. “I worry that we’re not even seeing the full effect of it now,” says Al-Aly, who also works as a kidney specialist. Covid has left a lot of patients like Guerinot “alive, yet suffering with these chronic diseases that they probably otherwise would not have had,” he says. “What makes this really profound is that we have literally millions of them.”Rapid DeclineOn the evening of Jan. 9, 2021, Guerinot was getting ready for bed when he was suddenly overcome by breathlessness so severe that he and his wife, Bette, realized he needed medical help. They headed for the car, but he collapsed at the front door and then again at the gate. She called emergency services, which dispatched ambulance technicians who helped him into the car so she could drive him to the hospital. “In two or three hours, I went from having problems breathing to a maximum loss of air,” Guerinot says. The first doses of Covid vaccine had arrived in Texas only a few weeks earlier, and Guerinot wasn’t yet immunized. His lack of oxygen was managed for a month in intensive care, where he endured spells of delirium and hallucinations, he says.Doctors wanted to put Guerinot on a mechanical ventilator, a form of life support for patients in respiratory failure, but he and his wife refused because of concern about the device’s potential effects on the lungs. They instead asked for a pressurized breathing device known as a BiPap, which resembles the CPAP technology used to treat sleep apnea.Male, elderly and suffering from chronic disease, Guerinot was a prime target for severe Covid, says Nikola Dragojlovic, a rehabilitation physician who was part of his treatment team at TIRR Memorial Hermann hospital. Guerinot had experienced multiple bouts of pneumonia as a child that had scarred his lungs. “That is a pattern that we see in a lot of older Americans,” Dragojlovic says. “In the setting of preexisting lung disease, when you get a Covid infection it’s always worse. The potential for having complications is increased, and then the timeline for the recovery is lengthened.”Bacterial PneumoniaGuerinot’s case shows how recovery from Covid can be elusive and fraught with dangerous snags. Five weeks after being discharged, he caught a common respiratory virus that led to bacterial pneumonia, kidney failure and another trip to the hospital. Chest X-rays later showed lung abnormalities typically associated with pulmonary fibrosis seen in Covid patients.In a person with a history of structural lung disease who’s had Covid, “a relatively common respiratory viral illness can become deadly,” Dragojlovic says. Covid can trigger a cascade of damage. Diminished lung capacity, for example, strains the heart. “The heart is effectively pumping through something that is not as conducive to blood flow as it was before,” he says. “The smallest event could tip someone over into hospitalization or worse.”After his second trip to the hospital, Guerinot spent three weeks in a rehab center, where the focus was on rebuilding his strength and weaning him off the supplemental oxygen he required to tolerate physical activity. “In the beginning, he struggled with just basic bedside mobility,” says Dragojlovic, an assistant professor of physical medicine and rehabilitation at the McGovern Medical School of the University of Texas Health Science Center at Houston. “When people have pulmonary fibrosis following Covid-19, they don’t tolerate long bouts of activity very well. They become anxious or panicky, as if they can’t breathe, and no amount of rest can make that better.” Some patients just give up at that point, he says.Compared with noninfected counterparts, survivors have about a 63% increased risk of an array of potentially deadly cardiovascular problems, including abnormal heartbeat, inflammation, clots, strokes, heart attacks and heart failure in the year after recovering from the illness’s acute phase, according to a study by Al-Aly and colleagues, published in February. “Once the inflammatory process rages through, it’s like a war zone in some patients,” says Andreas Barth, medical director of the Center for Inherited Heart Diseases at Johns Hopkins University in Baltimore. “They might not have died immediately from Covid but from the complications of acute Covid disease.”Hospitalized patients who survive at least a week after being discharged are more than twice as likely to die or be readmitted than people in the general population, British scientists said in January. They’re almost five times more likely to die in the following 10 months than the general population. Wes Ely, a critical care pulmonologist at Vanderbilt University Medical Center in Nashville, tells his patients who’ve experienced severe illness to expect to be climbing a “recovery ladder,” with progress interrupted by some regression. “It’s going to be two steps up, one step back, three steps up, one step back,” Ely says. “When you go out into the world as a frail human being, you succumb to new infections that wouldn’t get a healthy person.”Stumbling BlocksGuerinot was discharged in July 2021 and was well enough to dispense with supplemental oxygen and return to part-time work three months later. In January 2022, a full year after his bout with Covid began, he resumed appearing daily at the courthouse, his face covered by a protective mask. “I still am reluctant to go where there are large crowds,” he says. “And that really is as a result of my immune system being compromised.”Guerinot’s work since has been disrupted by at least two bouts of a drug-resistant infection in his urinary tract, possibly linked to a catheterization in 2021. The infection eventually required seven weeks of daily intravenous infusions of an antibiotic used only when others fail, he says.As cooler weather set in late this year, he was laid up for two weeks with a cold that sapped his strength, causing him to fall twice, says his wife, Bette. Six weeks of physical therapy helped him regain his fitness, but he now has bronchiectasis, a chronic lung condition that occurs when the walls of the main airways thicken from inflammation or infection.His breathing is helped by medication inhaled through a nebulizer for 15 minutes each day—a treatment Guerinot will probably stay on for the rest of his life, Bette says. “We’re happy he’s alive. We’re happy that he’s up and going—for his age and everything that he’s been through, it’s a miracle,” she says. “But I think it’s taken a toll on him. He is more frail. It’s really altered his life.”More stories like this are available on bloomberg.com©2022 Bloomberg L.P.

Long Covid’s Effects Go Beyond Respiratory Issues

The coronavirus can attack multiple organs and weaken overall immunity for months. Its impacts are evident in global death rates that remain high.

Choose a plan