The relationship between vaccination and autism spectrum disorder

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“Pulmonary sequelae in recovered COVID-19 patients.”

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Miami Regional University

ENC 2201: Report Writing and Research Methods

Uliana Gancea, PhD

December 13, 2020

Abstract

Background: The pulmonary sequelae seen in patients recovered for COVID-19. In March of 2020, when the pandemic of COVID-19 was declared, there has been more than 11,000,000 cases and a non-determined number of pulmonary sequelae due to the recent outbreak and few studies about it. Objective: To determine if there is a correlation between the COVID-19 and subsequent pulmonary sequelae. Method: In this study, a meta-analysis of the bibliography in virtual libraries and databases were used. From the full text presented, only focused on lung sequelae were chosen. Results: Many reports showed a high percentage of patients with persistent abnormalities three months after recovery. Conclusions: COVID-19 produces damage in many systems; the respiratory been the most affected. The injuries resulting has different grades of severity, from Pulmonary Fibrosis, Acute Lung Injury (ALI) to Acute Respiratory Distress Syndrome (ARDS). Recommendation: It is recommended that further research be done to determine what type of treatment and respiratory therapies would allow for a faster recovery and a lower chance of pulmonary sequelae.

Keywords: COVID-19, SARS-CoV-2, Pulmonary sequelae, SARS. 

Pulmonary sequelae in recovered COVID-19 patients

On March 11, 2020, there have been over 11,136,253 cases and 232,639 deaths in the United States, according to the Centers for Disease Control. On that day, the World Health Organization (WHO) declared a worldwide pandemic caused by the SARS-CoV-2 virus, which became known as COVID-19. This virus affects the respiratory system of its host, causing damage that can be long-lasting. It has been seen that once COVID-19 patients recovered from the illness, they presented with lung damage. So far, the magnitude of the pulmonary sequelae in this disease has not been clarified. This study aims to determine the relationship between pulmonary sequelae and COVID-19.

Literature Review

The study from Zhao et al. (2020) follows the effects of COVID-19 in patients three months after recovery. Fifty-five survivors were tested using tomography of the thorax and antibody screening, and their results were compared. Additional radiologic data were collected and used as another means to determine lung function. It was determined that symptoms related to the infection and lung function impairment persisted. This study had a limitation that only 55 patients that were not critical were studied, which does not allow for the results' generalizability.

            The study conducted by Huang et al. (2020) followed 57 patients of COVID-19 during the first early stages of recuperation. The study showed that 75.4% of the cohort had an abnormal pulmonary function. More than half of the patients also showed lowered diffusion capacity, which indicates the gas exchange's ability to occur within the lungs. Given that the COVID-19 pandemic is so recent, information from similar viruses can be used to determine what possible outcomes patients can expect. The study completed by Zhang et al. (2020) studied the rehabilitation of pulmonary fibrosis caused by SARS-CoV in 71 patients over the period from 2003-2018. The study showed that the most recovery from pulmonary lesions occurred within the first two years after infection, with a plateau in recovery for the rest of the study. This study shows the possibility that COVID-19 patients that are showing pulmonary fibrosis damage post-infection can still recover.

            A recent study by Rogliani et al. (2020) supports that patients with mild to moderate forms of the COVID-19 infection do not have a risk of developing pulmonary fibroids. This research was conducted by testing their lungs with a high-resolution tomography during hospitalization and a follow-up checkup. This study does show the limitation of small sample size and a brief time observation period, which might affect the data collected. The study conducted by Salehi and partners (2020) shows that although there has not been enough time for the sequelae left from COVID-19 to become completely clear, there have been obvious pulmonary concerns apparent during the post-recovery period. The authors mention that long-term follow-up of surviving patients of COVID-19 is needed to determine the full extent of the alveolar and gas exchange damage that can be left behind. Zhu et al. (2020) analyzed chest CT images from 72 asymptomatic COVID-19 patients. Patients were classified as under 60 years and over 60 years, finding that the older ones had extensive lesions in the pulmonary lobes and thickening of the pleura or subpleural line. They concluded that these lesions could be related to the evolution and prognosis of COVID-19.

Method

The method used in this study was Meta-analysis of the bibliography found in virtual libraries and databases. The libraries EBSCOhost and LIRN were searched using keywords such as COVID-19, Pulmonary sequelae, and SARS. From the list of possible texts presented, only full texts focused on lung sequelae were chosen. The publishing journals were reviewed to discern if any possible bias could be found in the articles. Due to the short time of evolution of the pandemic, a concise bibliography was available to consult. Since the 20 works found in the search, only seven could be used since the remaining works did not meet the criteria used.

Results

Pulmonary sequelae in recovered COVID-19 patients
Article	results
Zhao et al. (2020)	“Fifty-five recovered patients in the study”: 36 (65.45%) of them had a different degree of the radiologic abnormality. “Of all the subjects, 47-55 patients tested positive for SARS-COV-2 IgG” that was stronger in females than males.
Huang et al. (2020)	Fifty-seven patients studied; 31 patients (54.3%) had abnormal CT findings.
Salehi et al. (2020)	“Organizing pneumonia and diffuse alveolar damage are the most common forms of lung injury. The ground-glass opacities (GGO) are usually seen during the initial stages. The lesions' pattern can progress of pure consolidation or present the melted sugar sign to the parenchymal band in the later stages of the disease and complicate the recovery phase.”
Zhang et al. (2020)	“The pulmonary CT scans of the 71 SARS patients showed that 27” (38.1%) “patients exhibited ground-glass opacities or cord-like consolidations during the 15-year follow-up. Two patients” (2.81%) “had no abnormalities on their pulmonary CT scans. We calculated the percentage of area with lesions on two sections of the CT scan and analyzed the overall variations in the proportion of lung area with lesions in 27 patients”.
Zhu et al. (2020)	“Characteristic CT findings included the lobes of bilateral lung extensively involved, sometimes accompanied by interlobular septal thickening, and subpleural line and pleural thickening. (Fig.1-5)”
Rogliani et al. (2020)	From 109 hospitalized patients, 27 was included in the study because they had Hight Resolution Computerized Tomography (HRCT) at admission and follow up. 11.11% had “Acute Respiratory Distress Syndrome (ARDS)”; 37.04% with “Acute Lung Injury (ALI)”; and33.33% had a normal pulmonary function ratio.

FIGURE 1: A 57-year-old woman who presented with fever for 4 days. A, CT shows multiple ground-glass opacities (GGO) distributed in the peripheral area and GGO with consolidation in the lower lobes (arrow). B, GGO with vacuolar sign in the upper tongue segment of the left lung (white arrow) and GGO with interlobular septal thickening in the right inferior lobe (black arrow) (Zhu et. al, 2020).

FIGURE 2: A 57-year-old man who presented with fever and fatigue for 7 days. CT scan shows GGO with streak consolidation (white arrow) and subpleural line in the lower left lung (black arrow) (Zhu et. al, 2020).

FIGURE 3: A 43-year-old woman who presented with dry cough for 2 days. CT scan shows a rounded, peripheral GGO with slight consolidation in the right lower lobe (arrow) (Zhu et. al, 2020).

FIGURE 4: A 41-year-old man who presented with fever for 3 days. CT shows GGO with consolidation (white arrow) in the right lower lobe, accompanied by air bronchogram (black arrow) (Zhu et. al, 2020).

FIGURE 5: A 61-year-old man who presented with fever and cough for 12 days. CT scan shows GGO distributed around the periphery with a reticular pattern or honeycombing changes (arrows) (Zhu et. al, 2020).

Discussion

Previous studies indicated that symptoms such as fatigue, dyspnea, cough, among others, in patients in recovery and up to months after the acute illness. However, the most severe complications were, among others, pulmonary such as “acute respiratory distress syndrome (ARDS), acute lung injury (ALI), and pulmonary fibrosis” (Zhao et al., 2020). SARS-CoV-2 enters the cell through ACE2 receptors, which could cause acute systemic inflammatory responses and a cytokine storm (Zhao et al., 2020)”, with the consequent death of the cell and fibrotic tissue repair. According to the study's data, we can infer that the survivors of COVID-19 will present some degree of sequelae, the respiratory ones being the most symptomatic.

Limitation and Implication

The main limitation of this study is the short amount of time of evolution of the COVID-19 disease. This has brought many implications to the completion of this project. First, it restricted the number of subjects available for research of the topic due to the virus's deadly nature. Additionally, given the short period of the pandemic, the ability to determine the long-term effects of this infection in patients recovering is not possible without making predictions that might or might not come to pass.

Conclusion

It has been shown that COVID-19 produces damage many of the body's systems, but mostly the respiratory system. These injuries present most commonly in, ALI (acute lung injury), Pulmonary fibrosis, and ARDS (acute respiratory distress syndrome), which damage the lungs' ability to function correctly. These results consider the short development time of the COVID-19 pandemic and the implication that a short number of reference sources were available for review. As such, further research could be done to determine what type of treatment and respiratory therapy would allow for a faster recovery and a lower chance of pulmonary sequelae following COVID-19 infection.

References

Huang, Y, Tan, C., Wu, J, et al. (2020) Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respiratory Research. 21(1):163. https://doi:10.1186/s12931-020-01429-6external icon

Rogliani, P., Calzetta, L., Coppola, A., Puxeddu, E., Sergiacomi, G., D'Amato, D. & Orlacchio, A. (2020). Are there pulmonary sequelae in patients recovering from COVID-19? Respiratory Research, 21, 286. DOI: 10.1186/s12931-020-01550-6

Salehi, S. MD, Reddy, S. MD & Gholamrezanezhad, A. MD. (2020, July) Journal of Thoracic Imaging, 35(4) pW87-W89. https://doi:10.1097/RTI.0000000000000534

Zhang, P., Li, J., Liu, H. et al. (2020). Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Res 8, 8. https://doi:10.1038/s41413-020-0084-5

Zhao, Y.M., Shang, Y.M., Song, W.B., et al. (2020) Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine, 25. https://doi.org/10.1016/j.eclinm.2020.100463

Zhu, T MD, Ph.D.; Wang, Y. MD; Zhou, S. MD, Ph.D.; Zhang, N. PhD; Xia, L. MD, Ph.D. (2020, July). A comparative study of Chest Computed Tomography features in young and older adults with Corona Virus Disease (COVID-19). Journal of Thoracic Imaging, 35 (4) p W97 – W101. https://doi:10.1097/RTI.0000000000000513.