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COVID-19 plus other complications

BY: Dr Moses de Gaulle Dogbatsey
• The writer

If you have COVID-19, the illness that comes from infection with the recently discovered COVID-19, your symptoms may be relatively mild and manageable at home. That’s true for most people, but if you’re older or have another illness such as diabetes or heart disease, you’re more at risk for the serious form of COVID-19.

Some people — about one in six — will have complications, including some that are life-threatening. Many of these complications may be caused by a condition known as cytokine release syndrome or a cytokine storm. This is when an infection triggers your immune system to flood your bloodstream with inflammatory proteins called cytokines. They can kill tissues and damage your organs, including your lungs, heart and kidneys.

Respiratory failure

When you have acute respiratory failure, your lungs might not pump enough oxygen into your blood or might not take enough carbon dioxide out. Both of these problems can happen at the same time.

In one study of 68 Chinese people who died of COVID-19, acute respiratory failure was the leading cause of death.

Pneumonia

A spike in pneumonia cases was the first sign of the new coronavirus in China. When you have pneumonia, the air sacs in your lungs become inflamed, making it harder to breathe.

Scientists who have studied images of very ill COVID-19 patients’ lungs found them filled with fluid, pus and cell debris. In those cases, patients’ bodies weren’t able to transfer oxygen to the blood to keep their systems working properly.

Respiratory distress syndrome

Early in the outbreak of COVID-19 in China, Acute Respiratory Distress Syndrome (ARDS) was one of the most common complications.

With ARDS, the lungs are so severely damaged that fluid begins to leak into them. As a result, the body has trouble getting oxygen into the bloodstream. You may need mechanical help to breathe — such as a Ventilator — until your lungs recover.

Liver injury

Research shows that the most seriously ill patients run the greatest risk of liver damage. Scientists aren’t sure yet whether the virus harms the liver or if it happens for another reason.

Acute liver injury and Liver failure are life-threatening complications. (“Acute” means it happens suddenly.)

Cardiac injury

Studies of people in China who were hospitalised with COVID-19 found that some developed heart problems, including arrhythmias. Researchers studying people in Washington state who were very ill from COVID-19 and being treated in a hospital also found high levels of cardiac ailments. But it’s not clear whether the virus itself affected patients’ hearts, or if the damage happened simply because the illness caused such stress on their bodies overall.

COVID-19 also could cause cardiac problems that last long after people have recovered from the coronavirus infection. But since the illness is so new, that’s not clear yet.

Secondary infections

A secondary infection means that you get an infection unrelated to the first problem you had. In this case, it means someone with COVID-19 gets infected with something else.

A review of several studies done so far on hospitalised COVID-19 patients found that secondary infection is a possible — but not common — complication. Sometimes, a person fighting off, ­or recovering from, a virus gets infected by bacteria. Streptococcus and Staphylococcus are common culprits. This can be serious enough to raise the risk of death.

Kidney injury

This doesn’t seem to be a common complication, but if it happens, it’s serious. If your kidneys stop working properly, doctors will start treatment to stop the damage. You might get dialysis (in which a machine filters your blood) until your kidneys get back to working normally. But sometimes the damage doesn’t heal and people get chronic kidney disease which would need to be managed long term.

Septic shock

Septic shock happens when your body’s reaction to an infection misfires. The chemicals released into your bloodstream to battle the illness don’t trigger the right response and instead your organs are damaged. If the process isn’t stopped, you can go into what’s called septic shock. If your blood pressure drops too much, septic shock can be fatal.

Septic shock affected some people with COVID-19 in China.

Intravascular coagulation

When you have disseminated intravascular coagulation, or DIC, the body’s blood-clotting response doesn’t work right. Abnormal clots form, which can lead to internal bleeding or organ failure.

In one study of Chinese COVID-19 patients, DIC was common among those who died

Blood clots

A condition called disseminated intravascular coagulation (DIC) causes your body’s blood-clotting response to work differently than it should. Unusual clots form, which can lead to internal bleeding or organ failure. In one study of Chinese COVID-19 patients, DIC was common among those who died.

A Dutch study found that nearly a third of people who were in the intensive care unit (ICU) for COVID-19 had blood clots. Some were in patients’ legs (deep vein thrombosis or DVT), lungs (pulmonary embolism or PE), or arteries, but none of the patients had DIC.

Some researchers say the coronavirus may be causing a new clotting condition, COVID-19 associated coagulopathy (CAC). It’s marked by different protein levels in your blood than the ones caused by DIC.

Inflammatory syndrome in children

Some children and teens have been hospitalised with a condition called multi-system inflammatory syndrome in children (MIS-C) or pediatric multi-system inflammatory syndrome (PMIS). Doctors are still learning about it, but they think it’s linked to the new coronavirus. Symptoms include fever, belly pain, vomiting, diarrhoea, rash, headache and confusion. They’re similar to those of toxic shock syndrome or Kawasaki disease, which causes inflamed blood vessels in children

Some people who’ve had COVID-19 develop a condition similar to chronic fatigue syndrome. They may have a brain fog, severe fatigue, pain, trouble thinking or dizziness.

Rhabdomyolysis

This is an extremely rare condition, but it’s one COVID-19 researchers are watching. In rhabdomyolysis, your muscles break down and tissue dies. As cells fall apart, a protein called myoglobin floods your bloodstream. If your kidneys can’t flush it out of your blood quickly enough, it can overwhelm you and death awaits you.

At the onset of the COVID-19 pandemic, now-familiar symptoms such as diarrhoea and a loss of smell or taste hadn’t yet been confirmed. Now, they’re hallmark signs of the illness. Although we know much more about the novel coronavirus now than we did months ago, doctors are still discovering new side effects of infection, including hair loss and lingering fatigue. The latest discovery? Research points to a surprising link between COVID-19 and erectile dysfunction (ED), the inability to obtain and/or maintain an erection for satisfactory sexual function.

A review of research published earlier this year was the first to note a correlation between survivors of COVID-19 and ED, plus evidence of other sexual and reproductive issues in recovered men, both short- and long-term.

The virus causes your body to have a very strong [immune] response,” which can impact the cardiovascular system, circulation, and the heart, explains Anthony Harris, M.D., M.B.A., M.P.H., CIO and associate medical director for WorkCare.

Any major stressor can disrupt your normal hormone function, which can, in turn, “completely obliterate the libido,” says Amin Herati, M.D., director of male infertility and men’s health at the Brady Urological Institute and assistant professor of urology at Johns Hopkins University. Since COVID-19 infiltrates so many different parts of the body, from the skin to the brain, experts say it’s no surprise that ED could be a lingering effect, even post-recovery.

Erectile dysfunction has multiple origins

The causes of ED vary widely. Psychologically, there must be arousal; physiologically, the brain and body need to release the proper compounds to initiate an erection; and physically, the penis must be able to become erect.

Remember that strong immune response? Dr Harris says it also “affects your blood vessels, heart and lungs, and that impact can affect your erection.” (In this case, the driver might want to get moving, but the car won’t start.)

Long-term effect

COVID-19 attacks blood vessels, and symptoms caused by this complication of the virus have been well-documented over the past few months. Blood clots in the lungs, for example, can cause intense breathing issues, while clots closer to the skin’s surface can cause “COVID-19 toes.” If blood flow is weakened or blocked by COVID-19, ED could be one of the ways that underlying issue presents itself—after all, a healthy erection requires healthy blood flow.

And in a more general sense, weaker overall health caused or aggravated by the virus could also play a role. “Men with poor health are at greater risk for developing ED and also for having a severe reaction to COVID-19,” per the Cleveland Clinic. For instance, ED could point to underlying issues with the heart or circulation, especially when combined with COVID-19. If you’re barely getting enough blood to other parts of your body because of clotting or a weakened heart, achieving an erection will be difficult.

Mental health

Beyond the physical effects, the mental toll of recovering from the virus might play a role in suppressing libido. “There is a very strong association with [ED] and the psychological effects from COVID,” Dr Harris says. “We have to be aware of that.”

For certain people, recovery is not so simple. So-called “long-haulers,” or people who have technically recovered from COVID-19, but still experience long-term symptoms or side effects, could be particularly at risk for ED caused by psychological distress. Depression, anxiety, and fatigue can all destroy the sex drive, leading to reproductive issues.

Until COVID-19 has been around long enough to study its long-term effects, experts can’t be sure which symptoms are most likely to linger—or who is most at risk for prolonged illness.

But there is some hope. Testosterone levels often rebound to their normal levels once a temporary illness has passed. “To my knowledge, there is no data that says that COVID-19 affects the [structures of the penis],” Dr Herati says. With hormones replaced and blood vessels intact, ED could be a short-term issue.

Still, there is no guarantee. “I can give you a solid ‘I don’t know,’” Dr Harris says. “We don’t know how long these effects will last prospectively, but we’ve seen them last for three months, six months, or even longer.” Like with neurological and cardiovascular symptoms, there simply isn’t enough research yet to determine how long patients can expect ED to last after COVID-19.

COVID-19 vaccine

Whether or not COVID-19 directly causes ED, the two conditions are at least correlated. (Other adverse effects such as permanent lung damage, chronic fatigue and even death, however, are confirmed side effects of the illness.)

But it is crucial to note that there’s no evidence that the COVID-19 vaccine causes ED. Its side effects are akin to those of the annual flu shot, which is also encouraged by medical experts. Avoiding ED could be reason enough to seek out the vaccine. “This is why men should go get vaccinated,” Dr Harris says with a laugh. “It’s worth it.”

Talk to doctor

COVID-19 is a serious illness, and your first step should be addressing serious symptoms and side effects such as shortness of breath or heart problems. Compared to these complications, ED should hit the bottom of the priority list. (Keep in mind that when you’re sick, you might not be in the right mental state to maintain an erection either.)

The writer is a pharmacognosist, Chief Medical Officer and CEO of the Medi Moses Group of Companies