After reading my previous two critical posts on mass testing, you may have got an impression that I tend to see COVID-19 and its causal pathogen as just another contagious disease and just another common bug which plague us on these fall and winter days. But it's not! Similar to influenza, COVID-19 falls into the set of the most dangerous infectious conditions present in the developed world. Recently, a nice and very important paper by my colleagues Thomas Sonnweber and Sabina Sahanic was issued in the prominent European Respiratory Journal (DOI: 10.1183/13993003.03481-2020, open full text) with may tiny contribution as a data analyst. Interestingly, it seems to be one of a handful stories which investigate the recovery of COVID-19 individuals, both those with mild 'cold-like' symptoms and hospitalized patients, in a systematic way with a spectrum of quality-of-life parameters and hard-figure lung/heart function and imaging parameters. Let's have a brief look at the main findings and some perspectives.
Once you're tested, nobody cares...
It's provocative to say that but in many cases true - you're literally bombarded with numbers of new infections, recoveries and COVID-19 deaths every day, it's enough you open your favorite news portal or a dashboard (I personally ceased to do the later already months ago...). But despite that mass of cases, we still don't know or don't want to know more on the disease. The standard procedure, at least in Austria, looks as follows: you're tested with a SARS-Cov2 PCR assay if you manage to reach the local corona hot line and somebody decides that your symptoms make you a candidate case, asked to stay at home for at least 10 days and need to wait sometimes days for your result. Maybe a policeman visits you in between to make sure you are at home. 10 or 14 days over, you're claimed healthy and free again... To me, it doesn't look like a correct medical practice. In fact, nobody interviews you about the symptoms, calls you to check your well- (or ill-) being, prescribes or delivers pain- and fever-killers not to mention a basic and extremely important medical investigation. If you have bad luck (fortunately it happens very rarely, more on risk factors in a future post), you may experience an acute lung dysfunction or even die at home or elderly care facility without any medical aid. Undoubtedly, health monitoring and care of COVID-19 is ill insufficient... Apart from the humane and ethical aspect of fighting off the pandemic, this strategy won't help us to fill blank areas of our knowledge, since every COVID-19 case is a source of valuable information on the disease course, recovery, possible secondary pathologies and immunity.
For this reason, the work of Sonnweber and Sahanic is particularly important as it attempts to characterize the recovery of COVID-19 far beyond the 10 or 14 day interval of quarantine. In brief, a two-center Tyrolean team recruited a cohort of 145 COVID-19 patients with differing magnitude of symptoms reaching from a 'cold-like' without hospitalization to life-threatening severity. At the peak of the disease and two follow-up visits, 60 and 100 days after the initial diagnosis, the participants were subject to multiple clinical investigations including lung and heart function tests and imaging, blood biochemistry and, last but not least, were asked to describe their symptoms and physical constitution.
COVID-19 impacts on quality of life for months after infection
Anecdotally, acute COVID-19 is liked to a sudden loss of smell and taste and you have surely came upon stories of people complaining about it for months. However, the acute infection went rather hand in hand with symptoms more characteristic for influenza-like conditions: breathing difficulties (dyspnea), cough, fever and pain. The smell loss was reported for less than a half of participants. Interestingly, the initial symptoms, except of fever, are still present in a substantial percent of the recovering individuals for as long as 100 days after the diagnosis! Breathing and sleeping problems, night sweat and pain persisted in roughly a quarter of the study population and significantly lowered their quality of life.
COVID-19 symptoms at acute infection and the followup 100 days after the diagnosis are still present in a substantial percent of individuals. Note: loss of smell/taste (Hyposmia/Anosmia) was not the most frequent and characteristic acute COVID-19 symptom! Credits to Thomas Sonnweber and Sabina Sahanic et al. (DOI: 10.1183/13993003.03481-2020)
Even more strikingly, 77% participants, the vast majority of hospitalized cases, displayed lung pathology in computer tomography and such pathological alterations were still present in over 60% of convalescents! Well, this is definitively an argument against all COVID-denialists who play down the consequences of the SARS-Cov2 infection.
Lung
recovery after COVID-19 is a prolonged process: even 100 days after the
initial diagnosis up to 63% individuals display pathological lung
alterations assessed by computer tomography. Credits to Thomas Sonnweber
and Sabina Sahanic et al. (DOI: 10.1183/13993003.03481-2020)
Not really surprisingly, the persistence of lung alterations was over 22 times higher among the former intensive care unit patients, 11 times higher for cancer individuals and 6 times more probable for patients over 65 than for the non-hospitalized participants. In addition, they were almost twice as probable in men than in women and tended to be more frequent in people suffering from diabetes. The paper of Sonnweber, Sahanic and colleagues delivers one positive message: in contrast to influenza, COVID-19 seems not to harm the heart.
In sum, the paper of the Tyrolean team sheds some light on the prolonged convalescence from COVID-19 and it's, at least for me, a gloomy story. It proves that this disease is debilitating with a disastrous potential far beyond its mortality. If one things of thousands of hospitalized SARS-Cov2 individuals during the fall/winter season 2020 and 2021 - alone in Austria they make up 10% of all cases and around 37000 individuals in total since beginning of the pandemic - it's not hard to imagine the extent of human distress, burden for the medical system and losses for the economy caused by the tough recovery process. In fact, I expect it to be much weightier in a long run for the society than the mortality itself! Hence, serious, evidence-based efforts have to be taken by politicians and mere citizens to brake the spread. Again: distance, contact reduction, mask and hand hygiene, even if you find it boring, and finally the vaccination are all that matters instead of scientifically unsound mass testing! Stay healthy!
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