Scars of virus could cause life-long harm
One third of recovered patients could suffer fatigue, lung damage or psychological trauma
One in three patients who recovers from Covid-19 could be harmed for life, with long-term damage to their lungs, as well as chronic fatigue and psychological issues, research suggests. There is growing evidence that the virus may cause persistent or even permanent trauma, including impairment to the brain and an increased risk of Alzheimer’s disease. Around 30 per cent of patients who recover from Covid-19 may be left with damaged and scarred lung tissue.
ONE in three patients who recovers from Covid could be harmed for life, with long-term damage to their lungs, as well as chronic fatigue and psychological disturbances, research suggests.
Experts said there was growing evidence that the virus could cause persistent or even permanent trauma, including impairment to the brain and an increased risk of Alzheimer’s disease.
NHS guidance seen by The Daily Telegraph suggests that around 30 per cent of patients who recover from Covid-19 may be left with damaged and scarred lung tissue, if it follows patterns of similar diseases.
This could amount to around 100,000 of the 300,000 people who have so far tested positive for Covid-19 in the UK. Limited testing during the pandemic means the figure may be still higher. Some estimates suggest around 3.5 million people in the UK are likely to have been infected by Covid-19, meaning that many who suffered badly could be left facing long-term consequences.
In an interview with this newspaper, the head of the new NHS centre for Covid-19 recovery said she was worried about how little was known about how long the consequences could last.
Dr Hilary Floyd, clinical director at the NHS Seacole Centre in Surrey, said she had been shocked by how young many of its patients were. Healthy people who were in their 40s and 50s when the virus struck were now facing long-term fatigue and disability.
She said: “These are people who were independent, they might be running their own business, going to the gym, swimming, active – now they are at the point they can’t get out of bed.
“We have a couple of patients in their 40s at the moment; we really didn’t expect that. We were expecting them to be older, we have seen a lot in their 50s and 60s, who are really struggling, particularly because their expectation of getting back to normal is much greater.”
“They may always have some level of debilitation,” she warned.
The NHS guidance for GPS and community services warns that up to half of patients treated in intensive care units for the virus may be left with “persistent physical, cognitive and psychological impairments” including chronic fatigue.
So far, about 13,000 patients have received such treatment. And one in 10 of those discharged from hospitals in England after treatment for Covid-19 had been left with acute heart injury, it said.
Last month, the NHS opened its first hospital dedicated to helping Covid-19 patients recover from the long-term effects. Its clinical director said loss of mobility and chronic fatigue were two of the most common problems seen in patients who had come through Covid-19, with physiotherapy one of the main treatments for recovery.
In many cases fatigue and breathlessness were so severe that patients were only able to do 10 minutes of activity at a time, Dr Floyd said.
Many patients were also struggling to cope with the psychological impact from the changes to their health, she said. “There is a lot of anxiety.” For clinicians, the most frightening aspect is that so little is known about the longterm consequences of the virus.
“I think what is worrying is that there is so much we just don’t know,” Dr Floyd said. “We don’t know how long-term ‘long-term’ is. We don’t know if the generation who is in their 50s and 60s now will be much more frail or have an increased risk of dementia in 20 years’ time.”
The centre, based at Headley Court, formerly a military rehabilitation site, opened four weeks ago, and can treat up to 300 patients.
Prof Peter Openshaw, who sits on the Government’s New and Emerging Respiratory Virus Threats Advisory Group (Nervetag), said: “We are quite alarmed about the number of people needing follow-up treatment after being hospitalised. Many are suffering quite prolonged effects, particularly those who had severe disease.”
He said that intensive care
would normally take about a year to get back to full health, while some never do.
Prof Openshaw, an immunologist at Imperial College London, said there was particular concern about patients who suffer extensive blood clots, which can cut off blood supply to parts of the lungs, leading to a slow recovery.
Others were found to be suffering “chronic scarring pneumonia” due to inflammation of the lungs, he said.
He said long-term effects were only beginning to become clear, adding that he believed around one in 10 of patients hospitalised with the disease would have “quite persistent problems”.
The guidance issued by NHS England to primary care and community services suggests that almost one in three people who had Covid could suffer long-term damage if it follows patterns seen by similar viruses.
“Approximately 30 per cent of survivors of the global Sars outbreak caused by Sars-cov and the Middle East respiratory
‘We are alarmed about the number of people needing follow-up treatment after being hospitalised. Many are suffering prolonged effects’
syndrome coronavirus (Mers-cov) experienced persistent physiological impairment and abnormal radiology consistent with fibrotic lung disease. It is envisaged that pulmonary fibrosis [lung damage and scarring] is likely to be an important sequela/condition which is the consequence of Covid-19,” it states.
Health officials will next month launch a recovery programme for all patients who have suffered from Covid. The website will provide advice for anyone struggling to recover from the virus, track symptoms and direct those who need specific rehabilitation towards the right treatment.
The NHS guidance, called After-care needs of inpatients recovering from Covid-19, suggests that one in seven intensive-care cases could be left with long-term or permanent brain damage.
Seventy per cent of all such patients will suffer delirium, and in one in five cases, this will become “established
cognitive impairment”, it warns. Mild damage in brain functioning may be seen in about one quarter of patients, who have suffered acute respiratory distress, it says. And it warns that this in turn may increase the risk of degenerative diseases such as Alzheimer’s.
Experts are particularly concerned about the risk of prolonged fatigue, saying prompt treatment is needed to reduce the risk of long-term syndromes.
Dr Janet Scott, a post-viral sequelae [consequences] expert at the University of Glasgow-mrc Centre for Virus Research, said: “Forty per cent of those who have acute respiratory disease syndrome, which people with Covid-19 have been getting, have problems coping with daily activities afterwards.
“With Sars, a proportion had problems up to two years later.”
Dr Scott added: “Some will get post traumatic stress, anxiety or depression. Some chronic fatigue syndrome patient groups fear there will be a peak of ME.”
‘Some will get post traumatic stress, anxiety or depression. Some fear there will be a peak of ME’
But she said the lack of testing in hospitals had hindered efforts to establish the scale of long-term complications.
Lessons from other diseases suggested that long-term ill effects could be widespread, she suggested.
“Post-ebola, every survivor was impacted in some way and 70 per cent were left with a pain syndrome. Around 80 per cent had a moderate or severe disorder,” she said.
Prof John Hurst, professor of respiratory medicine at University College London, said that while the NHS had organised well to cope with the acute epidemic, there had been too little planning to respond to the long-term needs presented by Covid.
Prof Hurst, a member of the British Thoracic Society’s science and research committee, said: “We would expect that a proportion will go on to have lung fibrosis. What we want to do is identify them early but there is no central way of doing that. We are learning on the hoof.”