En español | If you've been diagnosed with COVID-19, it's important to alert your primary care physician. That may seem like a given, but with the increase in public testing sites and the ability of people with a mild case of the disease to recover at home, it's understandable why some patients forget to fill in their doctor. Others may neglect to share the info if they are consumed with unrelated health issues or suffer memory loss. And “some people find it stigmatizing and worry that people will avoid them” because of their diagnosis, says Ronan Factora, a staff physician at the Center for Geriatric Medicine at the Cleveland Clinic.
But your doctor needs to know if you've had COVID-19 because it could affect your health risks in the future, experts say. Even after some people recover from the disease caused by the new coronavirus, they “are left with ongoing health problems, long-lasting symptoms or organ dysfunction,” says internist David Aronoff, director of the Division of Infectious Diseases at Vanderbilt University Medical Center in Nashville. A study involving 143 patients in Italy, for example, found that 87 percent of people reported at least one lingering symptom of the illness; 55 percent had three or more persistent symptoms (such as fatigue, difficulty breathing, joint pain and chest pain) after recovering from COVID-19.
And “for people who think they went through the disease unscathed,” Aronoff says, “we don't know if it impacts their risk for health problems later.” There's still a lot that doctors are learning about the new coronavirus, but several possible long-term repercussions are already on the radar screen.
Because severe COVID-19 is characterized by intense inflammation, a hyperactive immune response and markers of cardiac injury, doctors are concerned about the potential for long-term cardiac problems.
"COVID-19 can cause heart inflammation and heart failure — people can leave the hospital with new heart problems as a result of COVID-19,” Aronoff says. If you're predisposed to atrial fibrillation (AFib or AF), a quivering or irregular heartbeat, “it can worsen from infection with COVID-19,” he adds.
Granted, some of these risks aren't unique to COVID-19: Research has found, for example, that influenza can lead to complications such as myocarditis (inflammation of the heart muscle), heart attack and exacerbation of heart failure, while SARS (severe acute respiratory syndrome) has been linked to low blood pressure, heart rhythm abnormalities and heart attack.
What's different about COVID-19, however, is that people with the disease “have a propensity to develop blood clots — they can occur in the arteries and lead to heart attacks or strokes,” says Benjamin Singer, a pulmonary and critical care medicine specialist at Northwestern Memorial Hospital in Chicago. It's unclear how long that increased risk remains, Singer says, but if your doctor knows you've had COVID-19, he or she can better screen you for these cardiovascular conditions and possibly prescribe medications to protect your heart.
One of the biggest concerns after a severe respiratory infection like COVID-19 is whether it could lead to future lung problems. Aronoff points to COVID-19 patients who have had problems with blood clots in the lungs: “How long that risk remains isn't entirely clear,” he says. Given that a study in the February 2020 issue of Bone Research found that 35 percent of people who had SARS 15 years earlier have reduced lung capacity, experts are concerned that COVID-19 may inflict similar long-term damage.
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After severe illness from COVID-19, people can have exercise intolerance, including respiratory problems and exhaustion afterwards, notes neurologist Mitchell Elkind, a professor of neurology and epidemiology at Columbia University in New York and president of the American Heart Association (AHA). Be sure to tell your doctor about any breathing difficulties you have after COVID-19.
It's increasingly recognized that COVID-19 can affect brain health and functionality. The infection itself is often accompanied by neurological problems such as a loss of taste and smell, and it can affect cognitive function as well. In addition, “1 to 2 percent of patients hospitalized with COVID have strokes, primarily during infection, and some brain injuries may persist,” Elkind notes. “These could be manifested as persistent weakness or numbness, loss of vision, balance problems, cognitive impairment or dementia.”
Especially for people who were in intensive care with COVID-19, there may be an increased risk of cognitive dysfunction, potentially brought on by inflammation, exposure to medications that can interfere with brain function, and being in bed for weeks, Singer says. “The brain could atrophy to some extent just like the muscles can,” he adds.
Even if you weren't hospitalized with the infection, “if you're at risk for dementia or you already had some problems with dementia, those problems may get worse after COVID-19,” Aronoff says. That's why it's important for patients and their family members to keep their doctor in the loop about any cognitive changes experienced, post-COVID-19.
Particularly if you required life support in the intensive care unit, you may be at increased risk for depression, anxiety or post-traumatic stress disorder (PTSD).
"It's a life-threatening situation — you're not on a battlefield, but you're fighting for your life,” Singer says about surviving COVID-19. You're also experiencing the equivalent of solitary confinement to reduce the risk of exposing others to the virus. Even with powerful pain medications and calming sedatives, you may have been aware enough of the setting and the possible risks to your life that you can end up with PTSD-like flashbacks and frightening memories after recovering, Singer says.
If your doctor is aware of the severity of your COVID-19 infection, hospitalization experience and any lingering psychological symptoms, he or she can guide you toward appropriate help. “PTSD is a very serious condition, but it's also manageable with psychological therapy and sometimes medications,” Singer says.
Altered kidney function
Patients with COVID-19 can experience kidney problems during the course of their illness. “And while kidney function can return to normal following recovery, a return to baseline might take a long time, and the kidneys may remain vulnerable to injury even after that,” Aronoff says. These changes could result in decreased urine output, but they're more likely to be picked up with simple blood tests that measure creatinine and blood urea nitrogen (BUN).
If your doctor is aware of kidney problems that may be related to COVID-19, he or she may check these levels more often. In addition, “kidney problems can affect your ability to metabolize some medications and they can lead to more side effects, so you may need lower doses,” Factora says. You also may need to avoid certain drugs until your kidney function is back to 100 percent.
If you have residual symptoms that could be attributed to COVID-19, tell your primary care physician about them. These include: shortness of breath, a chronic cough, palpitations or a fluttering sensation in your chest, weakness or numbness, swelling in your legs, urinary problems, vision changes and difficulty concentrating.
"Knowing a patient had COVID-19 can help us assess whether new symptoms are a result of past COVID-19 infection,” Aronoff says.
As doctors learn more about the potential long-term consequences of COVID-19, the recommendations for screening measures and/or their frequency may change. In the meantime, if you've had COVID-19, you and your doctors should stay attuned to subtle changes that could affect your health and ability to function, both physically and cognitively.
"People are very concerned about the acute and long-term effects of the virus,” Elkind says. “It's important to share those concerns with your doctor.”