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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)

24 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

    • 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.

  • 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.

  • 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.

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