As the medical community gets a better handle on new acute cases of COVID-19, questions concerning long-term symptoms and lasting injuries persist. To help answer some of these questions, Eamonn Costello, CEO of Dublin-based digital healthcare company patientMpower, invited two respiratory experts, along with patientMpower’s chief scientific officer, to present research on long-term COVID-related lung disease and damage.*

Does COVID-19 cause pulmonary fibrosis?

According to Dr. Gisli Jenkins, the Margaret Turner-Warwick Chair of Thoracic Medicine at Imperial College London, the most common risk factors for COVID-19, namely increasing age, type 2 diabetes, and irregular heartbeat, are also risk factors for idiopathic pulmonary fibrosis (IPF). 

Across two studies of post-COVID-19 lung function, one at one month post-diagnosis and one at three months, patients exhibited:

• Significant reduction in pulmonary gas transfer,
• Considerable inflammation, and 
• Some scarring.

When combining both study’s findings, at least 80% of the study participants had some evidence of interstitial lung disease (ILD).

Dr. Jenkins explains that over time, CT scans showed that ventilation reduced inflammation, but fibrotic changes (i.e., lung tissue scarring) did not resolve, and lung function did not improve. In fact, ventilation appeared to make fibrosis worse.

Jenkins said that given the scale of the pandemic, COVID-19 will likely lead to substantial post-COVID ILD, but there is hope. Possibilities for preventing the development of post-COVID ILD include:

• Vaccinations, and avoiding infection in the first place
• Dexamethasone, a steroid that reduces illness severity
• Tocilizumab, an immunosuppressant that may also be anti-fibrotic, used to treat acute lung tissue inflammation (i.e., pneumonitis)
• Other anti-fibrotic drugs that have the potential for inhibiting viral entry or viral replication

Further research and testing on all of these drugs are necessary to determine their various uses and long-term effects.

Models of care for post-COVID recovery

Dr. Killian Hurley, an associate professor at ‎Royal College of Surgeons in Ireland and consultant respiratory physician at Beaumont Hospital in Dublin, Ireland, discussed models of care for post-COVID-19 recovery both in hospitals and in the community. 

Early in the pandemic, Dr. Hurley’s team based its multidisciplinary approach on previous research concerning the SARS outbreak of 2002-2004 and the H1N1 virus. After studying the results of their efforts regarding both acute and follow-up care, Hurley determined that:

• The hybrid approach involving both virtual and in-person clinics was successful.
• Some impairment remained at three months, especially for post-ICU patients, suggesting that a more comprehensive assessment should be done for ICU patients initially and at post-discharge follow-up.
• More work is needed to provide care for patients with post-COVID syndrome (i.e., patients who experience ongoing symptoms after 12 weeks) including:
  • Assessment and treatment of concurrent illnesses and new diagnoses
  • Rehabilitation for chronic conditions
  • Specialized care

Improved care resources are also needed for both physical and mental health conditions.

Using patient-reported data to understand long-term effects

Dr. Colin Edwards, the chief scientific officer of patientMpower, is excited about the patient-led research collaborative that’s informing healthcare providers about the long-term effects of COVID-19, the impacts of care and recovery in different settings, and the needs of COVID long-haulers.

One recent survey, of more than 3,000 participants, showed that:

• Only 8% had been hospitalized
• Most had symptoms after 90 days 
• The most common symptoms were:
  • Fatigue
  • Post-exertional malaise (i.e., feeling sick or fatigued after even minimal effort)
  • Cognitive dysfunction

Another survey, with 153 respondents, revealed that:

• 62% did not feel they had regained full health
• 48% were clinically fatigued
• Of the 74 who had been hospitalized, 14 had persistent infiltrates in their lungs that showed up on X-rays, while none of the participants in the non-hospitalized group had abnormal X-rays.

Patient-led research does not only capture a wide variety of symptoms, but it also helps providers individualize care, said Dr. Edwards.

*Eamonn Costello (Host). (2021, Apr. 16). Impact of COVID-19 on Long-Term Respiratory Health [Webinar]. patientMpower. https://www.youtube.com/watch?v=sB0OsijIjJg 

Much about the novel coronavirus, i.e., COVID-19, is still not fully understood. As research progresses and our knowledge of the virus increases, information can change rapidly. We strive to update all of our articles as quickly as possible, but there may occasionally be some lag between scientific developments and our revisions.