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Professor Schreiber, from the Kiel University Clinic, must investigate the possible long-term consequences of a coronavirus infection. What could be previously infected?
That is exactly what it is about. Covid-19 was initially considered a pure lung disease. Today, however, we know that the lungs are probably the main carriers of symptoms of the infection and that it is more of a systemic disease. The endothelium, the cells that line the blood vessels, for example, are massively involved. In addition, among other things, blood clotting and evidence of heart and liver involvement. Sars-CoV-2, therefore, could possibly also damage other organs.
That sounds pretty grim.
If we know what long-term damage could occur, we can take countermeasures in due course. Let’s take the endothelium as an example: if you are infected with the coronavirus, it becomes inflamed, which in turn could damage the arteries to such an extent that it increases the risk of arteriosclerosis, that is, calcification of the blood vessels. This in turn would increase the risk of heart attacks and strokes. The opposite could also be the case. If we know this risk, we can pay attention to the appropriate warning signs and initiate therapy in due course. And, of course, it also helps assess the challenges facing our healthcare system if the virus infects a large part of the population, sooner or later.
What do you estimate? Do Covid-19 patients with severe courses have a higher risk of consequent harm than patients who are only mildly ill?
This is currently unclear. However, we suspect that patients with severe courses may have different long-term risk profiles than those with mild illness, particularly with respect to the lungs. Population studies like ours are based on a representative basis: our goal is to find all infected patients in Schleswig-Holstein, no matter how easily they get sick. Even if there are hardly any symptoms on the outside, many things can happen inside the body. Hopefully we can answer exactly these questions in the years to come.
Listen to the podcast “We and Crown” on the subject:
Covid-19 focuses on lung symptoms, including cough, but also shortness of breath. What do you know about the possible long-term consequences especially for this organ?
We are still at a very early stage in terms of research. Case reports suggesting consequential damages are piling up, but I think these reports are too premature. It takes months, fewer weeks before a seriously ill Covid-19 patient has fully recovered and recovered. It is not uncommon for patients to continue to perform poorly after six to eight weeks. We also know this from infections and pneumonia with other pathogens. However, Covid-19 differs from these other severe pneumonias: The virus affects much more than just the lungs. For example, this is not the case with influenza.
Additional Covid-19 research at UKSH
How exactly should patients recovered in Kiel be examined?
We plan to do a complete medical review with patients and accompany them for at least ten years. Above all, functional tests are being considered for all key organs, including lung, heart, liver, and skin examinations. In addition to blood samples, we also want to use imaging techniques such as MRI of the entire body. It can be said: almost no patient who comes to a clinic is examined so well and thoroughly.
That sounds expensive: what is the advantage for the patient?
You will learn a lot about your own health: In addition to the complications of Covid-19, you can also identify other possible diseases at a very early stage. In addition to the individual value for their own health, they also make an important contribution to research.
Where can interested patients contact?
We are currently requesting research funds from the Federal Ministry of Science and Research (BMWF). Once distributed, health authorities will contact patients in Schleswig-Holstein. We look forward to a great response.
Sweden has chosen a special route against Covid-19: the country is currently trying to develop collective immunity against the pathogen. How do you rate this approach given the current data situation?
Such an approach poses two problems: First, as I mentioned, we know very little about the long-term consequences of this disease. Suppose that the risk of atherosclerosis would increase significantly after a Sars-CoV-2 infection. Who would want to expose their children to such an immunization attempt? Furthermore, as of today it is still questionable whether this virus is protected by herd immunization. There is increasing evidence that immunization with the virus does not always result in immune protection. There is data from different countries, South Korea started there, indicating that patients who have survived the infection well and produced antibodies can also become newly infected. If so, we have a problem. Because then this concept will not work and we will only cause a lot of suffering with the infection and do little good.
So is the solution just a vaccine?
A vaccine may well provide more effective protection than immunizing the pathogen. But to do that, we must first be able to produce an effective vaccine. If we are not lucky, acute virus control would play a particularly important role. Various drugs are currently being tested in clinical studies, for example Remdesivir here in Kiel. We have a very positive impression of the first races. In my opinion, it is particularly important to administer the appropriate agents early. The only question right now is: how early? We are currently trying to figure that out too.
