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COLUMN: Long-term consequences of COVID-19

"Serious emotional, financial and health consequences are now upon us society-wide as we try to contain the virus’ spread."
Murdock Alan-col
Columnist Alan Murdock

We do not know why we are having a surge of COVID-19 this winter, though the disease, like influenza, is diminishing in activity in countries south of and closer to the equator. Golfing at Lago Mar is beginning to look increasingly attractive.
 
In Canada, as is happening globally, most of the deaths take place amongst the elderly and in younger adults who have pre-existing illness such as obesity or other forms of malnutrition, diabetes mellitus, chronic lung disease and kidney or heart problems. Canadians age 70 years and older account for 89 per cent of deaths from COVID-19.
 
As the numbers of infections soar, deaths amongst the elderly do increase – largely because we haven’t, in Canada at least, done anything substantively about the living arrangement deficits in our residential care facilities or their operating practices, except to react emotively when outbreaks become politically sensitive.
 
Presently, a rapid increase in the numbers and severity of illness among our younger adult citizens has us focused on how to lower infections, particularly in our 20 to 39 age group, and create/maintain healthy working and social settings. Canadians of working age now account for 46 per cent of hospitalizations and 62 per cent of ICU admissions. These circumstances are also threatening to overwhelm our healthcare system.
 
If this were not worrying enough, for those who become ill with COVID-19 infection, symptoms can sometimes persist for months. And the risk of not fully recovering seems to be independent of the severity of the acute illness. Data from follow-up studies report that up to 20 per cent of young adults have symptoms that persist beyond 21 days. One report of a group of infected college athletes who were not hospitalized had continuing illness complaints ranging from 12 to 53 days after diagnosis.
 
The most common complaints presently reported are fatigue, headaches, vertigo, inability to concentrate or think clearly (learning problems) and loss of exercise tolerance. One study from Italy reported that 50 per cent who became ill had more than three complaints affecting their quality of life, with the most common being chest pain and joint pain.
 
As time goes on, we are finding out more about the immunologic, end organ damage and the cerebral/emotional consequences of being infected.
 
We do know that those who are at greatest risk of early onset deterioration and death are those whose immune systems over-react to the virus. And we have learnt that the use of corticosteroids can dampen this over-reaction and prevent some deaths. The long-term consequences, if any, of this adverse allergic reaction to the virus are as yet unknown for those who survive.
 
But beyond this, the type of pneumonia associated with COVID-19 infection can permanently damage the tiny air sacs (alveoli) in the lungs and cause widespread scarring and long-term breathing problems. Radiologic imaging of hearts taken months after infection, in some otherwise fully recovered adults, has found permanent damage to heart muscles. Even in young people, brains can be damaged with strokes, seizures, long-term loss of smell, or a form of temporary paralysis (Guillain-Barre syndrome). Whether we will later see chronic brain disorders such as early onset Parkinsonism or Alzheimer’s type disease is unknown. Permanent kidney damage is also a potential problem as this virus attacks and destroys the body’s small blood vessels of which the vascular-rich kidney is a prime target organ.

A rare but deadly post-viral reaction called multisystem inflammatory syndrome has also been described in children.
 
We are uncertain of the reason(s) for the increased incidence of post-illness emotional/behavioral complaints of anxiety, depression, mood swings, ‘brain fog’, PTSD symptoms and substance abuse disorders. These may be experiential in nature, or may reflect brain injury from viral infection within the brain or indirectly cause brain cell death due to cerebral blood vessel damage and clot formation – or all three.
 
Two major concerns are apparent about the emergence of late onset or persistent health complaints. First, the illness has been recognized for less than a year, so we don’t know the longer-term frequency or severity of COVID-19 infection complications. Secondly, we do not know who is at greatest risk of long-term complications – except that those who are infected but asymptomatic do not appear to be risk-free.
 
The above information is not offered as a clarion call to shut down our society until we get this disease under control. Serious emotional, financial and health consequences are now upon us society-wide as we try to contain the virus’ spread. This includes a recent surge of an even more deadly measles virus outbreak, now infecting 870,000 people globally, as COVID-19 has interrupted immunization programs. We can also expect poliomyelitis to re-emerge.
 
This pandemic needs a sensible, balanced, community-based approach. Individually, the least we can do for the moment is to wear our face masks and respect spatial distancing until we have a vaccine.

Alan Murdock is a local pediatrician.

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