Permanently or permanently: for how long can complications remain after coronavirus?
For six months now, scientists and doctors have been trying to assess the harm that the Covid-19 human body causes, but despite more than 400 thousand deaths, millions of patients and thousands of studies and reports, the picture has not been fully clarified. Writes about it with the BBC.
The data obtained by British researchers indicate that the primary symptoms of the disease can manifest, disappear and reappear within 30 or more days, which is noticeably longer than the official two-week period indicated by WHO experts.
And for some, the disease can only mean the beginning of a long and painful struggle with the virus, which can turn into a new "post-coronavirus syndrome."
According to the authoritative journal Science, this coronavirus "does things that no other disease known to mankind has done."
While the authorities took one measure after another in an attempt to stop the spread of the infection, and doctors were looking for a cure or vaccine that could fight the disease, people learned more and more details about the coronavirus, and our understanding of it changed, and in some aspects - radically.
At first it seemed like a common respiratory illness like SARS or bird flu, but later it turned out that coronavirus (its official name is SARS-CoV-2) can affect the lungs, brain, nasopharynx, eyes, heart, blood vessels, liver, kidneys and intestines , that is, literally all vital organs.
According to the results of studies already conducted, Covid-19 is accompanied by a wide range of symptoms, and for those who are seriously ill, the long-term effects can be most serious: from scarring of the lung tissue and kidney failure, to inflammation of the heart muscle, arrhythmia, and liver damage , cognitive impairment, psychosis, accompanied by a sharp change in mood, and much more.
The effect of the disease on people in the long term remains to be fully understood, but now there are many indications that the consequences of this disease continue to be experienced even by those who have had a fairly mild coronavirus.
There is one more important question: can the SARS-CoV-2 virus persist in the human body in a dormant state, and will it not manifest itself in some form in a few years?
There will be nothing surprising in this, doctors say, because viruses are known that behave this way. For example, after a person has had chickenpox, the herpes virus that caused it does not disappear anywhere, he can quietly hide for decades, and then, if necessary, result in a painful herpes zoster.
And the virus that causes hepatitis B can lead to liver cancer after many years.
Even the Ebola virus, discovered many months later in surviving patients in the eye fluid, subsequently causes blindness in 40% of those infected.
Therefore, given the fact that SARS-CoV-2 prefers lungs, doctors suspected that it was there that the virus was primarily capable of causing irreversible changes.
Back in March, experts at Wuhan University of Technology reported that 66 out of 70 patients who experienced pneumonia with Covid-19 had CT scans that showed visible lung damage.
These lesions ranged from blockage of blood vessels in the alveoli to scarring of the lung tissue. This scarring, or thickening of the tissue, is called pulmonary fibrosis and can lead to shortness of breath. There is currently no way to stop or reverse this process.
“Fibrosis can stabilize and not change over time, that's right. In some patients, lung function may not fully recover, but the consequences of this will not be so significant, - explains Professor Louise Wayne at the University of Leicester. “But there are also cases of progressive fibrosis, which is really dangerous, because sooner or later it kills.”
In addition, even before the introduction of strict quarantine in Britain, the Faculty of Intensive Care Medicine (FICM), the professional medical organization responsible for the training of British emergency physicians, warned that patients with severe Covid-19 could suffer such severe lung damage that recovery they will need up to 15 years.
FICM emphasized that many patients admitted to intensive care units developed acute respiratory distress syndrome (ARDS), a severe pneumonia in which fluid from the blood enters the alveoli, making breathing impossible without a special apparatus.
Given the history of lung tissue damage in SARS and MERS patients, a medical team led by radiologist Melina Hosseini at the University of California, Los Angeles strongly recommends that patients recovering from Covid-19 be monitored and their lungs checked “for long-term or permanent damage. including fibrosis ”.
Heart and blood vessels
As doctors try to assess the damage caused to various organs of patients who have had Covid-19, they face a very expected problem: people suffering from diseases of the lungs, heart, kidneys or blood, as a rule, became the first victims of coronavirus, and In their case, the disease most often proceeded severely. Therefore, it is not always possible to determine what the virus led to and what was already damaged before it.
However, one thing is clear: when the symptoms of infection begin to manifest, the functions of many organs are violated, and the failure of one leads to the failure of others.
The acute inflammatory process, which leads to strokes and heart attacks, also plays its role.
According to a March report published in the specialized medical journal JAMA Cardiology, cardiac muscle damage was noted in almost 20% of the 416 patients examined in Wuhan hospitals.
In the same place, but already in intensive care units, arrhythmia was noted in 44% of 36 patients.
Doctors attribute this to hypercytokinemia, or the cytokine storm, a potentially fatal reaction of the body that triggers the uncontrolled activation of immune cells, which leads to the destruction of tissues of the focus of inflammation. Such a reaction was observed in some patients with coronavirus.
In particular, inflammation of the heart muscle (myocarditis) occurs, which interferes with electrical impulses, leads to artemia and disrupts blood circulation, causing shortness of breath.
Complications of the cardiovascular system are not unique to Covid-19: many viral diseases can cause myocarditis. And although most patients recover, in some, damage to the heart muscle is irreversible.
Moreover, Covid-19 negatively affects the blood itself. In 38% of 184 patients with coronavirus who went to intensive care in the Netherlands, increased blood clotting was detected, and almost a third of them showed blood clots.
Although coronavirus primarily affects the lungs, in some patients the infection also spreads to the kidneys.
According to a sample study in China, 27% of 85 patients admitted to Wuhan hospitals with coronavirus had kidney problems.
According to another study, 59% of the nearly 200 patients hospitalized in the provinces of Hubei and Sichuan had a protein in their urine indicating infection, and 44% had blood, indicating serious kidney damage.
Moreover, in patients with acute renal failure (ARF), the risk of death was 5 times higher than in ordinary patients with coronavirus.
Of the 214 patients examined with Covid-19, one third showed neurological symptoms, including dizziness, headache, and cognitive impairment.
So far, scientists are only wondering what exactly caused these symptoms. However, existing theories focus on how the virus affects neurons - nerve cells. The loss of taste and smell, and inflammatory processes (in this way, our immune system reacts to the virus), and the lack of oxygen, which some patients felt, are also mentioned.
Cognitive disorders can be associated with patients staying in intensive care, this is also called temporary clouding of the mind, or delirium, when a person has hallucinations, however, this is more often observed in older people.
Although symptoms usually disappear over time, some of them may persist. According to doctors, the restoration of cognitive functions in patients with coronavirus strongly depends on the age, comorbidity (that is, the coexistence of two or more diseases or disorders in a patient) and the severity of the course of the disease itself.
As Lynn Turner-Stokes, professor of rehabilitation medicine at Royal College of London, points out, the virus can affect the brain of even those patients who have been ill in a fairly mild form.
And according to University of Cambridge professor Ed Bullmore, we already have enough reason to believe that SARS-CoV-2 causes a "neurotoxic disease" that leads to "a kind of change in the mental state of the patient."
“We don't know exactly what causes this neurotoxicity,” says Professor Bullmore. - Maybe the virus infects the brain, maybe the reaction of our immune system to the virus leads to damage to neurons, or it's all about the blood that goes to the brain. All these options are possible at the moment. ”
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