What Steps Can Individuals Take to Assess Their Risk for Long-Term COVID Lung Problems? This is what experts say

Several studies suggest that COVID-19 may induce persistent lung scarring reminiscent of idiopathic pulmonary fibrosis, a chronic lung condition. This lingering lung damage could lead to a progressive decline in patients’ respiratory function over time. Scientists now explore the crucial question: What Clues Can Predict Long-Term COVID Lung Problems?

Researchers at UVA Health have uncovered a potential breakthrough in predicting outcomes for severe COVID-19 patients, differentiating between those likely to recover well and those susceptible to “long-haul” lung complications. This discovery holds promise for tailoring treatments to individual patients.

Moreover, the study by UVA sheds light on a crucial aspect: dispelling fears of severe COVID-19 triggering relentless lung scarring akin to idiopathic pulmonary fibrosis, a chronic lung ailment. Such continuous lung damage could deteriorate patients’ respiratory capacity over time.

Dr. Catherine A. Bonham, MD, a leading expert in pulmonary and critical care at UVA Health’s Interstitial Lung Disease Program, expressed optimism: “We are excited to find that people with long-haul COVID have an immune system that is totally different from people who have lung scarring that doesn’t stop. This offers hope that even patients with the worst COVID do not have progressive scarring of the lung that leads to death.”

Long COVID or Post-COVID

Months after surviving severe COVID-19, up to 30% of hospitalized patients continue to grapple with lingering symptoms. Among these, lung scarring emerges as a prevalent concern, observed both early in hospitalization and up to six months post-illness, according to prior research. Dr. Bonham and her research team sought to delve deeper into the mechanisms behind this scarring, examining parallels with progressive pulmonary fibrosis and exploring avenues for identifying at-risk patients.

Their study tracked 16 survivors of severe COVID-19 from UVA Health, 14 of whom had required ventilator support during hospitalization. At their initial outpatient follow-up, all patients reported ongoing breathing difficulties, fatigue, and abnormal lung function.

Six months later, the team discovered distinct trajectories among the patients: one group experienced improved lung health, termed “early resolvers,” while the other group, termed “late resolvers,” continued to battle lung issues and pulmonary fibrosis.

Analysis of blood samples taken prior to divergence in patient outcomes revealed a significant discrepancy in circulating immune cells, specifically monocytes, between the two groups. Monocytes, vital for disease defense, were notably depleted in patients experiencing prolonged symptoms compared to both those who recovered and healthy controls.

Moreover, the decline in monocyte levels correlated with the severity of ongoing symptoms, suggesting a potential avenue for early identification of long-haulers using a straightforward blood test.

This indicates that doctors may use a simple blood test to identify patients who are likely to become long-haul drivers—and enhance their treatment.

“About half of the patients we examined,” Bonham added, “still had lingering, bothersome symptoms and abnormal tests after six months.

“We were able to detect differences in their blood from the first visit, with fewer blood monocytes mapping to lower lung function.”

The researchers also sought to know whether severe COVID-19 may result in progressive lung scarring, as seen in idiopathic pulmonary fibrosis. They discovered that the two situations had extremely distinct impacts on immune cells, suggesting that although the symptoms were identical, the underlying reasons were highly different. This was true even for those with the most severe long-term COVID-19 symptoms.

“Idiopathic pulmonary fibrosis is progressive and kills patients within three to five years,” according to Bonham. “It was a relief to see that all our COVID patients, even those with long-haul symptoms, were not similar.”

Due to the limited number of participants in UVA’s study, predominantly male to facilitate comparison with IPF, they stress the necessity of broader, multi-center studies to validate their findings. However, they remain optimistic that their groundbreaking discovery will equip doctors with a valuable tool to identify COVID-19 patients prone to long-term lung complications and steer them towards recovery.

“We are only beginning to understand the biology of how the immune system impacts pulmonary fibrosis,” added Bonham. “My team and I were humbled and grateful to work with the outstanding patients who made this study possible.”

The work was published in the journal Frontiers in Immunology.

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