Long-Term Pulmonary Effects of COVID
From the Show: Highland Medical P.C.
Summary:
Air Date: 2/9/21
Duration: 10 Minutes
Dr. Joshpaul Jolly shares is insight on the long-term pulmonary effects of COVID.
Transcription:
Prakash Chandran: This Sound Advice COVID-19 podcast was recorded on January 29th, 2021.
Although most people who have contracted the coronavirus recover in full after a few weeks, some report lingering respiratory symptoms for a time after the recovery. We're going to talk about it today with Dr. Joshpaul Jolly, a pulmonologist at Highland Medical PC.
This is Sound Advice, the podcast from Highland Medical PC. I'm Prakash Chandran. So first of all, Dr. Jolly, it is great to have you here today. A lot of us have heard about the coughing and the shortness of breath if you contract COVID-19, but can you tell us specifically how COVID-19 affects the lungs?
Dr. Joshpaul Jolly: Yeah. Hi, Prakash. First of all, thanks for having me. So great question. It's a question I get asked a lot. The lung damage that occurs with COVID-19 is multifactorial. When we talk about the lung damage from COVID, I think it's important to understand a little about the components of the lung, of the normal lung, to allow us to understand different parts that can be affected and damaged, right?
So when we talk about the normal function of the lungs at its simplest form, we have blood vessels that carry red blood cells to the lung. Once they reach the lung, we have millions of tiny little air balloons. They're called alveoli. They participate in gas exchange when we breathe, allowing us to get oxygen into and carbon dioxide out of those red blood cells. So when we talk about COVID-19 and the damage that it causes in the lungs, it's a combination of things. It's a combination of toxicity from the virus itself, but also damage to the blood vessels that carry those red blood cells to the lungs and the body's immune response to the virus, leads to severe inflammation in those tiny air balloons called alveoli.
So how does this translate into symptoms? How is this important? Those that get sick from COVID with severe disease, respiratory and multiorgan failure, they're more likely to have persistent viremia, blood vessel damage leading to blood clots and severe inflammation of those alveoli, which can ultimately lead to stiff damaged lungs.
We still don't know who will get very sick from the virus and who will be less symptomatic. But we do know certain factors, things like older age, obesity, the underlying immune system of the patient and having comorbidities all play into determining how you'll fare from the disease. Pulmonary conditions, things like COPD, asthma, lung fibrosis, for example, can also all be worsened by COVID.
Prakash Chandran: Yeah, that's a really good explanation. But one of the things I wanted to dig into a little bit is if you have one of the comorbidities that you're talking about here, what are the long lasting effects that linger on after you contract cOVID-19? A lot of us have heard about the loss in taste and the potential loss in smell, but not necessarily a lot about those long lasting pulmonary effects afterwards. So, can you speak to that a little bit?
Dr. Joshpaul Jolly: Yeah. So this is something that we're all still actually learning about, right? SARS-CoV-2, the virus that causes COVID-19, has only been around for about a year. But some of that data is starting to come out now. There was a study recently that looked at patients hospitalized from COVID-19 that survived and they looked at those patients two months after and found that almost 50% of the patients still had difficulty breathing with shortness of breath.
And four months after they left the hospital, many patients still had symptoms, right? So what they did was they had these patients do what are called pulmonary function tests. That's a test that measures the ability to get air into and out of the lungs, measures lung expansion, measures the lung's ability to exchange gas. This is what we were talking about earlier with oxygen and carbon dioxide. So they looked at these patients and did pulmonary function tests on these patients.
A few of those patients couldn't do the test because they had such a difficult time breathing. But of those that completed the test more than half had impairment in the ability to exchange gas with 15% having severe impairment and these findings are pretty much consistent with other studies that have followed patients for short periods of time after recovery, right?
We know that inflammatory changes in the lungs have been found in COVID patients months after they've recovered with specific types of pneumonias found that have required further treatment. And when you extrapolate data, you look at other coronaviruses, things like SARS-1 and MERS, we know functional lung impairment could last for months to years in patients.
Prakash Chandran: So when we're talking about some of these after-effects or the damage that lingers on months or potentially years afterwards, can any of this be reversed?
Dr. Joshpaul Jolly: Great question. So I would say the short answer is it depends, right? If the lung damage is related to inflammation or even blood clots in the lungs, then yes, it is possible for the lungs to recover over time, right? Once that inflammation subsides or the blood clots dissolve, a lot of times with the assistance of medications, lung function might improve, although it's important to know that some of this will depend on the lung function to begin with, right? If the lung was damaged from a previous medical condition, it might not be as easy to recover, right? And, you know, if the lung damage is severe and that inflammation is long-standing, some of those patients can progress to lung fibrosis which unfortunately typically is permanent.
Prakash Chandran: So one of the things that we touched on earlier were these comorbidities like COPD or obesity that basically make matters worse because they exacerbate everything. But one of the things I was thinking about is there are a lot of people that smoke or vape and my sense is that also contributes to making matters much worse if you contract COVID-19, what are your thoughts on that?
Dr. Joshpaul Jolly: Sure. Your sense is right. Smoking and vaping can make things worse, right? There was a study that looked into the smoking history of patients who tested positive for COVID-19. They found that patients who had smoked more than a pack per day for 30 years, and this didn't have to be active smokers, these could be former smokers too, but the minimum smoking history of a pack per day for 30 years, those patients were two times more likely to be hospitalized from COVID and almost two times more likely to die from COVID compared with patients who had never smoked, right? And the thought is that these results might in fact underestimate the effect that smoking has on COVID.
When we talk about vaping, right, it's interesting. Young adults comprise a big chunk of individuals who vape. So while they may not always get sick enough to be hospitalized because they are in fact, commonly younger and otherwise healthier, studies have shown individuals who vape are five times more likely to contract COVID-19 compared with individuals who didn't. This is partly related to the habits that go along with vaping, right? You vape sometimes in group settings, where everyone is exposed to the aerosols or commonly use shared vapes and you pass them around. So that might be one of the explanations as to why that number is so high.
Prakash Chandran: Okay. So Dr. Jolly, if someone that is listening to this has contracted COVID recovered from it and is still experiencing these long-term effects that we're talking about, what is their best course of action?
Dr. Joshpaul Jolly: Yeah. You know, I think obviously one of the more important things is to make sure you follow up with your primary doctor. And if you have a pulmonologist, follow up with a pulmonologist, right? We don't have any special treatments for COVID long haulers, for example, patients that have persistent symptoms weeks or months after getting the disease, but we can try to optimize other conditions, right? So if you have underlying asthma or COPD, we can try to make sure we keep those conditions well-controlled as your body has it's time to recover.
Prakash Chandran: And, you know, one of the things that I always like to ask is how can we be proactive, especially if we have not contracted COVID-19 yet? As a pulmonologist, how would you recommend that we improve our respiratory health so we can be the most protected and avoid contracting this virus?
Dr. Joshpaul Jolly: Yeah. So this is a question I get asked a lot by patients, by friends, by family. Everything that you hear on TV, things like social distancing, avoiding large gatherings, washing hands, avoiding traveling if you can, they're all super important, right? They really will help you.
Wearing a mask, everyone has heard about wearing a mask, but there's another factor that, you may not always think about. Wearing a mask, decreases your risk of COVID, but it also decreases the risk of other respiratory viruses, right? Other winter viruses that we commonly see things like influenza or RSV or other common cold viruses.
So I think wearing a mask is really important this time, particularly this year. I would say when the vaccine becomes available to you, get vaccinated as soon as you're able to. I recommend that to everyone. We talked about smoking a little earlier. So if you smoke, now is probably the best time to stop. Smoking cessation will really help you. And then I think ultimately if you have an underlying medical condition, even if it's not a pulmonary condition like asthma or COPD, but it's something like diabetes or heart disease, make sure you follow up with your doctors and ensure you're doing everything you can to optimize those conditions.
Prakash Chandran: So one of the things that you mentioned was the importance of wearing a mask, not only for protecting yourself against COVID-19, but also protecting yourself from other diseases. But one of the things that I've heard is that if you're wearing a mask and you're potentially doing rigorous activities, or just exerting yourself a little bit more, that it can potentially not be good for your respiratory health. So what might you say to that?
Dr. Joshpaul Jolly: You know, I've had patients in my office telling me that they're unable to breathe with their mask on, patients that aren't doing rigorous activity, right? You know, I can say that while everyone is different and everyone has their own threshold for what they can tolerate, wearing a mask is completely safe. And if you're able to things with your mask on and not feel like, you know, you're suffocating, I would say absolutely wearing a mask is the best thing that you can do right now.
Prakash Chandran: So Dr. Jolly, one of the things that I wanted to ask you about as we close is just your thoughts on this whole pandemic, we have been in it for a little over a year now, at least since we first started hearing about those initial cases. And I think so many of us are just tired, right? We're tired of being quarantined. We're tired of just living this restricted life. And it feels like there's light at the end of the tunnel. It feels like the vaccines are rolling out and soon there'll be given to everyone, but will we really be back to normal then? So I think it's hard, you know. I think we're just all going a little bit crazy and I'd love to hear your thoughts around what you might say to all of us that are experiencing these feelings.
Dr. Joshpaul Jolly: Yeah. I hear it right. I think we all do. It's all driving us a little nuts but the light is at the end of the tunnel, right? And we're starting to see it. Do everything you can to keep yourselves and your family safe right now. The vaccine is starting to be ramped up. We're distributing it here in New York and everywhere else across the country. The numbers are increasing in terms of number of individuals getting vaccinated. Now is not the time to let that fatigue set in, right? Stay on top of it. Do all the things that you've been doing for the last year. We're going to get through this together.
Prakash Chandran: Well, Dr. Jolly, I think that is great advice and a perfect place to end. Thank you so much for your time today. That's Dr. Joshpaul Jolly, a pulmonologist at Highland Medical PC. Thanks for checking out this episode of Sound Advice. Call (866) 550-HMPC to make an appointment with Dr. Jolly or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.
Prakash Chandran: This Sound Advice COVID-19 podcast was recorded on January 29th, 2021.
Although most people who have contracted the coronavirus recover in full after a few weeks, some report lingering respiratory symptoms for a time after the recovery. We're going to talk about it today with Dr. Joshpaul Jolly, a pulmonologist at Highland Medical PC.
This is Sound Advice, the podcast from Highland Medical PC. I'm Prakash Chandran. So first of all, Dr. Jolly, it is great to have you here today. A lot of us have heard about the coughing and the shortness of breath if you contract COVID-19, but can you tell us specifically how COVID-19 affects the lungs?
Dr. Joshpaul Jolly: Yeah. Hi, Prakash. First of all, thanks for having me. So great question. It's a question I get asked a lot. The lung damage that occurs with COVID-19 is multifactorial. When we talk about the lung damage from COVID, I think it's important to understand a little about the components of the lung, of the normal lung, to allow us to understand different parts that can be affected and damaged, right?
So when we talk about the normal function of the lungs at its simplest form, we have blood vessels that carry red blood cells to the lung. Once they reach the lung, we have millions of tiny little air balloons. They're called alveoli. They participate in gas exchange when we breathe, allowing us to get oxygen into and carbon dioxide out of those red blood cells. So when we talk about COVID-19 and the damage that it causes in the lungs, it's a combination of things. It's a combination of toxicity from the virus itself, but also damage to the blood vessels that carry those red blood cells to the lungs and the body's immune response to the virus, leads to severe inflammation in those tiny air balloons called alveoli.
So how does this translate into symptoms? How is this important? Those that get sick from COVID with severe disease, respiratory and multiorgan failure, they're more likely to have persistent viremia, blood vessel damage leading to blood clots and severe inflammation of those alveoli, which can ultimately lead to stiff damaged lungs.
We still don't know who will get very sick from the virus and who will be less symptomatic. But we do know certain factors, things like older age, obesity, the underlying immune system of the patient and having comorbidities all play into determining how you'll fare from the disease. Pulmonary conditions, things like COPD, asthma, lung fibrosis, for example, can also all be worsened by COVID.
Prakash Chandran: Yeah, that's a really good explanation. But one of the things I wanted to dig into a little bit is if you have one of the comorbidities that you're talking about here, what are the long lasting effects that linger on after you contract cOVID-19? A lot of us have heard about the loss in taste and the potential loss in smell, but not necessarily a lot about those long lasting pulmonary effects afterwards. So, can you speak to that a little bit?
Dr. Joshpaul Jolly: Yeah. So this is something that we're all still actually learning about, right? SARS-CoV-2, the virus that causes COVID-19, has only been around for about a year. But some of that data is starting to come out now. There was a study recently that looked at patients hospitalized from COVID-19 that survived and they looked at those patients two months after and found that almost 50% of the patients still had difficulty breathing with shortness of breath.
And four months after they left the hospital, many patients still had symptoms, right? So what they did was they had these patients do what are called pulmonary function tests. That's a test that measures the ability to get air into and out of the lungs, measures lung expansion, measures the lung's ability to exchange gas. This is what we were talking about earlier with oxygen and carbon dioxide. So they looked at these patients and did pulmonary function tests on these patients.
A few of those patients couldn't do the test because they had such a difficult time breathing. But of those that completed the test more than half had impairment in the ability to exchange gas with 15% having severe impairment and these findings are pretty much consistent with other studies that have followed patients for short periods of time after recovery, right?
We know that inflammatory changes in the lungs have been found in COVID patients months after they've recovered with specific types of pneumonias found that have required further treatment. And when you extrapolate data, you look at other coronaviruses, things like SARS-1 and MERS, we know functional lung impairment could last for months to years in patients.
Prakash Chandran: So when we're talking about some of these after-effects or the damage that lingers on months or potentially years afterwards, can any of this be reversed?
Dr. Joshpaul Jolly: Great question. So I would say the short answer is it depends, right? If the lung damage is related to inflammation or even blood clots in the lungs, then yes, it is possible for the lungs to recover over time, right? Once that inflammation subsides or the blood clots dissolve, a lot of times with the assistance of medications, lung function might improve, although it's important to know that some of this will depend on the lung function to begin with, right? If the lung was damaged from a previous medical condition, it might not be as easy to recover, right? And, you know, if the lung damage is severe and that inflammation is long-standing, some of those patients can progress to lung fibrosis which unfortunately typically is permanent.
Prakash Chandran: So one of the things that we touched on earlier were these comorbidities like COPD or obesity that basically make matters worse because they exacerbate everything. But one of the things I was thinking about is there are a lot of people that smoke or vape and my sense is that also contributes to making matters much worse if you contract COVID-19, what are your thoughts on that?
Dr. Joshpaul Jolly: Sure. Your sense is right. Smoking and vaping can make things worse, right? There was a study that looked into the smoking history of patients who tested positive for COVID-19. They found that patients who had smoked more than a pack per day for 30 years, and this didn't have to be active smokers, these could be former smokers too, but the minimum smoking history of a pack per day for 30 years, those patients were two times more likely to be hospitalized from COVID and almost two times more likely to die from COVID compared with patients who had never smoked, right? And the thought is that these results might in fact underestimate the effect that smoking has on COVID.
When we talk about vaping, right, it's interesting. Young adults comprise a big chunk of individuals who vape. So while they may not always get sick enough to be hospitalized because they are in fact, commonly younger and otherwise healthier, studies have shown individuals who vape are five times more likely to contract COVID-19 compared with individuals who didn't. This is partly related to the habits that go along with vaping, right? You vape sometimes in group settings, where everyone is exposed to the aerosols or commonly use shared vapes and you pass them around. So that might be one of the explanations as to why that number is so high.
Prakash Chandran: Okay. So Dr. Jolly, if someone that is listening to this has contracted COVID recovered from it and is still experiencing these long-term effects that we're talking about, what is their best course of action?
Dr. Joshpaul Jolly: Yeah. You know, I think obviously one of the more important things is to make sure you follow up with your primary doctor. And if you have a pulmonologist, follow up with a pulmonologist, right? We don't have any special treatments for COVID long haulers, for example, patients that have persistent symptoms weeks or months after getting the disease, but we can try to optimize other conditions, right? So if you have underlying asthma or COPD, we can try to make sure we keep those conditions well-controlled as your body has it's time to recover.
Prakash Chandran: And, you know, one of the things that I always like to ask is how can we be proactive, especially if we have not contracted COVID-19 yet? As a pulmonologist, how would you recommend that we improve our respiratory health so we can be the most protected and avoid contracting this virus?
Dr. Joshpaul Jolly: Yeah. So this is a question I get asked a lot by patients, by friends, by family. Everything that you hear on TV, things like social distancing, avoiding large gatherings, washing hands, avoiding traveling if you can, they're all super important, right? They really will help you.
Wearing a mask, everyone has heard about wearing a mask, but there's another factor that, you may not always think about. Wearing a mask, decreases your risk of COVID, but it also decreases the risk of other respiratory viruses, right? Other winter viruses that we commonly see things like influenza or RSV or other common cold viruses.
So I think wearing a mask is really important this time, particularly this year. I would say when the vaccine becomes available to you, get vaccinated as soon as you're able to. I recommend that to everyone. We talked about smoking a little earlier. So if you smoke, now is probably the best time to stop. Smoking cessation will really help you. And then I think ultimately if you have an underlying medical condition, even if it's not a pulmonary condition like asthma or COPD, but it's something like diabetes or heart disease, make sure you follow up with your doctors and ensure you're doing everything you can to optimize those conditions.
Prakash Chandran: So one of the things that you mentioned was the importance of wearing a mask, not only for protecting yourself against COVID-19, but also protecting yourself from other diseases. But one of the things that I've heard is that if you're wearing a mask and you're potentially doing rigorous activities, or just exerting yourself a little bit more, that it can potentially not be good for your respiratory health. So what might you say to that?
Dr. Joshpaul Jolly: You know, I've had patients in my office telling me that they're unable to breathe with their mask on, patients that aren't doing rigorous activity, right? You know, I can say that while everyone is different and everyone has their own threshold for what they can tolerate, wearing a mask is completely safe. And if you're able to things with your mask on and not feel like, you know, you're suffocating, I would say absolutely wearing a mask is the best thing that you can do right now.
Prakash Chandran: So Dr. Jolly, one of the things that I wanted to ask you about as we close is just your thoughts on this whole pandemic, we have been in it for a little over a year now, at least since we first started hearing about those initial cases. And I think so many of us are just tired, right? We're tired of being quarantined. We're tired of just living this restricted life. And it feels like there's light at the end of the tunnel. It feels like the vaccines are rolling out and soon there'll be given to everyone, but will we really be back to normal then? So I think it's hard, you know. I think we're just all going a little bit crazy and I'd love to hear your thoughts around what you might say to all of us that are experiencing these feelings.
Dr. Joshpaul Jolly: Yeah. I hear it right. I think we all do. It's all driving us a little nuts but the light is at the end of the tunnel, right? And we're starting to see it. Do everything you can to keep yourselves and your family safe right now. The vaccine is starting to be ramped up. We're distributing it here in New York and everywhere else across the country. The numbers are increasing in terms of number of individuals getting vaccinated. Now is not the time to let that fatigue set in, right? Stay on top of it. Do all the things that you've been doing for the last year. We're going to get through this together.
Prakash Chandran: Well, Dr. Jolly, I think that is great advice and a perfect place to end. Thank you so much for your time today. That's Dr. Joshpaul Jolly, a pulmonologist at Highland Medical PC. Thanks for checking out this episode of Sound Advice. Call (866) 550-HMPC to make an appointment with Dr. Jolly or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.
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