Color & Control:

Going, going, not gone: The struggle to treat long-term effects of COVID-19

By Kevin Spurgaitis

Back in March, professional diver Emiliano Pescarolo spent 17 days in the hospital in the Italian port city of Genoa after contracting COVID-19.

Three months later, the 42-year-old still experienced difficulties breathing. “… I couldn’t see any progress,” Pescarolo told the press. “If I took a small walk, it was like climbing Mount Everest. I was also out of breath from just talking. I was very worried.”

Subsequently, he needed extra oxygen while in Genoa’s Voltri hospital, but wasn’t intubated or admitted to the ICU. Eventually, Pescarolo joined Genoa’s Post-COVID Rehab Centre, where he discovered that he wasn’t the only person experiencing the prolonged consequences of the disease. His rehab mostly consisted of regular physical exercises, which gradually increased in intensity. He started to feel better and focused on returning to work as a commercial diver after another month. Despite his physical progress, however, Pescarolo said that he grew concerned about his cognitive abilities. He still couldn’t concentrate fully and had trouble remembering “simple things” in the short term. “I don’t know why…Maybe it’s an ugly gift that this virus gives us,” he jokingly told to CNN.

Trouble moving on
Pescarolo and tens of thousands of other “early” victims—known as “long-haulers”—are said to be redefining what was thought of as a short-term illness with their unrelenting and inexplicable symptoms that go on for weeks—and even months—after their initial sickness. The lasting effects are mostly neurological in nature and include confusion, memory loss, and poor concentration or brain fog.

Patients report having rapid heartbeats, facial numbness, skin rashes and fevers too. Coronavirus is also known to be a predator that can damage not only the lungs, but the heart, brain, liver, kidneys, skin, nervous system and gastrointestinal tract. After four or five months, some patients tend to feel better. However, recovery—whether in the hospital or at home—isn’t the least bit guaranteed. As Adrian Owen, a professor at Western University and head of the COVID-19 Brain Study, told the CBC, “there is clearly evidence that this is a multi-organ problem.” And without getting a grasp of the residual impacts, experts cannot fully understand the depth of pandemic itself and by extension, neither can governments.

As the European nations worst hit by the pandemic, the UK and Italy were some of the first to notice wide ranging after effects and provide rehab and recovery care to COVID-19 survivors. “It’s really important we support people who are in that situation and, also, that we do the research to find out what we can do about it,” said UK health secretary Matt Hancock, who contracted COVID-19 in March. In recent months, the cabinet minister announced a major study into the long-term health effects of the coronavirus on patients who have been hospitalized. Over the next 12 months, the PHOSP-COVID study promises to track 10,000 people.

Will there be recovery?
According to the World Health Organization (WHO), it can take anywhere between two and six weeks for someone to recover completely from COVID-19. It all depends on the severity of the case. Nevertheless, there is “relatively little” known about what to expect in the coming months and years for survivors beyond early indicators that some 10 per cent of them will feel longlasting symptoms and most are women in their 40s who were previously fit and healthy.

This is in stark contrast to the early pandemic’s typical COVID-19 patient: an elderly person with pre-existing health problems.

In Canada, patients are generally at their sickest roughly a week after their symptoms start, according to Dr. Bram Rochwerg, who leads the intensive care unit (ICU) at Hamilton’s Juravinski Hospital. As in other countries, the rate at which men and women are hospitalized and admitted to an ICU—and the length of their stay—varies. Rochwerg, who is also an associate professor at McMaster University, told the CBC that some hospitals in China have admitted most, if not all, patients with the virus. The Canadian way has been to send patients home to quarantine for 14 days if their symptoms aren’t severe. Of note, the two Chinese studies revealed that patients hospitalized in general wards stayed for 10 or 12 days on average. According to the same studies, those who died in general wards typically did so within the same timeframe. These patients, however, no longer represent the worst-case scenario.

Widespread tissue death
Early on, clinical radiologist Ali Gholamrezanezhad and his team from University of Southern California observed their patients showing signs of scarring and lung damage after clearing their infection. Data from computed tomography (CT) scans has not been published yet but he suggests that more than a third of these patients had tissue death leading to visible scars. He plans to follow the same group for several more years.

Because infected people don’t always end up in hospital, the reported rate of intermediate-term lung damage is less than 10 per cent. But, given that more than 28 million people have been infected by the coronavirus so far—and lungs are merely one of the places that physicians have detected damage—Gholamrezanezhad predicts that hundreds of thousands of people will be living with the prolonged health consequences of COVID-19. Of course, it remains a veritable mystery why people are not reporting the same symptoms consistently as well. Just why is the virus affecting people in so many different ways? Pre-existing conditions are an agreed risk factor but age, gender, blood type, and environmental factors are a few additional theories being tossed around. We still don’t know. Accordingly, researchers are worried about a sharp worldwide increase in the number of people living with lingering chronic illnesses and disabilities. Some effects may be the result of intensive treatments like intubation, while the disease itself might cause other lasting issues. Either way there are some alarming predictions.

In for the long haul
With many threatened by long-term illness and the economic impacts of job loss and healthcare expenses on the country, there is work to be done. Patients like Pescarolo, from around the world who want to resume their “normal” lives post COVID-19 will have no choice but to advocate and call for ongoing clinical studies and research as well as personal support. Pescarolo, meanwhile, has some advice for his fellow COVID veterans. “Don’t give up. It takes about four to six months for rehab, in a case like mine. Maybe for people who had bigger problems than mine it will take more time, but they [shouldn’t] give up.”

Kevin Spurgaitis is a Toronto-based writer interested in ethics and public health issues.

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