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Months After Recovery, COVID-19 Survivors Often Have Persistent Lung Trouble

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Lung function test
Caption: Testing breathing capacity with a spirometer. Credit: iStock/Koldunov

The pandemic has already claimed far too many lives in the United States and around the world. Fortunately, as doctors have gained more experience in treating coronavirus disease 2019 (COVID-19), more people who’ve been hospitalized eventually will recover. This raises an important question: what does recovery look like for them?

Because COVID-19 is still a new condition, there aren’t a lot of data out there yet to answer that question. But a recent study of 55 people recovering from COVID-19 in China offers some early insight into the recovery of lung function [1]. The results make clear that—even in those with a mild-to-moderate infection—the effects of COVID-19 can persist in the lungs for months. In fact, three months after leaving the hospital about 70 percent of those in the study continued to have abnormal lung scans, an indication that the lungs are still damaged and trying to heal.

The findings in EClinicalMedicine come from a team in Henan Province, China, led by Aiguo Xu, The First Affiliated Hospital of Zhengzhou University; Yanfeng Gao, Zhengzhou University; and Hong Luo, Guangshan People’s Hospital. They’d heard about reports of lung abnormalities in patients discharged from the hospital. But it wasn’t clear how long those problems stuck around.

To find out, the researchers enrolled 55 men and women who’d been admitted to the hospital with COVID-19 three months earlier. Some of the participants, whose average age was 48, had other health conditions, such as diabetes or heart disease. But none had any pre-existing lung problems.

Most of the patients had mild or moderate respiratory illness while hospitalized. Only four of the 55 had been classified as severely ill. Fourteen patients required supplemental oxygen while in the hospital, but none needed mechanical ventilation.

Three months after discharge from the hospital, all of the patients were able to return to work. But they continued to have lingering symptoms of COVID-19, including shortness of breath, cough, gastrointestinal problems, headache, or fatigue.

Evidence of this continued trouble also showed up in their lungs. Thirty-nine of the study’s participants had an abnormal result in their computed tomography (CT) lung scan, which creates cross-sectional images of the lungs. Fourteen individuals (1 in 4) also showed reduced lung function in breathing tests.

Interestingly, the researchers found that those who went on to have more lasting lung problems also had elevated levels of D-dimer, a protein fragment that arises when a blood clot dissolves. They suggest that a D-dimer test might help to identify those with COVID-19 who would benefit from pulmonary rehabilitation to rebuild their lung function, even in the absence of severe respiratory symptoms.

This finding also points to the way in which the SARS-CoV-2 virus seems to enhance a tendency toward blood clotting—a problem addressed in our Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) public-private partnership. The partnership recently initiated a trial of blood thinners. That trial will start out by focusing on newly diagnosed outpatients and hospitalized patients, but will go on to include a component related to convalescence.

Moving forward, it will be important to conduct larger and longer-term studies of COVID-19 recovery in people of diverse backgrounds to continue to learn more about what it means to survive COVID-19. The new findings certainly indicate that for many people who’ve been hospitalized with COVID-19, regaining normal lung function may take a while. As we learn even more about the underlying causes and long-term consequences of this new infectious disease, let’s hope it will soon lead to insights that will help many more COVID-19 long-haulers and their concerned loved ones breathe easier.

Reference:

[1] Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. Zhao YM, Shang YM, Song WB, Li QQ, Xie H, Xu QF, Jia JL, Li LM, Mao HL, Zhou XM, Luo H, Gao YF, Xu AG. EClinicalMedicine.2020 Aug 25:100463

Links:

Coronavirus (COVID-19) (NIH)

How the Lungs Work (National Heart, Lung, and Blood Institute/NIH)

Computed Tomography (CT) (National Institute of Biomedical Imaging and Bioengineering/NIH)

Zhengzhou University (Zhengzhou City, Henan Province, China)

Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) (NIH)

34 Comments

  • rumah h. says:

    covid-19, anywhere, any country, it’s scary

  • Lynne B. says:

    Another off the wall comment from Lynne…1) Is there any possibility of on going assessment of these patients re: Viral sponsorship of lung cancer? (ex: HPV/cervical cancer) 2) Is there any possibility of using SARS/Covid 19 in reverse engineered way to help hemophiliacs? Just a thought….

  • Tim Lundeen says:

    Lung damage appears to heal, just takes time:

    “CT scans at 6 weeks showed lung damage from inflammation and coronavirus-induced fluid accumulation — which shows up as “ground glass” patches — in 88% of patients. At 12 weeks, this measure dropped to 56%. The severity of overall lung damage dropped from 8 points on 6-week CT scans to 4 points on 12-week CT scans.

    “There was also improvement in lung function from 6-week to 12-week follow-up.”

  • Kristie J. says:

    It might take a while for ANY patient who is sick enough to be hospitalized to recover. If we looked at flu hospitalizations and studied lung function in the same way, would we expect to find the same results? Do we even know? The tone of this piece seems to indicate an unwillingness to accept any good news.

  • Peter Wolczko says:

    One area of interest is the difference in the air quality of various countries. We have cleaner air than we used to have. Would the air quality difference have an effect on those 55 patients if they were tested here after having COVID-19?

    • Emily says:

      Hi, I live in the Big Sky State with abundant fresh air, and I had a very mild case of Covid. I was not hospitalized, nor did I have symptoms beyond what we would consider a mild cold with a little fatigue for three days (I took naps on two of them and powered through the third). When I was working cattle one day mid-quarantine, I noticed I had mild shortness of breath (my husband made a joke about how hard I must have been working). I’m pretty fit, I have no pre-existing conditions, and I had been hiking fairly effortlessly just two weeks before the virus. Now, I’m three weeks past the virus, I have returned to normal life for the most part, but as I sit here even now, I feel that sensation of shortness of breath. It doesn’t wind me or disrupt my ability to speak in full sentences, but it is there. I don’t think anyone around me would notice it, but I feel it. I wonder how long it will take for my lungs to return to their healthy state.

      • David F. says:

        Your guess is anybody’s guess! I’m. 3 months recovering from Covid Double Pneumonia and the Shortness of Breath is the most disconcerting aspect of my recovery! It’s a Novel Virus so Drs. don’t have any answers! That scares the hell out of me! My advice to others is to stay focused, stay strong, eat well, and maintain 6ft from others! Stay Well and Be Safe!

        • Mel says:

          What kind of treatment did you get? My husband was sent home but still has trouble breathing after walking to the bathroom. He has antibiotics and an inhaler. 14 days – seven days of steroids and seven days of antibiotics.

      • Jimmy says:

        I’m 3.5 months after recovery from the virus and I still get fatigue, shortness of breath (my lungs hurt and it feels like an asthma attack for the past 3 hours, as I sit here writing this), and taste/smell are still slowly recovering. I had a serious case though. I can tell there has been a lot of improvement over the past 3 months, so, if I were to make a guess…. If you had a mild, short-lived case of infection, I would expect your recovery would be faster and easier. If you give it a month or so, you may rarely notice the symptoms or they may go away. I was in pretty bad shape, but as I’ve healed, it has gotten a lot better and it seems like it would eventually go away. I hope that helps to put your mind at ease!

        • Muffy says:

          My husband tested positive 12/1 he hardly had symptoms drainage and stuffy nose. 12/8 came shortness of breath and constant coughing he went to the ER. He was sent home with inhaler, steroids and antibiotics but blood work and chest x-rays were good. Today he went back to the ER shortness of breath an cramping up. He was admitted, his o2 level was 80. They put him on supplemental oxygen and steroids. I’m terrified can someone give me some hope😢

          • Carrie C. says:

            I’ve just read your post. I totally understand where you are coming from. I’ve always prayed but I pray even more Now. I Thank Our Good Lord throughout the day Now. I’d say A Lot more Prayers, My big brother Johnnie would call My Honey David and I everyday, I had Johnnie call Our family and friends to call My Honey David to encourage him. Since I was at home with shortness of breathe. In one of tge calls, My Honey was told by one of Our very closest friend Sista LBR, to please just listen and not say a word. David did just listened. He had shortness of breathe so he would tire easily at the hospital. He was at the Ascension Seton from November 19th to November 25, 2020. They Are All Amazing at Ascension Seton Hospital. He told me he would be coming home on oxygen. My response was Honey it is okay as long as You come home. I’d do whatever it takes to get you better. Please make sure to read all discharge paperwork when your husband gets sent home. Your husband will come home when it is time. Because My Honey was sent home but on oxygen. His paperwork said to schedule a follow up appointment with Primary Care Physician 3 to 5 days after discharge. Our Primary Care Physician came upon him needing to be set up on his Home Health which started on the 8th of December and set up Pulmonary doctor visit which is on 14th of December. He tested postive on the 16th. Please keep in mind he lost his appetite for like 6 to 7 days before going into the hospital, fever, coughing, chills, fatigue, vomiting and on the 18th he finally was able to tell me he had been having diaherra 4 days prior. On this day My big brother Johnnie asked him to please eat and move in his bed but just keep moving. I’m sure I would be tell you a different story if My big brother Johnnie wouldn’t have called this 18th day of November. Our 15 year tested on the 19th positve asymptomatic and I on the 17th of November positive which I was in ER with shortness of breathe. I was sent and monitored at home from the 16th so I used my oximeter on My Honey. At 3:00 am the morning of the 19th his O2 was at 93 but it dropped to 88 by 6:00 am. This is when I told My Honey I had to call the ambulance to take him. I knew he was in better hands at Ascension Seton Hospital. I Thank God for his Doctors and Nurses. Please tell your husband to eat all of his hospital food even if he doesn’t like something. When I asked My Honey what food he ordered. He said “He didn’t. He just knew any food and Ensure drinks would only help him.” We were trying to get Our 15 year out since she didn’t have any signs to stay with her Big Brother and Big Sister. We had Our Angel LifeSaver take Our 15 year old to get tested on the 19th but tested Positve Asymptomatic. Our Angel LifeSaver brought her back to me. I on the 17th of November was Positive. All 3 of us were in self isolation so we couldn’t help one another. I know it is Very Scary but your husband is in the Best Place at The Hospital. The Doctors and Nurses know A Lot more about COVID 19 than in March when The World was shutdown. When I was in the ER. My nurse wasn’t suited up. She just had the surgery mask just like me. She told me she wasn’t afraid because I wasn’t coughing. I just had the shortness of breathe. Mrs. Muffy, Please Ask God To Remind You To Take One Day At A Time and To Hold Your Hand While Going Through This Journey With Your Husband. I will ask My Lil’ Sister M.E.G.to pray for your husband and You Mrs. Muffy. Also to light a candle for You Both as she has done for my family and I. Please Please Wear Your Mask Around Everybody You Love Inside/Outside Your Homes For Their Safety and Yours. I’m sending Air Hugs and An Air Kiss For Both of Your foreheads. Please know it has A Lot of Love From Me and Most Importantly Know Jesus LOVE You Both. Have a Great Day! May God Bless Us All!!

            Your Sister In Christ,

            Mrs. Carrie

          • Ally says:

            The virus has been around long enough now for medical professionals to better know how to treat it. If he has good doctors, and he started out in pretty good health, he should recover. It is very hard on the body. Long term effects are known to occur, so plan to give him extra care after he returns home. He may eventually fully recover, or he may have some long term problems.

            Try to keep yourself healthy, and see if talking with a counselor helps you. It is a very stressful time for you, but the best thing you can do for your husband right now is to make sure that you will be healthy when he needs your care later. Part of that is taking care of your emotional health. I wish you both well.

    • Ellie says:

      From my husband as immediate response, who just being discharged from the hospital for COVID 19 pneumonia, after we vacuumed the whole house, he felt much, much better with breathing. I also want to let him go to the backyard for deep breaths with fresh air and exposing him under the sunlight daily.

  • Herpezine says:

    This is why people are so scared on this virus. If you survive this virus, your lungs will not be the same as before.

    • Sally L. says:

      I was hospitalized with COVID-19. It has been horrible. I will have good days and bad days. I have COPD. It has changed my lungs. They are worse than before. I have been out of the hospital for 2 weeks. I still feel like crap. I already had a hard time breathing. Now with COVID. Even worse. I know it will take time to recover. But I don’t think my recovery will be speedy. Anyway. I keep hope I will get thru this. But get scared I won’t.

  • Kenneth Capron says:

    The lung cells were damaged by COVID and just need time to heal and replace the damaged surfaces.

  • mrmoose says:

    Visited my pulmonologist last week, who is very concerned about the recovering Covid 19 patients she is seeing. She states that the recoveries seem very prolonged in almost all cases, that the patients are having more and more various unanticipated effects from the virus, and has been surprised at how many much younger patients have had the virus and the serious aftereffects they are having also. She is very concerned about what she terms the politicization of the virus with the resulting relaxation of protective measures. This from St. Petersburg, Florida.

  • Jason R says:

    My brother is in prison. It’s been 12 weeks since he recovered from COVID 19. But he is still having trouble breathing. Can I get some advice to give him so he can breathe easy? He said it feels as if his throat is closing.

    • harrison d says:

      I just read your comment, I hope your brother is feeling better. I also just got out of the hospital for Covid pneumonia. There are several things that can help him that I know. Like taking deep breathes, if he doesn’t have one of them breathing incentives, he can just take 1. deep breathes every hour , and 2. drink lots of water. 3. Sleep on his side or better his stomach. 4. take a aspirin daily to avoid blood clots, and vitamins if he can get them. 5. Move around as much as he can without over doing it, because this thing also causes strain of the heart. Hope this is a help.

    • PhilZ says:

      YES,LAY ON YOUR STOMACH!
      The Covid ICU unit in Ashland Oregon had doctors and nurses that were on the first cases a year ago in Seattle and Portland. They intubated every patient. Not a good outcome. They found that on your stomach lungs cleared out faster and easier. I was in a full oxy mask {I am claustrophobic}. I did not want to turn over. Intubation was next. My wife on the phone and nurses told me to turn over. I did. Next day I called my wife, she was amazed I was still alive.

  • Karen S. says:

    After hospitalized with acute respiratory failure and multi focal pneumonia in early February, I became a suspected index case for covid. My healthcare provider was disinterested in me before and after my first hospitalization. I never recovered. I was diagnosed with high anxiety, because my heart would race and I couldn’t breathe. Then the chest pains became constant. In September, I was briefly hospitalized again, this time with bilateral pulmonary emboli. I am a covid long hauler who at this moment, ten months after her first symptoms, still experiences sharp chest pains. “Modern healthcare” has me feeling like a woman of the Victorian era diagnosed with hysteria, but slowly dying from consumption. I understand that today’s physicians still learning about the disease and are overwhelmed by fatigue and anxiety themselves. I ask that they treat their patients with regard.

  • Jane jarvis says:

    I had covid 19 in April was venterlated had pneumonia,sepsis,blood clots in both lungs, and nearly died twice. 8 months on and I still having trouble with my breathing, does any one know if this is how it’s going to be from now on or is there still hope I will recover?

  • Richard J. says:

    I have had covid for 4 weeks now. I asked my doctor can if I still get really sick, and she said no, if I was going to be real sick it would of happened 2 weeks ago. I had a chest x-ray done yesterday, and my lungs are clear, my oxygen level is 97 percent, and my smell came back a few days ago, and I have not had a fever at all, But I still have a nagging cough and still get tired. My question is: am I on my way to recovery, even though I am still coughing and tired sometimes?

    • Jane J. says:

      Sorry to hear you’re still having problems. I had covid back in April. Unfortunately, I was very sick in icu on a ventilator. It’s now coming up to 10 months, and I still have breathing difficulties. a cough, and tiredness. I live in hope that one day soon I will feel like my old self before this virus took hold hope you feel better soon.

    • Suja says:

      Post-covid, it can time for symptoms to clear. Four in my family had it, and each of us had different symptoms. One had persistent cough, two of us had a mild fever and the other was asymptomatic. Almost a month or two, after covid we still had a mild fever, cough and shortness of breath. An unusual fatigue was one of the major issues we faced post-covid during recovery. Pace yourself. You are on the way to recovery.

  • Robin says:

    My 24 year old daughter is a asthmatic. She was diagnosed with Covid on 12/13/2020 and has been experiencing Worsening breathing issues in the last two weeks. She just finished a round of steroids, and does 3 to 4 aerosol treatments a day along with taking her Rescue inhaler multiple times a day with Short term relief.She has had 2 chest x-rays that both show no signs of pneumonia. I’m very concerned and I don’t know what to do for this situation.

    • Suja says:

      Hi, post-covid it takes some time for the lungs to return to full capacity, so a lingering shortness of breath will still be present. I notice it in my case, and I am an asthmatic too. I hope your daughter has finished her course of medicine and has now tested negative. I get panicky when I feel that shortness of breath, but my doctor assured me that this becomes better with time. It could take as much as 2-3 months to get back to normal.

      • yupei m. says:

        Hi Suja, I had covid, self-quarantined and recovered mostly in 10 days. I was completely normal for next 2 weeks. But my coughing and shortness of breath slowly showed up again after. My x-rays are normal. Doctors told me it is post-covid asthma and prescribed a steroid inhaler. I was wondering is this something similar to your situation and should I not be worried too much? Thanks!

  • Patsy B says:

    I finally tested negative January 11th, I’d been sick since November, even canceled Thanksgiving truly thought it was just my typical seasonal flu. I finally tested December 20th and was positive. I still have sinus issues with plugged ears etc. sense of smell is coming back but fatigue is real frustrating. I’m waking at all hours from the chest pain. Monday my doctor prescribed my usual inhaler and a nebulizer but it was $80 after insurance. 5:30am awake from chest pain again I decided I better google, thanks to everyone for your comments I’m going to suck it up and get the nebulizer today. Lol. Nice pun😷

  • Debbie S. says:

    Varying symptoms in my family from losing sense of smell and taste to constantly coughing, delirium, electrical stimuli on skin, nausea and extreme fatigue. My 80 year old father was in ER on an oxygen level of 15L at first weaning down to 3L after 12 days. His oxygen was reading 95-97 in the hospital but now that he is at home his oxygen level is only at 91-93 and drops into the 80’s when he walks or moves a lot. The doctors in and out of the hospital say his lungs sound good but he is going for a chest x-ray in 2 weeks. He did have a mild case of Covid pneumonia with the glassy looking particles in his lungs. He is going to be put on a nebulizer but he is experiencing these same symptoms with the breathing and lung issues. He has no underlying conditions except his age. I hope time and therapy will heal his lungs and bring his oxygen levels back to normal. Good luck to everyone going through this awful experience.

  • David Summers says:

    There is a FDA approved drug that is used to treat neo-nates with ductus arteriosus. This is “blue baby” syndrome – condition of the baby born with a hole in its heart. The drug used to maintain the baby until surgery can be preformed is call prostaglandin e1 (PGE1). It temporarily paralyzes the heart’s valve smooth muscle cells so they cannot migrate and close the open duct to the artery. This drug can do the same thing to platelets and prevent blood clots though out the circulatory system and in all the vital organ, including the lungs.

    The first benefit is that PGE1 is a potent anti-inflammatory. It suppresses inflammation by inhibiting the release of both interleukin6 (Il-6) and of tumor necrosis factor alpha (TNFa) These factors are the first line of inflammation and if blocked or down-regulated by PGE1 the inflammatorily process can be controlled. Physician’s monitor inflammation by observing (microscopically) the blood levels of thrombotic debris called D-dimers. Remarkably, PGE1 reduces the production of D-dimers thus it can be assumed that the process of platelet and micro embolism aggregation can be prevented of ameliorate via elevation of cyclic adenosine monophosphate (cAMP) constituted though release of circulatory PGE1

    Why is not the medical provider no prescribing PGE1? Because the label does not include this condition or other serious pathologies related to COVID-19. But any licensed physician can prescribe any FDA approved drug. Added to the beneficial effects is its viricidal and bactericidal effects on enveloped organisms such as all the coronaviruses. Upon contact it releases reactive oxygen species (ROS) instantly incapacitating the virus.

    Another vital and beneficial effect is PGE1 dilates the arterioles around the aviola which aids breathing. Of course, all of these reports are substantiated in the medical literature. Yes, there are problems in the dosing and the drug’s short half-life, but there are various ways around these problems such as putting the PGE1 into a tiny capsule about the same size as the virus. The capsule is made from lecithin which is a natural building block of the body. The chemical name for lecithin is phosphatidylcholine or (PCT). The liposomal process controls the release of the drug.

    Finally, PGE1 up-regulates the resolution and healing of the inflamed tissue by activation of anti-inflammatory factors such as Lipoxin-4 (LX-4) Resolvins, and Protectins. The agents are naturally imbedded in all tissue and used by the body itself to heal. However, they cannot be used when the inflammation is ubiquitous and pervasive such as develops in what is called the cytokine storm – a condition of inflammation throughout the body. PGE1 turns these healing factors on and accelerates the healing process.

    I have extensively studied the advantages and disadvantages of of this drug and feel it is high time to get it into the treatment of COVID-19.

  • Elizabeth N. says:

    I got diagnosed with covid on Jan13th. I stayed at home. I was moderately ill. It seemed it was in my upper chest. I recovered and was quarantined for 20 days. since I have an autoimmune disease and on an immune suppressant. It will be 3 months soon and I am still out of breath. Any exertion and I’m wheezing and out of breath. I’m also tired. I can feel my heart pounding and it feels like the blood buildup and then the valve opens and I get a rush in my throat and my eyes. I am trying to get some testing but the facilities have not gotten the order from the Dr. it been a least 2 weeks waiting. I’ve called these facilities and am trying to get it straightened out. My family is very worried. As am I.

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