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A thread to expand upon the chronic and unusual presentations of COVID-19 that we need to further understand. Another reason why COVID-19 is not your usual influenza infection, even for those who are never hospitalized. 1/n
Unlike flu, where 90% report return to “usual health” with 2 weeks, 1 in 5 healthy young adults hadn’t returned to their baseline health after 2-3 weeks https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm via @CDCgov 2/n
This number almost 50% for those age >50, and those with co-morbidities. Those reporting “return to health” continued to report loss of smell, shortness of breath, cough, and fatigue. 3/n
We need more clinical research and a shift in expectations about return to work and possibility of ongoing impairments in some who have experienced COVID-19. Now understanding #COVID19 impacts brain, heart, vasculature etc in addition to the lungs 4/n
#COVID19 Brain? Fatigue may not just be tiredness. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30228-5/fulltext details headaches, limb pain and numbness, headache, mood change, and memory loss in many patients hospitalized for COVID-19 5/n
Compared to controls, patients 3 months after COVID-19 hospitalization had less grey matter volume in olfactory, cingulate, hippocampus, insula via MRI. No changes in white matter volume.
Several areas of the brain had much lower diffusion indices. 3 months AFTER #COVID19. 6/n
Several areas of the brain had much lower diffusion indices. 3 months AFTER #COVID19. 6/n
In this @TheLancet paper Lu et al. show us that when our patients tell us they still don’t feel right, it is possible that COVID-19 has changed their brain volume and function 7/n
#COVID19 Heart? In 100 patients with COVID-19 in Germany, 67 with asymptomatic or mild (outpatient) illness, 78% had abnormal cardiac MRs 2-3 months after infection. People recovering had lower ejection fractions and higher ventricular volumes and mass compared to controls 8/n
Late enhancement showed both ischemic and non-ischemic patterns, myocardial inflammation in 60%, some with ongoing pericardial inflammation or elevated cardiac biomarkers 2-3 months later! 9/n https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916
We need more long-term follow up data to understand how long cardiac, neurologic, and pulmonary complications persist and what proportion of patients with these have chronic deficits from COVID-19 infection. @MeaganWasfy @jasonwasfy @Payal_Patel @AndrewJSauer 10/n
We also need to understand whether antivirals and monoclonal antibodies avert some of these complications. And whether immunomodulator therapies improve or worsen them 11/n @PergamIC @GermHunterMD @CJohnston_MD @CarlosdelRio7
And we need resources, like cardiopulmonary rehab and clinics attuned to study and iterate care for people with long-term sequelae. Stroke only one aspect, but challenges of pandemic rehab outlined here. 12/n https://journals.lww.com/ajpmr/Abstract/9000/COVID_19_Ischemic_Strokes_as_an_Emerging.97926.aspx
Are we ready to focus on the post-infection phase for our patients? #WeAreID needs to keep this insight, but it's a multidisciplinary effort. Who's in #rheumtwitter #cardiotwitter #neurotwitter #pulm @uwpccm @IDSAInfo
