Everyday, new findings related to COVID-19 are adding to the woes of already panicked people. The latest one is the persistent damage in the lungs of COVID patients, even after three months of recovery. MUSBA HASHMI speaks with doctors to tell you more
It is a no-brainer that COVID affects the lungs. However, the fact that the mortality rate is less in COVID, people took a sigh of relief. Now, to add to the woes is the results of a study done by UK-based researches who have found out persistent damage in the lungs of a COVID patient even after months of recovery. These patients reported breathlessness even after six months of recovery.
“I will call them residual damages or post-COVID changes, instead of permanent damages, because long term follow ups are required for those patients who developed lung complications during COVID-19. But yes, changes have been found at three months follow ups. In lungs, fibrotic changes have been found on repeat CT scans. Fibrosis is basically a pathological wound healing response. Wound healing response elicited during severe inflammation anywhere in the body can lead to permanent damage of the respective tissue or organ, through a process of scarring called fibrosis,” Dr Ashish Gupta, Senior Consultant, Critical Care Medicine and Infectious Diseases, Apollo Spectra Karol Bagh, Delhi, tells you.
He adds that fibrosis leads to reduced tissue elasticity, causing organ dysfunction where elasticity is required for normal function (e.g., lungs, heart). So, just like lung tissue, heart muscles can also develop fibrotic changes if there was active involvement of heart during acute COVID-19.
Dr Charu Dutt Arora, Infectious Disease, Home Care, Critical Care Specialist and Covid Care Expert at Housepital, Sarvodaya Healthcare agrees with Gupta and says that it is a dangerous post-COVID complication since fibrosis (or scar tissue) is not elastic and non functional for oxygenation process. Hence, patients have to supplement oxygen from outside for long time even post recovery. The main symptom, he says, is breathlessness and low oxygen levels.
“Weakness, lethargy, breathlessness, chronic dry cough are some of the worrying symptoms of progressive fibrosis post-COVID,” he says. Depending on the severity of pneumonia, patients can develop fibrosis between two weeks and three months post recovery.
The surprising, or shall we say worrisome, fact is that these abnormalities weren’t visible in the CT scan. “CT and MRI scans can only inform about the presence of ground glass appearances or patches in the lung parenchyma. They let clinicians understand the lung pathology and correlate with the clinical symptoms. But, the new technology of 129Xe MRI throws light on the gas exchange and uptake of oxygen in the lungs. This function is useful to understand the actual physiological output of the lungs, specially in cases of post-COVID or fibrosis where CT scan might not detect any abnormality,” Arora explains.
The Xe MRI scan can inform about the decreased oxygen uptake in the lungs to the bloodstream that results in long term breathlessness or hypoxia.
“Xenon is a noble gas which is 4.5 times heavier than air and its spin is lower than Hydrogen or the protons in the body tissues (Hydrogen is an integral part of water in the body & the relaxation time of hydrogen is used for reading MRI signals). Researchers used hyperpolarised inhaled Xenon-129 to increase the MRI visibility of tissue changes occurring at the alveolar-capillary interface,” Dr. Tejinder Kataria Chairperson Radiation Oncology Cancer Center Medanta — The Medicity, Gurugram, explains.
However, she points out that not all patients will need Xe-MRI and that the Xenon MRI hardware is not yet commercially available.
This is not all. However, proper research is lacking, doctors predict certain long-term effects of the complication. “Fibrotic changes in the lung, lead to reduced elasticity, and reduced scope for lung expansion during deep breathing or exercise. So, it is easy to understand that a person with lung fibrosis has reduced effort tolerance or less respiratory reserve, leading to easy fatiguability with minimal exercise,” Gupta tells you.
But, level of symptoms depends on the extent of lung involvement. So, not all such persons will be severely symptomatic. Also, those who do regular exercise will have less severe aftereffects. E
The good thing is that doctors say even post-COVID, lung and heart function can be improved with guided and regular rehabilitative exercises and with regular healthcare consultations.
“Depending on the severity of lung inflammation and damage, as well as patient comorbidities, duration of injury and genetics, patients can see improvement in their lung function. Similar to having pneumonia, over time, patients’ lung function can recover. Looking at previous experience with SARS and MERS Coronaviruses, studies following patients after developing pulmonary fibrosis showed that pulmonary lesions diminished over time in some patients,” he opines.