15 minute read
COVID-19 Can Cause Lasting Lung Damage
COVID-19 Can Cause Lasting Lung Damage – 3 Ways Long COVID Patients’ Respiration Can Suffer
BY JEFFREY M. STUREK & ALEXANDRA KADL, THE CONVERSATION
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Persons say: “I just can’t do what I used to anymore.” As pulmonologists and critical care doctors treating patients with lung disease, we have heard many of our patients recovering from COVID-19 tell us this even months after their initial diagnosis. Though they may have survived the most life-threatening phase of their illness, they have yet to return to their pre-COVID-19 baseline, struggling with activities ranging from strenuous exercise to doing laundry. These lingering effects, called long COVID, have affected as many as 1 in 5 American adults diagnosed with COVID19. Long COVID includes a wide range of symptoms such as brain fog, fatigue, cough and shortness of breath. These symptoms can result from damage to or malfunctioning of multiple organ systems, and understanding the causes of long COVID is a special research focus of the Biden-Harris administration. Not all breathing problems are related to the lungs, but in many cases the lungs are affected. Looking at the lungs’ basic functions and how they can be affected by disease may help clarify what is on the horizon for some patients after a COVID-19 infection.
Normal lung function The main function of the lungs is to bring oxygen-rich air into the body and expel carbon dioxide. When air flows into the lungs, it is brought into close proximity with the blood, where oxygen diffuses into the body and carbon dioxide diffuses out. This process, as simple as it sounds, requires an extraordinary coordination of air flow, or ventilation, and blood flow, or perfusion. There are over 20 divisions in your airway, starting at the main windpipe, or the trachea, all the way out to the little balloons at the end of the airway, called alveoli, that are in close contact with your blood vessels. By the time a molecule of oxygen gets down to the end of the airway, there are about 300 million of these little alveoli it could end up in, with a total surface area of over 1,000 square feet (100 square meters) where gas exchange occurs. Matching ventilation and perfusion rates is critical for basic lung function, and damage anywhere along the airway can lead to difficulty breathing in a number of ways.
Obstruction – decreased airflow One form of lung disease is obstruction of airflow in and out of the body. Two common causes of impairments like these are chronic obstructive pulmonary disease and asthma. In these diseases, the airways become narrowed because of either damage from smoking, as is common in COPD, or allergic inflammation, as is common in asthma. In either case, patients experience difficulty blowing air out of their lungs. Researchers have observed ongoing air-
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COVID-19 Can Cause Lasting Lung Damage/continued from page 19 flow obstruction in some patients who have recovered from COVID-19. This condition is typically treated with inhalers that deliver medications that open up the airways. Such treatments may also be helpful while recovering from COVID-19.
Restriction – reduced lung volume Another form of lung disease is referred to as restriction, or difficulty expanding the lungs. Restriction decreases the volume of the lungs and, subsequently, the amount of air they can take in. Restriction often results from the formation of scar tissue, also called fibrosis, in the lungs due to injury. Fibrosis thickens the walls of the alveoli, which makes gas exchange with the blood more difficult. This type of scarring can occur in chronic lung diseases, such as idiopathic pulmonary fibrosis, or as a result of severe lung damage in a condition called acute respiratory distress syndrome, or ARDS. ARDS can be caused by injuries originating in the lungs, like pneumonia, or severe disease in other organs, like pancreatitis. Around 25% of patients who recover from ARDS go on to develop restrictive lung disease. Researchers have also found that patients who have recovered from COVID-19, especially those who had severe disease, can later develop restrictive lung disease. COVID-19 patients who require a ventilator may also have recovery rates similar to those who require a ventilator for other conditions. Long-term recovery of lung function in these patients is still unknown. Drugs treating fibrotic lung disease after COVID-19 are currently undergoing clinical trials.
Impaired perfusion – decreased blood flow Finally, even when air flow and lung volume are unaffected, the lungs cannot complete their function if blood flow to the alveoli, where gas exchange occurs, is impaired. COVID-19 is associated with an increased risk for blood clots. If blood clots travel to the lungs, they can cause a life-threatening pulmonary embolism that restricts blood flow to the lungs. In the long term, blood clots can also cause chronic problems with blood flow to the lungs, a condition called chronic thromboembolic pulmonary hypertension, or CTEPH. Only 0.5% to 3% of patients who develop a pulmonary embolism for reasons other than COVID19 go on to develop this chronic problem. However, there is evidence that severe COVID-19 infections can damage the blood vessels of the lung directly and impair blood flow during recovery.
What’s next? Lungs can work less optimally in these three general ways, and COVID-19 can lead to all of them. Researchers and clinicians are still figuring out ways to best treat the long-term lung damage seen in long COVID. For clinicians, closely following up with patients who have recovered from COVID-19, particularly those with persistent symptoms, can lead to quicker diagnoses of long COVID. Severe cases of COVID-19 are associated with higher rates of long COVID. Other risk factors for development of long COVID include preexisting Type 2 diabetes, presence of virus particles in the blood after the initial infection and certain types of abnormal immune function. For researchers, long COVID is an opportunity to study the underlying mechanisms of how different types of lung-related conditions that result from COVID-19 infection develop. Uncovering these mechanisms would allow researchers to develop targeted treatments to speed recovery and get more patients feeling and breathing like their pre-pandemic selves once again. In the meantime, everyone can stay up to date on recommended vaccinations and use preventive measures such as good hand hygiene and masking when appropriate.l
Jeffrey M. Sturek is an Assistant Professor of Medicine, University of Virginia. Alexandra Kadl is an Assistant Professor of Medicine and Pharmacology, University of Virginia
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Updating Your Will
Wills are designed to be ironclad documents that set forth how you want assets dispersed to loved ones. They take the guesswork — or, in some sad cases, the arguments — out of a critical moment in this very emotional process. But they’re not ironclad at all. In fact, there are several instances in which you should go back and update this document so that it doesn’t end up creating the very end-of-life problems you’re trying to avoid.
Marital Status If you get married after executing a will, you’ll need to add your new spouse as a beneficiary. Most states allow a spouse to receive their portion of an estate, even if a will is not in place. But securing that benefit can be a lengthy and difficult process. Obviously, your will might also be changed if you get a divorce, since your spouse would typically no longer be a beneficiary. Spouses are also generally named as guardians for minor children and estate executors in wills, so those designations may also need to be updated when a marriage ends.
Tax Laws Work directly with a professional estate planner when crafting this document, since they will have the most up-to-date information on your will’s tax implications. But be aware that these laws change, and sometimes your final document has to be updated in order to remain in the appropriate legal standing. A legal representative should make periodic reviews of your will, with an eye toward updating things like estate-tax issues.
Financial Situation If you endure an economic downturn, it may be necessary to pay out less to your beneficiaries to make sure that the estate’s other obligations are still met in your absence. On the other hand, if you experience a notable financial uptick, you may want to increase the benefit for those you leave behind — or maybe even add a new beneficiary.
Adding a ‘P.S.’ If you’re only adding a small change after the will has been competed, you may choose to make what’s called a codicil — basically a legal “P.S.” to your will. An extra page is written, signed and witnessed, just as your original will was, then attached. After death, both documents are to be read and followed. More important chances should involve an entirely new will.
Ask for Advice A will is your ironclad way to disperse your assets to loved ones as you wish. Don’t be afraid to ask your legal expert for advice on other moments that may benefit your last will and testament. Remember, this document is incredibly important to keep accurate as it articulates your vision and solidifies your legacy. Visit www.askthelawyer.us to schedule a consultation or call 855-768-8845.l
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CONVERSATIONS
22 As NYC School Board Meetings Return In Person, Will Parent Participation Dwindle?
BY AMY ZIMMER, CHALKBEAT
For many New York City parents, the move during the pandemic to virtual school board meetings meant they could attend without having to scramble for child care or figure out transportation. Now, participating in these meetings could once again become difficult, and that could have important consequences in terms of whose voices get heard when the city makes policy decisions. After extending New York’s COVID state of emergency several times, Gov. Kathy Hochul allowed it to expire earlier this month, putting an end to virtual public meetings governed by the Open Meetings Law. The city, however, extended its local state of emergency through Oct. 22, giving boards some more time to figure out next steps. Meetings covered under the state’s Open Meetings Law can go hybrid, but it could get complicated. A board can pass a resolution or change their bylaws allowing for individual members to attend virtually due to illness, disability, caregiving responsibilities, or any other “significant or unexpected factor or event.” But quorum of board members must still be present in person. Several public bodies governed by the state’s Open Meetings Law have passed resolutions to hold hybrid meetings, though many have not, and some parent advocates worry that will prevent many families from being able to show up. With unvaccinated parents still barred from schools, in-person-only meetings might mean they can no longer participate. Hybrid meetings, on the other hand, can require tech equipment and expertise that some of these volunteer bodies might not have. And for many school board members — most of whom are caretakers — who will get to dial in and who will have to show up? “You could be cooking dinner for your kid and participating in a meeting at the same time,” said Kaliris Salas-Ramirez, a member of the city’s Panel for Educational Policy, or PEP, of online meetings.
Open Meetings The rule applies to the PEP, a largely mayoral appointed board that only approves (or rejects) contracts, and also provides one of the few spaces for families and advocates to publicly express their views on issues from school closures to disciplinary changes. The panel, which is required to livestream their meetings, has yet to vote on whether to allow hybrid member participation or whether they will take public comment via teleconference.(PEP meetings have lasted well past midnight both virtually and in person.) The Open Meetings Law also affects charter school boards, school leadership teams (each schools’ joint educator-parent committee that makes instructional and other decisions), and the 36 parentled Community Education Councils, which are largely advisory but also have the power to shape school zone boundaries. These education councils, known as CECs, add “a layer of democracy,” and “to the extent that members use their platform, it’s an extra set of eyes that represent the views of parents,” one former member told Chalkbeat. They have also become the forum for heated debates over changing admissions policies in attempts to integrate one of the country’s most segregated school systems, with a recent election push from both sides of the aisle to get their preferred candidates on the councils. So far, nine of the 36 parent councils have sent resolutions to the education department to approve hybrid meetings, according to school officials. The open meetings rule does not apply to parent-teacher association meetings. Those bodies can choose to have in-person, virtual or hybrid meetings, according to regulations the PEP passed in November. (And while many board meetings are returning to in person, parent-teacher conferences at schools will be remote this year.) Many online CEC meetings have not only been helpful for parents, SalasRamirez said, but educators also found it easier to attend meetings, allowing more collaboration between parents and teachers, said Salas-Ramirez, a former president of the education council in East Harlem’s District 4. Since their meetings moved online, anywhere from 60 to 250 people attended, she estimated. “In person, I kid you not, it’s five people,” she said. “Before, half of the parents didn’t even know what a CEC does. They didn’t know what a PEP does.” ‘A big undertaking’ The Citywide Council on Special Education, the advisory group representing families who have children with disabilities, voted to hold hybrid meetings in the hope that it will allow their community continued access to its meetings, said member Paullette Healy.
“Our families experience a multitude of challenges of having children with disabilities and/or being disabled themselves,” she said. “Because we are citywide, we have an added challenge of traveling to all five boroughs ... That has always posed an immense challenge with acquiring enough members to make quorum, and we did not reach many of our community by doing it in this fashion.” The council plans to hold its first hybrid meeting of the year on Sept. 29 at the education department’s Lower Manhattan headquarters, but Healy is concerned the group may run into some technical difficulties. They had issues trying to broadcast from the 19th-century building before and without “proper technology,” the issues may continue. Healy worries that other parent councils might run into similar challenges given the lack of support from the education department in terms of providing the technology or equipment needed for hybrid meetings, she said. “Many of us use our own personal equipment or are forced to use our minuscule budget to purchase,” Healy said. “We have discussed this with the DOE on many occasions to no avail.” Many of schools still lack reliable WiFi, and CECs — typically their administrative assistants — have to bring a slew of equipment, including laptops, microphones, hotspots, and headphones, to the school hosting the meeting and back to their district office. “It’s a big undertaking,” Healy said. Education department officials said they typically provide technical assistance to CECs for their town halls with the chancellor and are exploring future tech assistance based on need and resources. In Bedford Stuyvesant’s District 16, Community Education Council President NeQuan McLean would like for his members to offer hybrid meetings — he even pushed Albany for the option — but for now, they don’t feel like they have the capacity to do so. “This situation has caught us in a tight predicament,” McLean said. His CEC is among several that lack an administrative assistant — “because the salaries are so low,” he said — which means all of the work to set up meetings and create various documents in the required timeframe fall on him and other parent volunteers.
Loss of flexibility Holding in-person meetings is easier than offering hybrid ones, McLean said. You can simply hand out documents without also making a slideshow. You don’t have to monitor online comments, or choose which of the six members out of 11 have to show up in person. Also when meetings are online, they tend to run longer, which could be a problem for the in-person members who might need to travel home late at night. Yet, McLean worries that being only inperson will hinder participation, and he’s still hoping to go hybrid at some point. His CEC, too, saw upwards of 100 people at remote meetings compared to about 25 for past in-person meetings. But the cost to do it well is beyond their meager budget. “The proper way to do it: you need a camera that shows the dais, you have microphones for people to speak into and then feed that in,” McLean said. “We need at least $25,000 to buy the proper equipment.” For charter schools, which hold regular board meetings, the New York Charter Schools Association has spread the word to make sure schools were aware of the new requirements and ready to implement them, its executive director Yomika Bennett said. The emergency pandemic meeting rules allowing more flexibility resulted in much greater engagement and participation for the public, Bennett echoed. “We are disappointed by the loss of that flexibility in the law and the layers of new rules boards have to navigate,” she wrote in an email. “That said, we are grateful that the law preserves a video conferencing option. We will see what the ultimate impact of changes is and will seek any amendments to the law if needed.”l
Parents at a January 2020 Community Education Council meeting for District 28 in Queens. These parent-led volunteer councils now have to meet in person though they could opt for hybrid meetings. Christina Veiga/Chalkbeat
