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Covid, the Aftermath Wha t We a s Ph y s i ci a ns Wi l l Be Lef t Wi th By JOSEPH F. ANSWINE MD FASA
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t this time, our EMR has a red “+” present on the record of many if not most of the patients that come to the operating room. That signifies a previous Covid infection. Thankfully, the majority of patients had a distant past positive Covid test, suffered minimal or no symptoms, and are now at baseline health. But for a small but definitely present few, it means residual problems. These are the individuals suffering from secondary organ damage, or have “long Covid”.
According to the CDC, lingering effects from a Covid infection are due to obvious organ damage from the initial infection or less obvious etiologies especially in those with minimal or no initial symptoms. For those with organ damage; whether the heart, liver, lungs, kidneys, brain and so on; direct damage from the virus, autoimmune attack or extended hospitalizations are the culprits. These will likely now be life-long problems, and pose future difficulty as we care for them. As for those experiencing symptoms after mild or no obvious initial symptoms, the etiology is not well understood. With the Covid pandemic continuously evolving, the data too are evolving, therefore, much is incomplete, or the data are conflicting. Any data in this editorial came from the CDC, Pubmed searches, or from a major institution’s website. According to the CDC, those with long Covid with less understood etiologies experience shortness of breath (SOB), fatigue, post-exertional malaise, difficulty concentrating, cough, chronic pain, palpitations, diarrhea, sleep disorder, and many other vague but life-altering symptoms. SOB, fatigue, and cognitive changes are the three most commonly described of the actually hundreds of documented conditions. Long Covid can last weeks or months after first being infected or can appear weeks after infection. It can occur in anyone who has had Covid, even if the illness was mild, or if they had no symptoms. Since the definition of long Covid varies, consistent statistics prove difficult but data have
16 Spring 2022 Central PA Medicine
been published stating that 50% of unvaccinated Covid sufferers experience the syndrome and 19% of those vaccinated with Covid do. Patients may or may not have abnormal laboratory values consistent with lingering infection or inflammation. There are at least three theories of the etiology of long Covid. One is that the virus is still present in the body and becomes intermittently reactivated. Two is that left over inflammatory cells continue to produce an inflammatory response. Lastly, the Covid infection has led to an autoimmune process therefore our own immune system is creating ongoing symptoms. It’s probable that a combination of two or all the theories are correct. A process described with Covid is Multisystem inflammatory syndrome (MIS), a continuing process seen in post-Covid patients. It has been seen in adults and children. MIS is not common but if present, is a serious condition in which different body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. As for mental health, literature describes a one in three likelihood of having generalized anxiety disorder post-Covid. Furthermore, one in four have disorganized sleep, one in five have depression, and one in eight have PTSD. As for treatment of all these processes, they are supportive and minimally defined. What this all means is lingering problems after surviving the acute infection, as if that was not enough, will be with us for years to come; and we will be treating them with a myriad of therapies that are as yet probably unknown.
