Dear Salvatore Saiu

https://theconversation.com/how-are-the-most-serious-covid-19-cases-treated-and-does-the-coronavirus-cause-lasting-damage-134398

Hi

Please check the following work. It describes the matters in details. I believe it will help you.

https://theconversation.com/how-are-the-most-serious-covid-19-cases-treated-and-does-the-coronavirus-cause-lasting-damage-134398

Regards

Salvatore Saiu

In ICU, various treatments can support these more serious breathing problems. This includes high-flow humidified oxygen, delivered via a nasal mask. The oxygen is warmed and its humidity artificially increased so as to avoid uncomfortable dryness. It is gently pumped into the lungs at a comfortable rate that still allows the patient to speak and eat.

If breathing worsens further, the patient is then intubated. This involves inserting a tube through the mouth and into the windpipe, through which oxygen is delivered via a ventilator. Intubated patients need to be sedated (kept asleep) until their lungs recover enough to work without assistance.

In the most severe cases, where the lungs fail and it is not possible to deliver enough oxygen by ventilator, patients are given extracorporeal membrane oxygenation, which effectively outsources the work normally done by the heart and lungs to an external machine. Blood is carried from the body, and carbon dioxide removed and oxygen added, before it returns to the patient’s circulation. This is the most advanced form of life support, but also carries the highest risks and the longest recovery times.

There is no data on the long-term effects of COVID-19. But we can look at the after-effects of other acute viral respiratory diseases such as influenza, SARS and Middle East respiratory syndrome (MERS).

In these diseases, collectively called acute respiratory distress syndromes (ARDS), the fragile small airways and air sacs become damaged by inflammation, can become blocked by fluid and blood, and are replaced by scar tissue as they heal. This can stiffen the lungs – at first from fluid and then from scar tissue – impairing their ability to transfer oxygen and making breathing more laboured. In SARS and MERS this damage appears to occur as the virus is being destroyed by the immune response.

Although there is still a shortage of data. The perminant damage associated with sever covid-19 disease are: lung scarring,Lung blockage, blood clotting and stroke embolisms.

Dear Dr. Salvatore Saiu , unfortunately, for survivors of severe COVID-19, beating the virus is just the beginning as you can read in this recent article https://www.sciencemag.org/news/2020/04/survivors-severe-covid-19-beating-virus-just-beginning#

Dear Prof. Daniele Porcheddu , Thank you very much for your valuable comments.

Best regards

Salvatore Saiu

Dear Najlaa Saadi Ismael I totally agree, in fact, as you observed there is still a shortage of data.

As Covid 19 leads to pnemonia ,frequent increase in oxygen demand and lack of oxygen supply to the vital organs leads to brain damage and life long complications.

You can find the WHO guideline for clinical management interesting..

Hi, dear Dr. Salvatore Saiu

when patients have chronic lung failure Like what happens in covid-19, they frequently have failure or dysfunction of their other organs, such as the kidney, heart, and brain.

From my opinion and experience the main problem is in oxygen delivery. In some recent investigations, virus attacks hemoglobin and produces disorders in oxygen delivery, tissue hypoxia, high levels of ferritin and D-dimers (but without signs of PE). These increased levels last for the weeks after recovery. On the other side, we had some strange observation that, despite to hypoxia, all of those patients had low levels of serum lactate. Finally, we have problems with lungs (ARDS - like problems) and with coagulation. Some patients had coagulation problems no matter if they received usual or higher doses of LMWH. Secondly, neurological disorders might be connected with virus attack on nicotine receptors (investigations of French and Italian authors) and some astonishingly data, that approx. only 5 – 6% of patients in ICU were smokers! Blockade of nicotine receptors in nervous system preserved those patients from serious complications (momentary investigation in France with nicotine sticking plasters).

lung involvement

Covid with stroke leaves focal deficit and neuro sequlae.

Covid with ards leaves lung fibrosis

Covid with ageusia and anosmia may be irreversible

Covid with sepsis can lead to MODS which can lead to persistant organ dysfunction, particularly kidney and lung.

Time will unfold the frequency and severity

Follow up is the key to detect

Hi, dear Dr. Salvatore Saiu

From my opinion and experience the main problem is ICUAW and functional problems that remains after recovery of pulmonary function test and oxygenation

of course until now