Post covid pulmonary experience.....

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Marcus Aurelius
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8:46p, 3/12/21
AG
So now we are hopefully on the back end of this thing. I thought I'd share my experience with the post covid survivors. They are flooding in now. I probably see 4 + a day in clinic now. From a lung standpoint- most common residual symptoms - dyspnea with exertion, pleuritic chest pain, difficult inspiration. Some coughers - though less frequent further out. Not much wheezing.

Those who require oxygen or further intense support in hospital are invariably still dyspneic, even with normal PFTs and CXR. Patients who survive a ventilator or BIPAP HFNC ( less than 20%) invariably have some residual CXR abnormalities. From frank fibrosis, traction bronchiectasis and honeycombing to milder basilar interstitial opacities.

Most common abnormal PFT I am seeing is decrements in DLCO. Mild restriction. More rare obstruction.

A good prognostic sign- if CXR abnormalities are clearing - those pts seem to be getting better. No surprise. The persistent fibrosis pts are not doing well. Prolonged O2 needs. Many disabled.

I have many with normal PFTs and CXR but a lot of dyspnea still. Not sure to do with those.

I have a partner putting many on prednisone. I prefer not to. No data and too many side effects. Not sure inhaled steroids are doing a whole lot for the long haulers either.

Anyway. Care is supportive. For now. A work in progress.
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Enrico Pallazzo
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9:21p, 3/12/21
Seeing any positive impacts from these long haulers getting vaccinated?
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bigtruckguy3500
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9:35p, 3/12/21
Do you think the DLCO increase with some restriction is epithelial granulation that may resolve over time? Or too early to tell?
Seeing any correlation to presentation by age?
What does your partner's prednisone course look like?
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Newoldarmy
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In reply to Marcus Aurelius • 6:55a, 3/13/21
AG
Thanks for the update.

Really looking forward to a full understanding of this thing. I had very mild disease, but three months in I can't shake the joint pain and occasional return of the headache, vertigo, and overall ill feeling of COVID. That's a distinct feeling that I'll know for the rest of my life.

I think I've possibly identified sugar as a trigger for relapse, but not sure. Looking forward to our bodies adjusting to this crap. I'm sure flu had all kinds of minor, weird effects on us and after thousands of years of dealing with it we just power through them now.
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Petrino1
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In reply to Enrico Pallazzo • 8:09a, 3/13/21
Fore Left! said:
Seeing any positive impacts from these long haulers getting vaccinated?


9.5 month covid long hauler here. For the past 9.5 months I've basically felt fine for 3-4 days, then symptoms return for 4-5 days. Every week, rinse and repeat lol. Typical flu/covid like symptoms: feeling feverish, hot feeling, chills, night sweats, ear ache, muscle aches and sores, fatigue, brain fog etc.

Ive seen stories on the reddit long hauler thread, and a lot of people experience symptoms for up to a year. It looks like around that year mark is when a lot of people start to feel a lot better. But Some are still experience symptoms after a year.

I received the Pfizer vaccine on Thursday, and so far so good. Haven't had any symptoms other than some muscle soreness, but that's going away as well. I'm hoping it stays like this. I've heard other long haulers feel better after the vaccine as well. Fingers crossed!
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Capitol Ag
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9:06a, 3/13/21
AG
So is the actual virus causing these long term conditions or is this a secondary effect brought on by the immune system or something else? This maybe a very poor example but like bronchitis after a cold?

Also, what ages and general health conditions are these patients in? Are they older, younger or all ages? Overweight or obese or all body types?
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bay fan
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In reply to Marcus Aurelius • 10:14a, 3/13/21
S
What percent of people seem to have these lasting consequences?
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bay fan
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In reply to Petrino1 • 10:17a, 3/13/21
S
ea1060 said:
Fore Left! said:
Seeing any positive impacts from these long haulers getting vaccinated?


9.5 month covid long hauler here. For the past 9.5 months I've basically felt fine for 3-4 days, then symptoms return for 4-5 days. Every week, rinse and repeat lol. Typical flu/covid like symptoms: feeling feverish, hot feeling, chills, night sweats, ear ache, muscle aches and sores, fatigue, brain fog etc.

Ive seen stories on the reddit long hauler thread, and a lot of people experience symptoms for up to a year. It looks like around that year mark is when a lot of people start to feel a lot better. But Some are still experience symptoms after a year.

I received the Pfizer vaccine on Thursday, and so far so good. Haven't had any symptoms other than some muscle soreness, but that's going away as well. I'm hoping it stays like this. I've heard other long haulers feel better after the vaccine as well. Fingers crossed!
Just curious but this has only been around for about a year....I hope that holds true for you and you are correct but it seems to me we don't really know yet.
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Petrino1
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In reply to bay fan • 10:35a, 3/13/21
bay fan said:
What percent of people seem to have these lasting consequences?


Ive read 10% of those with covid experience long term symptoms. Apparently it's happening with a lot of younger people as well. I'm a 35 yo male. In the covid long hauler sub reddit there's a lot of 18-40 year olds on there with long term symptoms.
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Petrino1
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In reply to bay fan • 10:36a, 3/13/21
bay fan said:
ea1060 said:
Fore Left! said:
Seeing any positive impacts from these long haulers getting vaccinated?


9.5 month covid long hauler here. For the past 9.5 months I've basically felt fine for 3-4 days, then symptoms return for 4-5 days. Every week, rinse and repeat lol. Typical flu/covid like symptoms: feeling feverish, hot feeling, chills, night sweats, ear ache, muscle aches and sores, fatigue, brain fog etc.

Ive seen stories on the reddit long hauler thread, and a lot of people experience symptoms for up to a year. It looks like around that year mark is when a lot of people start to feel a lot better. But Some are still experience symptoms after a year.

I received the Pfizer vaccine on Thursday, and so far so good. Haven't had any symptoms other than some muscle soreness, but that's going away as well. I'm hoping it stays like this. I've heard other long haulers feel better after the vaccine as well. Fingers crossed!
Just curious but this has only been around for about a year....I hope that holds true for you and you are correct but it seems to me we don't really know yet.


Yep, who knows lol. Maybe it never goes away.
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Kool
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4:53p, 3/13/21
AG
Marcus, I know it's early, but can you see anything that seems to be a risk factor in your patients that fall into this category??
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Marcus Aurelius
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5:02p, 3/13/21
AG
The vast minority of all people who get covid have long term pulmonary sequelae. However, all of our pts that have required ICU care and survived (20% of those admitted to ICU) have had some sort of respiratory decrement ongoing. The risk factors for this seem to mirror the same covid co-morbidities portending worsened outcomes (age, obesity, DM, HTM, renal disease, etc). I have many ICU survivors 6 mo + out still on O2, debilitated and sadly unable to work and have filed for disability.
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Marcus Aurelius
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In reply to bigtruckguy3500 • 5:11p, 3/13/21
AG
bigtruckguy3500 said:
Do you think the DLCO increase with some restriction is epithelial granulation that may resolve over time? Or too early to tell?
Seeing any correlation to presentation by age?
What does your partner's prednisone course look like?
DLCO is decreased in those pts (the ability of the alveoli to absorb O2. CO is used as a surrogate for O2 in the test as the affinity for CO diffusion across the alveoli to bind to Hg is extremely high.) So - the destruction of alveoli by inflammation and fibrosis from covid is what is driving this. For example - with emphysema - the sheer surface area of alveolar sacks is dramatically reduced which leads to severe DLCO reductions and hypoxia.

In my experience the worst pulmonary affected survivors are older. Seems the younger pts have more ability to bounce back.

He is using higher doses - up to 40mg daily. I have several on these type doses but trying to taper. For the more profound CXR persistent fibrosis, etc. Many pts "want to do something." Not sure it is helping and the side effects are tremendous.

BTW - for IPF (idiopathic pulmonary fibrosis) steroids have been shown to be detrimental actually.
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BBQ4Me
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7:05p, 3/13/21
AG
Is there a correlation between severity of COVID symptoms (while infectious) and severity of long-term complications?
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Marcus Aurelius
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In reply to BBQ4Me • 7:11p, 3/13/21
AG
Definitely it seems to me
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HotardAg07
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10:13p, 3/13/21
AG
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Cowbird
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11:40a, 3/14/21
AG
I feel like this is what I'm going through now. Got done with COVID around 6 weeks ago but still have trouble with shortness of breath and cough. Went to ER and CT scan showed "tree-in-bud" signs or aspiration pneumonia. Have you seen this in any of your patients. Still feel like crap.
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Marcus Aurelius
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In reply to Cowbird • 11:59a, 3/14/21
AG
Yes. And as i said - I have seen many pts with normal PFTs, CXR and exam with significant dyspnea, chest pain etc.
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Counterpoint
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4:58p, 3/14/21
AG
For the medical experts...does the science of the vaccine helping long haulers check out?
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superunknown
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In reply to Marcus Aurelius • 6:42p, 3/14/21
AG
Marcus Aurelius said:
The vast minority of all people who get covid have long term pulmonary sequelae. However, all of our pts that have required ICU care and survived (20% of those admitted to ICU) have had some sort of respiratory decrement ongoing. The risk factors for this seem to mirror the same covid co-morbidities portending worsened outcomes (age, obesity, DM, HTM, renal disease, etc). I have many ICU survivors 6 mo + out still on O2, debilitated and sadly unable to work and have filed for disability.


This seems to perfectly describe one of my employees, she was hospitalized for 5 weeks, most of that on bipap and in ICU. 60+, obese and diabetic. Frankly I was surprised she got well enough to go home so quick. And honestly, I don't expect her back at work. She was planning on retiring in a couple of years anyway. At some point she'll make some decision about going on short or long term disability.
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Kvetch
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9:03a, 3/15/21
AG
Have all the doctors here heard about Zyesami (aviptadil)? It is currently finishing up trials and the results should be released any day now. It is a synthetic version of vasoactive intestinal peptide that protects surfactant in the lungs. If it's approved, it will be the only drug approved specifically for the treatment of the critically ill with ARDS. They are also beginning an I-SPY trial for an inhaled version to treat these long haul type symptoms. The uses extend far beyond just COVID, though. Based on all the anecdotal stories I have seen of people requesting it for compassionate use, this is the only thing that really works. A man was just released from the hospital after 109 days after receiving treatment with it.

Full disclosure, I am invested in it and have been since August. However, I am only invested because I believe it the science behind it. I would be interested to hear the opinions of doctors on the matter.
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