- Lung and heart damage tends to linger in recovered Covid-19 patients
- Research presented at a conference highlights the importance of check-ups for discharged patients
- Rehabilitation, which includes physical activity, can facilitate faster recovery
Recovery from Covid-19 can be a long process, but there's some hope at the end of the tunnel.
Austrian and French researchers at the European Respiratory Society International Congress presented more evidence of the long-term lung and heart damage caused by the coronavirus, but are optimistic that the body eventually heals itself with time and physical rehabilitation.
This research is the first wave of studies on the recovery of Covid-19 patients. So far, studies have been focusing on acute cases and their treatment, but we've reached a point in the pandemic where follow-up studies on recoveries are finally being presented.
The first presentation focused on Austrian coronavirus patients hospitalised at the University Clinic of Internal Medicine in Innsbruck, the St Vinzenz Hospital in Zams and the cardio-pulmonary rehabilitation centre in Münster, Germany. The sample for their presented data is still small (86), but has since grown to include over 150 participants.
The demographics of the participants are:
- Average age 61
- 65% male
- Nearly half current or former smokers
- 65% overweight or obese
- 21% admitted to ICU
- 19% on ventilators
- Hospital stay average 13 days
After discharge, the patients were set to return three times for evaluation and treatments at various intervals where doctors would carry out examinations and tests like analysis of the amounts of oxygen and carbon dioxide in arterial blood; lung function tests; computed tomography; (CT) scans; and echocardiograms (ultrasounds of the heart).
At their first visit – six weeks after being released – 65% still complained about at least one Covid-19 symptom, almost half of which was breathlessness, and 15% were coughing.
About 88% of their scans still showed lung damage, which was reduced to half at their second visit, 12 weeks after discharge. Breathlessness also went down to 39%, while coughing remained at the same level as at the first check-up.
The researchers don't yet have data for the third visit, which will be at 24 weeks after leaving the hospital.
“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 in the presentation. Dr Sahanic is a member of the team that carried out the study.
In terms of their hearts, 58.5% of the echodiagrams at six weeks showed abnormality, i.e. dysfunction of the left heart ventricle. Biomarkers of heart damage, blood clots and inflammation were also still elevated in their tests.
“We do not believe left ventricular diastolic dysfunction is specific to Covid-19, but more a sign of severity of the disease in general. Fortunately, in the Innsbruck cohort, we did not observe any severe coronavirus-associated heart dysfunction in the post-acute phase. The diastolic dysfunction that we observed also tended to improve with time.”
The study highlights the importance of check-ups in those who have recovered from the disease in order to treat long-term effects as soon as possible. Sahanic also says it's important to note that lung scans showed damage that wasn't picked up by normal lung function tests.
Another presenter at the congress on a study done in France – PhD student Yara Al Chikhanie from the Dieulefit Santé clinic for pulmonary rehabilitation and the Hp2 Lab at the Grenoble Alps University – highlighted that patients that were on ventilators recovered better and faster if they went into a pulmonary rehabilitation programme as soon as they were able to do so.
This treatment plan is designed for people suffering from chronic lung conditions, and involves enhancing their fitness regimes, breathing exercises and teaching technique.
Patients on ventilators tend to lose muscle mass due to inactivity, which also affects their ability to breathe properly. Through pulmonary rehabilitation, they can strengthen their bodies again and effectively deal with the after-effects of being on a ventilator.
The sooner the better
Chikhanie analysed how far those in recovery could walk in six minutes. Their performances were very poor at the start of their rehabilitation programme, but after three weeks they had improved considerably, although still not on the same level as a healthy person.
“The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care, progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive," said Chikhanie.
"The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients’ walking and breathing capacities and muscle gain."
This is, however, dependent on being medically cleared by a doctor, and three weeks were still not enough for full recovery.
Her research complements the Austrian study, highlighting the need for recovered Covid-19 patients to devote time to their health, ensure they follow through with check-ups with their doctors, and get back into physical activity as soon as they can.
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