From Scarred Lungs to Diabetes: How COVID May Stick With People Long-Term

From Scarred Lungs to Diabetes: How COVID May Stick With People Long-Term

Even though we are still in the early stages of the COVID-19 pandemic, scientists are trying to figure out the ways in which this disease may stick with people in the long term - from lasting lung damage to potentially triggering diseases like diabetes and Alzheimers.

 The COVID-19 pandemic is, well, it’s new. We’re less than a year in. So it might seem a bit early to talk about the long-term effects of SARS-CoV-2 infection. But we’re already starting to see the ways in which this disease may stick with people, from lasting damage to the lungs to potentially triggering diseases like diabetes and Alzheimer’s. So researchers are calling for vigilance — and more research into this virus’s enduring effects. 

Let’s start with the most obvious thing:

this virus is a respiratory virus, after all, which causes pneumonia —and that can leave some patients with weakened lungs. 

In fact, one study, published in March in the journal Radiology, looked at 70 COVID-19 patients and found that nearly all of them still had lung abnormalities when they were discharged from the hospital. This isn’t totally surprising, because other coronavirus diseases like SARS and MERS, as well as respiratory infections like the flu, can have lingering effects in our lungs. But studies are also finding similar damage in patients that had mild or no COVID symptoms. So, a lack of symptoms doesn’t guarantee a person won’t have lung damage from the virus. And here’s the real worry: this kind of lung damage can sometimes progress to pulmonary fibrosis, or scarring of the lungs.

 Scars in your lungs aren’t quite like scarson your skin. Generally, scars on your skin just give you something cool to talk about at parties. Lung scarring is a problem because scar tissue doesn’t do what lung tissue does. It can’t exchange oxygen and carbon dioxide efficiently. Plus, it’s not flexible, which your lungs need to be in order to whoosh air in and out of you. So fibrosis gets in the way of breathing, which can make normal activities really difficult. And, scars being scars, this can take a longtime to heal. 

We don’t know exactly how long yet because many people are still in the thick of it. But that suggests complete healing could take weeks, months, or longer. And, given, what we know from SARS and MERS,that makes sense. Like, one follow-up study of 36 MERS patients found evidence of fibrosis in 12 of them months after theinitial infection. And a study of 78 SARS patients found thatsome of them had lung lesions when they were infected in2003 that cleared up by the next year. But a few of them had lung damage show upin chest scans… in 2018. So it seems likely that some COVID patients,especially older ones, will face a lengthy recovery. And lung damage is just one of the reasonsfor that. Some doctors are also sounding the alarm about diabetes. 

Now, it might seem like diabetes and a lung infection have nothing in common. One is a dysregulation of how the body processessugars—the other, is a viral infection. But doctors keep seeing diabetes-like symptoms in people infected with the virus, both in patients with and without history of diabetes. Like, one case study, published in June, described a healthy patient in their 30s with no history of diabetes whopresented at the hospital with diabetic ketoacidosis, a condition causedby a lack of insulin. The patient tested positive for SARS-CoV-2— and doctors blamed the episode on the virus. In another report, doctors noted that theyfound higher levels of glucose and triglycerides in the bloodof patients with more severe cases of COVID-19. 

This marker, called TyG for short, doesn’tfor sure mean someone has diabetes, but it is tied to agreater risk. Researchers don’t know exactly why thisvirus would affect sugar metabolism, but cells in the pancreasdo have ACE2 receptors on them—the molecule that the SARS-CoV-2virus uses to get inside cells. So, it’s been speculated that the viruscould be damaging cells in the pancreas and interfering with insulinproduction. The big question, though, is whether thesepatients will have diabetes for the rest of their lives, or if symptomswill clear up once the virus is gone. And that’s an area of ongoing research. Similarly, doctors are seeing neurologicalsymptoms like headaches, confusion, and sensory disturbances poppingup days or even weeks after the initial COVID-19 symptoms, and it’snot clear if they’re short or long term, either. These may be occuring in one third to onehalf of hospitalized COVID patients, though, which is a lot. 

Some of these symptoms are almost definitelyside-effects from the inflammation the body uses to attackthe virus— and that could mean that, once the virus isousted and the immune system calms down, everything willgo back to normal. But neuroscientists say it’s also possiblethat inflammation reaching the brain will trigger or exacerbatethe kind of neuronal breakdown that occurs in neurodegenerativedisorders. So, people at risk of diseases like Alzheimer’sor already in early stages might end up with more sudden and severecognitive declines. Even more troubling is that there seems tobe increasing evidence that this virus can cross the blood-brainbarrier to infect and damage the brain directly. We know that some other coronaviruses canaccess our brains through the olfactory nerve. And the loss of taste and smell some patientsexperience with COVID-19 may be evidence of this virusdoing the same. And, if it can get into our brains that way,then it might be able to hide out there for months, years, or evendecades, only to flare up again. Though we definitely don’t know yet if thatwill end up being the case.

 At this point, we should emphasize that many people with COVID-19 have mild symptoms, or none at all. And most will likely make complete recoveries. But unfortunately, for some, this won’tbe the sort of thing that’s over in a of couple weeks. And it’s good to be aware of the potentialfor long-term effects, because some people will need care for a longtime to come—and we, as individuals and as a society, need to preparefor that. 

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