Some COVID-19 patients later plagued with ‘aftereffects’

THE ASAHI SHIMBUN

August 29, 2020 at 07:00 JST
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Asahi Shimbun
More than three months after testing positive for the novel coronavirus, a teenage male student in Chiba
Prefecture still is experiencing symptoms.

As of mid-July, he still felt lethargic and had a persistent fever, headache and chest pain, and occasionally
developed a rash.
“I thought the symptoms would disappear in around two weeks after I tested negative for the virus,” he
said. “I’m worried that this might continue forever.”
After testing positive, he had to wait 20 days at home before being admitted to a hospital since there were
no beds available. He was discharged from the hospital about two weeks later and stayed at a hotel and his
home to recuperate.

But he was hospitalized again in June as his condition did not improve. He returned home after being
released from a hospital but sees a doctor when his symptoms worsen.

He said he aims to return to school in autumn, but he is not sure whether he will be fit enough to do so.

The teen is among many people who contracted the novel coronavirus and continue to experience fatigue,
difficulty in breathing and other symptoms even after they were deemed to have recovered.

Although little is known about long-term effects of COVID-19, many suspected cases of “aftereffects” have
been reported both in and outside Japan. The health ministry decided to launch a study on the matter
from August.

More than seven months have passed since the spread of viral pneumonia from an unknown cause was
reported in the Chinese city of Wuhan. The long-term effects of the novel coronavirus remain unknown
since it is still a new disease, but reports of its aftereffects have surfaced around the globe.

On Twitter, some users posted messages with the hashtag “corona aftereffects,” complaining of an
intermittent fever, dizziness, fatigue and an impaired sense of taste and smell.

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A group of doctors at a hospital in Italy published results of its study on 143 patients who were discharged
from the hospital after recovering from COVID-19 in the Journal of the American Medical Association in
July. The study found that nearly 90 percent of them still had some symptoms.

The patients were asked about their conditions two months on average after they developed symptoms.
Eighty-seven percent said they are suffering from one or more symptoms, such as fatigue and difficulty in
breathing.

The most common symptom was fatigue with 53 percent of them saying they felt it, followed by difficulty
in breathing with 43 percent, joint pain with 27 percent and chest pain with 22 percent.

Some of the patients complained of a cough and an impaired sense of smell. Fifty-five percent said they
have three or more symptoms.

“The study involved only a small number of patients at one hospital,” said one of the doctors. “We need to
keep monitoring the long-term effects of COVID-19 on patients after they are discharged from a hospital.”

According to local media, the Italian Respiratory Society also reported in May that 30 percent of COVID-
19 patients who recovered from the disease could suffer from aftereffects.

The report is based on data on severe acute respiratory syndrome (SARS), which is caused by another type
of coronavirus, and COVID-19 cases in Italy. Survivors of the novel coronavirus have a risk of aftereffects
on their lungs for at least six months, the report said.

SERIOUSLY ILL PATIENTS HAVE SEVERE LUNG DAMAGE

Researchers have long pointed out that COVID-19 damages survivors’ lungs. A group of doctors at a
hospital in Wuhan reported that many ground-glass opacities were found in CT scan images of lungs of
patients who were hospitalized for COVID-19 between January and February and later discharged.

In June, another group of doctors at a hospital in Guangzhou, China, published its findings on the lung
functioning of 110 COVID-19 patients who were released from the hospital, excluding those with serious
symptoms, in the European Respiratory Journal.

The results showed about 47 percent of the patients had abnormalities in their lung functioning and
roughly 25 percent could only take in a small amount of air in their lungs despite having normal blood
oxygen levels when they left the hospital.

The more severe the patients’ symptoms, the more serious the damage to their lungs, said the doctors.

According to Yasuhiro Setoguchi, a specially appointed professor of respiratory medicine at Tokyo

Medical and Dental University, some patients who recovered after becoming seriously ill said that they
run out of breath climbing stairs and that hampers their efforts to return to society.

Fibrosis of the lungs is thought to be the cause of such impaired lung functioning.

When a virus infection triggers the cytokine storm, in which immune reactions to infections run out of
control, the walls of tiny bags in lungs, called air sacs, become damaged. According to Setoguchi, air sacs
try to repair the damage, but they cannot completely recover from it, becoming fibrotic.

Air sacs let the air in and out by expanding and contracting. Having many fibrotic air sacs makes it
difficult for lungs to expand like inflating a thick rubber balloon, said Setoguchi.

The aftereffects of COVID-19 are not limited to damage to lungs.

Masamitsu Sanui heads the intensive care unit at Jichi Medical University Saitama Medical Center. He
said patients who were admitted to an ICU after developing serious pneumonia can, in general,
experience reduced cognitive functioning, including memory and attention, or develop depression or
post-traumatic stress disorder (PTSD) in addition to decline in lung functioning. 

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One published study found that about 20 percent of patients who suffered from acute respiratory distress
syndrome (ARDS), which is caused by serious pneumonia and other factors, became depressed one to two
years after their recovery, said Sanui.

ARDS can also occur after COVID-19 patients develop severe pneumonia. A combination of factors,
including the cytokine storm, impaired consciousness called delirium and hypoxia, is believed to
contribute to the development of depression after recovery from ARDS.

“The novel coronavirus can also cause similar aftereffects,” said Sanui. “(COVID-19 patients with serious
pneumonia) tend to require long hospitalization in an ICU, so we need to pay more attention to such
cases.”

GOVERNMENT TO STUDY AFTEREFFECTS OF COVID-19

Reports of suspected aftereffects prompted the health ministry to start a study on the long-term effects of
COVID-19 on some 2,000 patients who recovered from it from August.

The ministry will collect data from 1,000 moderate to serious patients on their subjective symptoms and
lung functioning at two times: three months and six months after they were discharged from hospitals.

It will also survey 1,000 mild to moderate patients about their symptoms persisting after being released
from hospitals and conduct blood tests on them.

The ministry has recently set up a research team and plans to continue the study until March next year to
help develop measures to prevent the aftereffects and treatment for the symptoms.

(This article was written by Hiromi Kumai, Hajime Mikami and Roku Goda.)

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