What are the long-term complications of COVID-19?

The prevalence of post-COVID-19 complications will become apparent but data from previous coronavirus outbreaks give us important information.

It is estimated that between 20% and 70% of survivors of the global SARS outbreak caused by SARS-CoV and the Middle East Respiratory Syndrome coronavirus (MERS-CoV) developed persistent symptoms from a range of organ dysfunction. It is envisaged that similar complications will be important sequelae of COVID-19.

Dr Anjani Prasad, one of our top consultants in respiratory and general medicine discusses the potential long-term complications of COVID-19 and describes the type of follow-up assessments he thinks all patients who have had the infection should be receiving.

Which organs might be affected in the long-term from COVID-19?

After combining data from the current and previous outbreaks, the likely organs affected after contracting COVID-19 are:

• Respiratory — 50-70% of patients might suffer from respiratory abnormalities; most commonly breathlessness, fatigue and chest heaviness. In addition, chest X-rays have remained abnormal and in some cases, patients may go on to develop fibrosis or scarring.
• Cardiac — 20-50% are expected to develop problems with the heart; most commonly palpitations on exercise, chest pain and tiredness.
• Kidney — 15% of patients may present with nausea and abnormal kidney function test.
• Brain — 15% may start to present with confusion, poor concentration and headaches.
• Blood clots — this is more likely in severe disease. The patient can present with breathlessness, chest pain and leg swelling.
• General wellbeing — 50-80% of patients may display symptoms that can affect their general wellbeing include fatigue, lethargy, tiredness and depression.

How should patients who have had COVID-19 be followed up?

People with ongoing symptoms will require an early assessment 4-6 weeks after being discharged by a respiratory physician. These patients may include those:

• with ongoing significant respiratory symptoms compared to normal
• who have been discharged with oxygen
• with acute rehabilitation, palliative care or psychosocial needs.

Patients with fewer symptoms should be followed up in 6-12 weeks.

Ideally, a remote or virtual consultation by a respiratory healthcare professional should be conducted in the first instance.

A face-to-face clinical assessment by a respiratory healthcare professional can then be arranged should a virtual consultation not be deemed sufficient or suitable to assess specific patients.

This appointment should include a post-COVID-19 holistic assessment which may include:

• Assessment and management of breathlessness
• Symptom or palliative care management when required
• Assessment and management of oxygen requirements
• Consideration of rehabilitation needs and onward referral if needed
• Psychosocial assessment and onward referral where required
• Assessment and management of anxiety

An assessment and management of dysfunctional breathing should be carried out, which can involve:

• Consideration of a new diagnosis of venous thromboembolic disease (VTE)
• A chest X-ray

What happens if there are ongoing symptoms?

If there are ongoing respiratory symptoms and/or the chest X-ray shows that the lungs have not cleared satisfactorily, then the following should be considered:

• Full pulmonary function testing
• Walk test with an assessment of oxygen saturation
• An echocardiogram to assess the heart
• Sputum sample if expectorating for microbiological analysis
• Assessing the need for referral to rehabilitation services if not already done
• A new diagnosis of pulmonary embolism (PE) or post-PE complications if diagnosed during acute illness
• A CT scan of the chest

Could long-term complications of COVID-19 last a lifetime?

This is certainly a possibility. The investigations mentioned above are to identify any long-term complications developing from a COVID-19 infection and are most commonly respiratory- and/or cardiac-related. Depending on the results, further assessment may be required if complications are discovered.

If complications are identified at an early stage, they will in most cases be treatable to a certain extent, which is why it’s important to get the appropriate assessments done promptly. Unfortunately, symptoms and disease can progress if they are left too late. Taking all this into account, it’s important to remember that the vast majority of patients with COVID-19 will recover back to normal with no lasting consequences.

If you have had COVID-19 and are concerned about any complications, you can discuss this with Dr Anjani Prasad by visiting his Top Doctors profile and booking a consultation with him.