Covid-19 can have lasting impacts on the body, but there is hope that patients can not only recover over time, but can do so more quickly with pulmonary rehabilitation, preliminary research suggests.
Two early research reports to be presented Monday at the European Respiratory Society International Congress describe how severe infection with the coronavirus that causes Covid-19 can leave lasting lung damage and, in some cases, even psychological wounds.
“The bad news is that people show lung impairment from COVID-19 weeks after discharge; the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves,” Dr. Sabina Sahanic, a clinical PhD student at the University Clinic in Innsbruck, Austria, who was involved in one of the reports, said in a news release.
So far, only study abstracts of the new research have been released and the findings are preliminary, but they shed new light on the long-term impacts of Covid-19.
‘A persisting shortness of breath’
Sahanic’s research included data on 86 patients with severe Covid-19 who were enrolled in the study between April and June. The patients were evaluated six weeks after being discharged from the hospital and then just recently evaluated again at 12 weeks, Sahanic said during a news conference on Friday.
Each evaluation included a clinical examination, laboratory testing, analysis of lung function, CT scans of the chest and echocardiograms of the heart, Sahanic said. The research will continue for a third evaluation at 24 weeks.
At six weeks, Sahanic and her colleagues in Austria found that 65.9% of patients exhibited persistent Covid-19 symptoms, with shortness of breath and cough being the most common.
“About 50% of our study population showed a persisting shortness of breath six weeks after discharge from hospital that improved slightly until visit two,” Sahanic said. “Regarding our CT findings, we found that about 88% of our study population still showed pathological findings in visit one, which ameliorated to 56% in visit two.”
The researchers also noted in their study abstract that some patients showed left ventricular diastolic dysfunction in the heart, which refers to an inability of the ventricle to fill to a normal volume, and lung function abnormalities.
“Covid-19 survivors have persisting lung impairment weeks after recovery. Yet over time a moderate improvement is detectable,” Sahanic said. “Therefore, a structured follow-up in Covid-19 survivors is to be considered.”
These preliminary findings have only been presented – not published in a peer-reviewed journal – and they come with limitations, including that the sample of patients was small and many of the study participants have a history of smoking. More research is needed to determine whether similar findings would emerge among a larger and more diverse group of patients.
The road to recovery
The other study presented at the European Respiratory Society International Congress on Friday found that among 19 patients with severe Covid-19, undergoing pulmonary rehabilitation early in their recovery process was associated with improvements in lung capacity, balance, muscle strength, fatigue and certain risk factors of depression and anxiety.
Patients who “spent less time bedridden” between their time in intensive care and pulmonary rehabilitation recovered faster, the researchers, based in France, wrote in their study abstract.
However, walking abilities did not appear to completely recover, which suggests that more rehab could have been needed, and there appeared to be no improvement in symptoms of post-traumatic stress disorder from Covid-19, according to these early findings.
“On the psychological level, some patients also had severe post-traumatic stress disorder after intubation but they didn’t improve after rehabilitation,” Yara Al Chikhanie, a PhD student at the Dieulefit Santé clinic for pulmonary rehabilitation in France, who was involved in the research, said during Friday’s news conference.
One patient “was disturbed by memories and having flashbacks. She was having nightmares and rapid heartbeats whenever thinking about intubation and being hospitalized from Covid-19,” Al Chikhanie said. “She remembers nothing other than wanting to extubate herself.”
The preliminary findings come with some limitations, including that more research is needed to examine rehabilitation among a larger group of patients – and the findings have not published in a peer-reviewed journal.
Overall, “anecdotal evidence has been emerging since the start of the COVID-19 pandemic that many patients suffer debilitating long-term after-effects from the coronavirus,” Thierry Troosters, president of the European Respiratory Society – who was not involved in the new research but hosted Friday’s press conference – said in a news release.
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“Dr Sahanic’s presentation is important because it is one of the first, comprehensive prospective follow-ups of these patients and shows the serious, long-term impact of COVID-19 on the lungs and heart. It is sobering to hear that more than half of the patients in this study showed damage to their lungs and hearts 12 weeks after hospital discharge, and that nearly 40% were still suffering from symptoms such as breathlessness,” Troosters said. “Al Chikhanie’s research complements this information and shows how essential it is for patients to start pulmonary rehabilitation as soon as they are physically able to do so.”