A calamitous first wave of the Covid-19 pandemic ravaged the United States two years ago. It can be hard to recall the horror of the experience and, thanks to advances in diagnosis, treatment, and vaccination, it is unlikely to happen again. However, it is crucial for scientists to revisit that dark time and rethink what happened by analyzing the almost endless amounts of data collected in order to better understand both the immediate and long-term effects of this disease.
According to autopsy reports, one crucial piece of information was how the virus affected different organs.
Since so many deaths were caused by respiratory failure, many of my colleagues expected to find progressive pneumonia with lung destruction. A new discovery was made, however: blood clots in the lungs (also known as pulmonary emboli). In addition, countless additional small clots were found in numerous other organs. For simplicity, we will call them all clots (although experts distinguish between clot, thrombus, and embolus).
Following an important Nature Medicine article, these findings are especially timely. In a study conducted by the Veterans Affairs Department (VA), researchers examined more than 150,000 survivors of Covid-19 infections and compared them to millions of people who were similar to them in age, sex, and other factors but never developed Covid-19.
Moreover, they examined overall health not only immediately after the infection, but also a year later. Researchers used statistical methods to estimate the “post-Covid year” period for people who did not contract the infection. The researchers included Covid-19 survivors who didn’t require hospitalization (131,612), in addition to those who recovered after staying in an intensive care unit (5,388 people) or regular hospital ward (16,760 people).
Those who recovered from infection had many more blood clots, heart problems, and strokes compared with those who had not been infected with SARS-CoV-2. I have read many clinical studies, but this study has the greatest differences across the 20 different cardiovascular conditions. It is jaw-dropping.
The study tells us something we’re not fond of hearing, but it’s an essential piece of information for several reasons. Firstly, it will help those trying to understand long-term Covid; secondly, it will be useful in the prevention and treatment of people with active Covid-19 and those who have survived the disease; and thirdly, it likely will contribute to a better understanding of how clotting and anti-clotting work in the human body, which occurs every single day.
There are important limitations to the VA study. SARS-CoV-2 was likely transmitted by the wild strain of SARS-CoV-2 or perhaps by the Alpha variant, which dominated in late 2020, to individuals who became infected in 2020. Although it hasn’t been long enough to determine whether the same long-term dysfunctions of the blood vessels and heart will occur in survivors of Delta or Omicron variant infections, it appears likely. Two and three and 10 years after recovering from Covid-19, the study cannot predict how it will affect your health.
I believe this is the most pressing concern. There is no way to predict how long the cardiovascular abnormalities will persist or if they will disappear. Therefore, advising such a large group of people who have recovered from Covid-19 and may still have lingering health issues is quite challenging. Should everyone see a cardiologist? What about a specialist in blood clotting? Is long-term Covid-19 management likely to become a new subspecialty in the same way AIDS specialists emerged not so long ago?
Nearly 80 million Americans have been infected, so a cohesive health care plan is vital. Basic guidelines will be drawn up by experts to guide patients. Nevertheless, as in the field of AIDS medicine, much will be done by trial and error. For example, some people may be followed too closely, while others may not be followed enough. There will likely be a clear, straightforward “if this, then that” approach over time.
It would be nice to think that the simple and horrifying truths about the consequences of this disease could convince people who continue to refuse the Covid-19 vaccine or the booster shot. There has been no effect of facts and figures on the heart of the hesitancy so far.
The truth, though, is likely to be different this time (hope springs eternal). In an unspeakably tragic way, the pandemic and so many deaths came suddenly. Nevertheless, for those patients and families who have managed to stay Covid-free over the last two years, the fear of Covid and acute desire to protect themselves may have been dulled by time and the relatively mild symptoms that were widely reported in the last version of the concern.
Perhaps the VA researchers will do something that almost a million American deaths haven’t: incite fear among many vaccine-hesitant people to roll up their sleeves and get the vaccine.