Research into the long-term impact of COVID-19 is essential

Sept. 24, 2020

Emerging evidence suggests that some COVID-19 patients struggle with lingering symptoms – such as fatigue, racing heartbeat and cough – for months. The debilitating virus may also lead to organ damage, increasing the risk for long-term health problems.

SARS-CoV-2 utilizes a spike protein on its surface to bind to angiotensin-converting enzyme II (ACE2) receptors, allowing it to infiltrate cells where it then replicates itself. Because cells lining the lungs, heart, kidney and GI tract express ACE2, scientists suspect that these organs may be vulnerable to damage from SARS-CoV-2.

Studies into the long-term implications of SARS-CoV-2 infections are limited because the disease is still relatively new, but this will likely change as more case histories from patients become available for longitudinal analysis. In fact, it is important for the healthcare field to build knowledge not only about why symptoms linger in some patients but also on the risk of patients developing long-term chronic diseases of the lungs, heart, kidneys or GI tract.

This information will help clinicians understand if there are treatments that might mitigate the risk of future health issues as well as the type of follow-up tests and other care that COVID-19 patients need.

Some sobering research is available already. Here are some examples:

  • In a study of nearly 4,000 patients hospitalized with COVID-19, researchers at Mount Sinai Health System said kidney issues, including acute kidney injury (AKI), occurred in 46 percent of hospitalized patients, one-fifth of whom required dialysis. And only 30 percent of patients who were hospitalized with COVID-19 and developed AKI survived and experienced renal recovery.
  • Based on a review of more than 100 studies on the impact of the virus on the heart, a researcher at Intermountain Healthcare in Salt Lake City, UT, determined that one out of five patients hospitalized with COVID-19 developed heart issues.
  • Writing in the Journal of the American Medical Association, Italian researchers found that 87.4 percent of patients reported problems – such as fatigue, joint pain, chest pain and labored breathing – at a mean of 60.3 days after their first COVID-19 symptom.
  • French researchers found similar findings in the Journal of Infection, reporting that most patients requiring hospitalization for COVID-19 had symptoms for a mean 111 days after returning home. Fatigue and shortness of breath were the most common.

New studies to assess the impact of the disease over the long term are underway, too. For example, the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), launched an observational study in June in which researchers hope to enroll 3,000 adult COVID-19 patients either while they are hospitalized or after they are discharged. NHLBI researchers will analyze not only chest images but also lab tests for markers of inflammation and coagulation as well as injury to the heart, liver and kidneys.

Clearly, there are holes to plug in the body of research about how SARS-CoV-2 infections impact long-term health and the risk of developing chronic diseases. But based on emerging evidence, laboratorians should be prepared to provide testing services to COVID-19 survivors well into the foreseeable future.

I welcome your comments, questions and opinions – please send them to me at [email protected]

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