COVID-19 patients have long-term damage to the lungs and heart but may improve over time

COVID-19 patients may suffer long-term lung and heart damage, but, for many, it improves over time, according to the first, probable follow-up of coronavirus-infected patients presented at the European Respiratory Society International Congress. [1]

Researchers at the COVID-19 ‘hot spot’ in the Tyrolian region of Ria Streia constantly recruited coronavirus patients for their study, who were admitted to the Internal Medicine of the University Clinic in Innsburst, St. Vincennes Hospital in James or the Cardio-Pulmonary Rehabilitation Center. In Monster, Austria. In his presentation before the Virtual Congress today (Monday), he reported on the first 86 patients registered between April 29 and June 9, although he now has more than 150 patients in attendance.

Patients were to return for evaluation six, 12, and 24 weeks after discharge from the hospital. During these visits, clinical examinations, laboratory tests, analysis of oxygen and carbon dioxide levels in arterial blood, lung function tests, computed tomography (CT) scans and echocardiograms were conducted.

At the time of their first visit, more than half of the patients had at least one fixed symptom, primarily breathing and coughing, and CT scans still showed lung damage in 88% of patients. However, at their next visit 12 weeks after discharge, symptoms improved and lung damage was reduced to 56%. At this stage, it is too early to get results from the assessment in 24 weeks.

“The bad news is that people have been showing lung damage since Covid-19 weeks after discharge; the good news is that the moment tends to ease over time, indicating that the lungs have a system in place to improve themselves,” said Dr Sabina. Was part of the University Clinic’s Clinical PhD student and study team at Insbook, including Associate Professor Evan Tensowski in Innsbruck, Professor Judith Löfler-R & G and Dr. Tho. Includes Thomas Sonweber.

The average age of the 86 patients included in this presentation was 61 and 65% of them were male. About half of them were current or former smokers and 65% of hospitalized COVID-19 patients were overweight or obese. Eleven (21%) were in the intensive care unit (ICU), 16 (19%) underwent invasive mechanical ventilation, and the average length of hospital stay was 13 days.

A total of 56 patients (65%) showed persistent symptoms during their six-week visit; Shortness of breath (dyspnea) was the most common symptom (40 patients, 47%), followed by cough (13 patients, 15%). By 12-week visit, breathing conditions improved and were present in 31 patients (39%); However, 13 patients (15%) were still coughing

Tests for lung function include FEV1 (the amount of air that can be forcibly expelled per second), FVC (air fuel is forcibly expelled), and DLCO (a test to measure how oxygen passes through the lungs into the blood). Included. . These criteria also improved between six and 12 week visits. At six weeks, 20 patients (23%) showed FEV1 less than 80% of normal, 18 patients (21%) improved at 12 weeks, 24 patients (28%) showed FVC less than 80% of improvement, improvement At 12 weeks 16 patients (19%), and 28 patients (33%) showed DLCO less than 80% of normal, 19 patients (22%) improved at 12 weeks.

CT scans show that the score that defines the severity of overall lung damage has dropped from eight points in six weeks to four points in four weeks. Inflammation and fluid loss in the lungs caused by coronavirus, which on CT scan shows what is known as ‘ground glass’, are referred to as white patches; It was present in 74 patients (88%) at six weeks and 48 patients (56%) at 12 weeks.

During the six-week visit, echocardiograms showed that the diagnosis (.5 58. %%) of obstruction of the left ventricle of the heart occurs when relaxation and excretion occur. Biological indicators of heart damage, blood clots, and inflammation were all significantly improved.

Dr. Sa. Sahanik said: “We do not believe that ventricular diastolic dysfunction on the left side is specific to COVID-19, but is usually a sign of disease severity. The diastolic dysfunction that we have observed has also improved over time. “

He concluded: “The findings of this study demonstrate the importance of implementing structured follow-up care for patients with severe COVID-19 infection. Significantly, CT revealed lung damage in this group of patients not identified by lung function tests.” Has a long-term effect, which can enable early treatment of symptoms and lung damage and have a significant impact on further medical recommendations and advice. “

In the second poster presentation to Congress [3]Mrs. Yara Al Chikhni, a Philippine and PhD student at the University of Grenoble Alps in France, said that the sooner COVID-19 patients started the pulmonary rehabilitation program after turning off the ventilator, the better and faster their recovery.

Patients with severe COVID-19 can spend weeks in intensive care on a ventilator. Lack of physical movement, on top of severe infections and inflammation, leads to severe muscle damage. The muscles that breathe are also affected, which impairs the ability to breathe. Pulmonary rehabilitation, which includes physical exercise and advice on managing symptoms, including shortness of breath and post-traumatic stress disorder, is crucial in helping patients recover fully.

Mrs. Al Chikhni used the Walking King test to evaluate the weekly progress of 19 patients. [4] Who spent an average of three weeks in intensive care and two weeks in the pulmonary ward before being transferred to the Dualifit Santa Clinic for pulmonary rehabilitation. Even when they arrived most people were unable to walk, and they spent an average of three weeks in rehabilitation. The Walking King test measured how far patients could walk in six minutes. Initially, they were able to walk an average distance of 16% which, in principle, should enable them to walk normally if they were healthy. After three weeks of pulmonary rehabilitation, this increased to an average of 43%, which was a significant gain, but still a serious disadvantage.

Ms Al Chikhni said: “The most important finding was that patients admitted to pulmonary rehabilitation immediately after leaving intensive care, progressed faster than they had spent long periods in the pulmonary ward where they remained inactive. Early rehabilitation began and prolonged As it went on, patients’ ability to walk and breathe and muscle improvement was faster and better. Patients who started rehabilitation within a week after taking off their ventilator progressed faster than those who were admitted two weeks later. Rehabilitation was given to patients by their doctors. Depending on what is considered stable, despite the significant improvement, the average period of three weeks in rehabilitation was not enough for them to fully recover.

“These findings suggest that doctors should begin rehabilitation as soon as possible, try to spend as little time as possible for patients to be inactive, and enroll in the Pulmonary Rehabilitation Program with motivation. If their doctors judge it to be safe, patients still Physical therapy should be started while in the pulmonary ward of the hospital. ”

Thierry Trusters, who was not involved in the study, is the president of the European Respiratory Society and a professor of rehabilitation sciences at KU Leuven, Belgium. He said: “Since the onset of the Covid-11 epidemic, there has been fictitious evidence that many patients suffer from long-term exposure to the coronavirus. And shows a serious, long-term effect of COVID-19 on the heart. More than half of the patients in this study reported damage to their lungs and heart 12 weeks after hospital discharge, and about 40% suffered from symptoms such as shortness of breath. That is, patients improve and this will definitely help in the rehabilitation process, as discussed in the second presentation.

“Mrs. Al Chikhni’s research complements this information and shows how important it is to start pulmonary rehabilitation as soon as patients become physically fit. That’s why rehabilitation can be started in programs, if the programs suit the patient’s abilities. This is in line with our society’s recent statement that we also advocate for favorable rehabilitation. Both studies make it clear that rehabilitation, including physical and psychological components, should be available to patients as soon as possible and discharge them from the hospital to give patients the best chances of better recovery. It should continue for weeks, even if it is not a given month. Governments, national health services and employers should be made aware of these findings and plan accordingly. ” [5]

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