Doctors look for reasons some COVID-19 patients develop post-recovery complications

Surviving COVID-19 — and leaving the hospital — isn’t always the end of the journey.

Crain’s interviewed several leading clinical specialists and researchers in Michigan who focus their care on patients most likely to have post-hospitalization complications from coronavirus.

Meilan Han, M.D., a critical care physician and professor of pulmonary disease at Michigan Medicine in Ann Arbor, said discharged patients are leaving the hospital with multiple other problems. “We are seeing patients having prolonged periods of not doing well” after recovering initially from COVID-19, Han said. “We don’t have tons of data yet and the information is anecdotal, but patients complain about persistent fatigue, malaise, lingering shortness of breath.” Han said patients sometimes have blood clots form in their lungs or legs either during hospitalization or after discharge, leading to the possibility of strokes.

Neurosurgeon Hazem Eltahawy, M.D., president of the Michigan Association of Neurological Surgeons, said some patients could face long-term neurological effects after a COVID-19 infection.

“There could be direct damage through thrombogenic effects (blood clots in the brain or lungs),” said Eltahawy, who also is chair of neurosurgery at St. Mary Mercy Hospital in Livonia. “It has been demonstrated that one of the significant reasons why this virus is so morbid is that it creates blood clots that are widespread and presents in multiple small vessels across the brain.”

Eltahawy said the clots could reduce blood flow and also create inflammatory reactions that could be severe enough to show up on imaging studies.

“The consequences could certainly leave a neurological mark on the central nervous system. The brain has limited ability to regenerate as opposed to other organs,” Eltahawy said. “Sometimes what is lost does not fully recover.”

Aditya Pandey, M.D., an associate professor of neurological surgery at Michigan Medicine, said some post-COVID-19 patients are coming back with stroke-like symptoms and other cerebrovascular complications.

Another possibility is people developing infections in the brain either caused by or associated with COVID-19.

“We don’t have any statistics yet or the downstream effects, but some people feel the hyperinflammation (with COVID-19) creates a propensity to form clots in the brain, or the legs and goes to the lungs that can lead to strokes,” he said.

Han said some people — after surviving COVID-19 in the intensive care unit on a ventilator — are developing what is similar to acute respiratory distress syndrome.

ARDS causes inflammation to the walls of the air sacs in the lungs that can make it difficult to breathe, limit the ability of red blood cells to deliver oxygen and possibly lead to pneumonia or asthma, Han said.

Patients can also develop sepsis, a general blood infection, because of inflammation in the body. Han said most pulmonologists believe COVID-19 patients who develop ARDS-like symptoms and lung damage should be treated as if they have acute respiratory distress syndrome. Treatment varies but usually includes oxygen, sedation, medication and fluids.

“Many of those patients are known to have significant lung function abnormalities that may persist for years. The data suggests five years, but not all have it,” Han said. “We’ll just have to see whether COVID tends to follow the same pattern.”