Patient Previously Diagnosed with COVID-19 Now Coping with ‘Long COVID’
As COVID-19 continues to impact the world, health care professionals are finding more patients who were diagnosed with the illness but still are dealing with symptoms long after the initial infection has gone. This condition is sometimes referred to as “long COVID.”
Take for example, H. Russell Frisby Jr., a 69-year-old Maryland man who has had asthma nearly all his life, but has managed to remain active and rarely needed an inhaler. In March of this year, Frisby became extremely tired, started having trouble breathing and couldn’t stop coughing. He went to Howard County General Hospital, a Johns Hopkins Medicine affiliate, where he recorded a fever of 39 degrees Celsius (102 degrees Fahrenheit). Frisby was tested for COVID-19, and the result showed he was infected with SARS-CoV-2, the virus that causes the disease. A CT scan revealed that he also had lung scarring.
With treatment, Frisby began feeling better, and although still short of breath, he was discharged after five days in the hospital. One month later, however, Frisby’s breathing worsened and he was unable to do household chores without feeling winded. Follow-up tests for SARS-CoV-2 proved negative, but his shortness of breath and fatigue persisted.
Sarath Raju, M.D., M.P.H., an instructor of medicine at the Johns Hopkins University School of Medicine and a specialist in pulmonary medicine, is now caring for Frisby as an outpatient through the Johns Hopkins Post-Acute COVID-19 Team (PACT), a multidisciplinary group that helps patients after hospitalization for COVID-19 and treats any persistent symptoms. Through PACT, Frisby receives ongoing care from pulmonary and rehabilitation specialists who are supporting his long-term recovery.
Raju says Frisby’s recovery is challenging — he still experiences the residual effects of COVID-19 more than four months after being discharged from the hospital. With each day, Frisby continues to feel better, but he now needs an array of new therapies, including daily inhalers and an injectable medication to help with his breathing.
Frisby and Raju are available for media interviews to discuss long COVID, from both the patient and physician perspectives.
Herd Immunity Is a Dangerous Strategy for Fighting COVID-19, Says Johns Hopkins Expert
Herd immunity — when the prevalence of immunity to a virus in a population reaches “herd” levels (enough people are resistant to keep an epidemic from growing) — has been considered by some countries as a strategy to combat the current COVID-19 crisis. However, according to Stuart Ray, M.D., professor of medicine at the Johns Hopkins University School of Medicine, rushing toward herd immunity by ignoring risky behavior in the hope that infected people will survive, become resistant and reduce the susceptible population is an approach that will increase deaths and disability, and should be avoided.
“For a highly infectious virus like SARS-CoV-2 [the virus that causes COVID-19], the minimal level to reach herd immunity — where we’d expect newly infected people to pass the virus to less than one additional person — is thought to be about 60% of the population,” says Ray, noting that estimates of that level vary. “Even if testing positive for antibodies to the virus indicates that immunity gained will be more than temporary, we are probably far from that threshold.”
“In fact, in countries that have avoided lockdowns, masks and physical distancing, we have not seen evidence that any have achieved herd protection on a national scale,” he adds.
Take for example, Sweden, a major country that prominently tried herd immunity earlier this year as a national strategy. As part of the plan, Swedish officials allowed the following to remain operating without restrictions: restaurants, preschools and grade schools, public transportation, public parks, hair salons, yoga studios, gyms, malls, movie theaters and ski slopes. They did limit public gatherings to 50 or fewer people, closed high schools and universities, closed museums, cancelled public sporting events and banned visits to nursing homes. Social distancing, however, was voluntary.
The results of Sweden’s decision to attempt herd immunity were disappointing — and devastating. By the end of May 2020, the nation recorded nearly 41,000 COVID-19 cases resulting in more than 4,500 deaths in a population of 10 million, compared with Scandinavian neighbors Norway and Finland that counted fewer than 600 COVID-19 deaths combined. Anders Tegnell, Sweden’s state epidemiologist and architect of the herd immunity plan, admitted at a press conference in early June that “too many people had died too soon” as a consequence.
As for whether herd immunity could work as a strategy for the United States, the answer from Ray is an emphatic “no.” That is unless, he says, much more effective treatments are developed.
“The United States has a large vulnerable population; differing strategies at community, state and national levels for dealing with COVID-19; and a health care system with shortcomings and inequities, so it would be very difficult to reach the necessary level of immunity without an effective vaccine,” he says. “For example, the inconsistency in accessing COVID-19 testing in this country erodes safety and weakens confidence in what the results tell us. If you don’t know who’s infected, you can’t protect vulnerable people or determine who actually has immunity.”
Ray says the bigger question still needing an answer is whether SARS-CoV-2 infection yields long-term immunity.
“For herd immunity to work, prior exposure to SARS-CoV-2 has to prime the immune system to produce a strong response to all future contact with the virus, and in turn, make the person less infectious,” Ray explains. “We don’t know if that happens with this specific coronavirus.”
“It’s a shaky foundation on which to base a disease-fighting strategy that could fail and lead to ‘whack-a-mole’ outbreaks of COVID-19 for a long time,” he warns.
Ray is available to discuss herd immunity with the media.
More Than 100,000 COVID-19 Tests Performed by Johns Hopkins Medicine
Johns Hopkins Medicine is marking a milestone in its efforts to prevent the spread of COVID-19 by surpassing more than 100,000 detection tests performed.
Clinical microbiologists at the institution first developed the in-house screening test in March of this year. Since then, the Johns Hopkins Medicine microbiology lab has tested more than 100,000 patients — with more than 10,000 testing positive for the SARS-CoV-2, the virus that causes COVID-19.
In the lab, a team of about 90 staff members, including about 15 molecular microbiologists, work around the clock to process as many as 1,500 tests each day — a number that will soon double as the lab continues to add processing platforms, says Heba Mostafa, M.B.B.Ch., Ph.D., assistant professor of pathology at the Johns Hopkins University School of Medicine and co-developer of the Johns Hopkins COVID-19 test. The turnaround time for results is less than 24 hours — with a goal to reduce that time to 12 hours.
Johns Hopkins Medicine tests patients and employees with symptoms based on guidelines and criteria set by the U.S. Centers for Disease Control and Prevention and the Maryland health department. Asymptomatic patients who are admitted or will undergo surgery at health system hospitals and surgical centers also are tested.
Tests are conducted at the hospital and at designated outdoor sites on hospital campuses. Tests also have been performed in the community neighboring the Johns Hopkins medical campus in Baltimore, including at homeless shelters and nursing homes, and in the 21224 ZIP code, an area designated as a COVID-19 “hot spot.”
“There are dozens of people throughout the Johns Hopkins Health System at various sites collecting test samples,” says Karen Carroll, M.D., professor of pathology and director of the Division of Medical Microbiology at the Johns Hopkins University School of Medicine, and co-developer of the Johns Hopkins COVID-19 test. “We are all committed to ensuring we do our part to avert transmission of COVID-19.”
Mostafa and other staff members who conduct testing are available to discuss the 100,000-test milestone with the media.
Nursing Home Study Suggests Dialysis Patients at Greater Risk of SARS-CoV-2 Infection
It’s widely known that the causative agent for COVID-19, the SARS-CoV-2 virus, can spread rapidly among residents in nursing homes and other long-term care facilities, leading to high numbers of cases and deaths in a very vulnerable population. According to a new study led by researchers at Johns Hopkins Medicine, residents receiving hemodialysis for chronic kidney disease may be at even greater risk for infection from the virus.
The finding was reported in the Aug. 14, 2020, issue of the Morbidity and Mortality Weekly Report, published by the U.S. Centers for Disease Control and Prevention (CDC).
For their study, the researchers investigated an outbreak of COVID-19 that occurred in April 2020 in a 200-bed Maryland nursing home with an independently operated, on-site hemodialysis center. Of the 170 residents at the facility, 32 received dialysis treatment between April 16 and April 30. By the end of the study period, testing for exposure to SARS-CoV-2 was conducted on all but three of the residents (they refused and were counted as negative).
The researchers reported that 15 of the 32 residents (47%) on dialysis tested positive while only 22 of the other 138 residents (16%) did.
“Based on our results, we believe that nursing home residents undergoing dialysis are more likely than others in a facility to have repeated and prolonged exposures to the SARS-CoV-2 virus, and therefore may be at greater risk of infection and subsequent COVID-19,” says Benjamin Bigelow, a fourth-year medical student at the Johns Hopkins University School of Medicine and the study’s lead author.
“Our study suggests that to prevent COVID-19 outbreaks, nursing homes and dialysis centers need to maintain clear and constant communication to improve infection prevention practices throughout the process of transporting residents to dialysis and during the dialysis itself,” says Morgan Katz, M.D., M.H.S., assistant professor of medicine at the Johns Hopkins University School of Medicine and senior author of the study. “Residents who undergo dialysis should be carefully monitored, and testing prioritization must account for any contact with dialysis staff who may have been exposed to SARS-CoV-2.”
“Identifying cases early, along with aggressive infection prevention and control, are the keys to protecting those in nursing homes with chronic kidney disease and who are most at risk during the pandemic,” she adds.
Bigelow and Katz are available for interviews.
Will COVID-19 Survivors Require a Lung Transplant in the Future?
Although doctors are currently uncertain about the long-term effects of COVID-19 on the lungs of those who get the disease, they do know that patients who recover from an episode of severe acute respiratory distress syndrome (ARDS), a secondary condition that can be caused by infections like COVID-19, may not recover their full lung capacity.
There are rare cases of patients who develop severe ARDS, experience respiratory failure and are not able to come off a ventilator. In those situations, experts say they would consider a lung transplant if the patient is otherwise reasonably healthy.
“I suspect that some patients may develop longer-term pulmonary problems following COVID-19, but it is too early to know how common this might be and what the spectrum of those problems will be,” says Brian Garibaldi, M.D. associate professor of medicine at the Johns Hopkins University School of Medicine and director of the biocontainment unit at The Johns Hopkins Hospital.
Among the main symptoms seen in patients with COVID-19 are shortness of breath and coughing. If these symptoms persist or worsen after recovery from COVID-19, Garibaldi says that those may be warning signs of debilitating lung damage. Those patients, he explains, will likely require oxygen when exerting themselves and perhaps, even while at rest, to maintain safe levels.
It will be important, Garibaldi says, for all patients who have survived severe COVID-19 — and experienced severe ARDS requiring mechanical ventilation or high levels of oxygen — to schedule regular follow-up visits with their primary care physician or a pulmonary specialist so they can be evaluated for potential long-term problems. If necessary, treatment options, including a lung transplant, can be recommended.
At Johns Hopkins, two clinics are dedicated to following COVID-19 patients to help them through the recovery process and to better understand the potential long-term problems associated with the initial infection, the immune system response to the infection and the recovery phase in general.
Garibaldi is available for comment on the possibility of COVID-19 survivors requiring a lung transplant.