People who have had COVID-19 may be at greater risk of developing chronic conditions, according to a study published on April 22 by the journal Nature. Authors of two articles in the American Heart Association’s journal Circulation also warn of an onslaught of chronic conditions due to COVID-19.
In the study, “High-dimensional characterization of post-acute sequalae of COVID-19,” the researchers studied the U.S. Department of Veterans Affairs medical records of 73,000 people in the United States who were diagnosed with COVID-19 but didn’t require hospitalization.
They found that beyond the acute illness, these patients had a higher rate of health issues, including pulmonary and extrapulmonary organ systems.
In addition, the risk of death for these patients one to six months out from diagnosis was 60 percent higher than the risk for those who had not been diagnosed with COVID-19.
The patients suffered from respiratory system issues as well as nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain and anemia. Some of these issues could become chronic conditions, the study noted.
One of the authors of the study, Dr. Ziyad Al-Aly, chief of the research and development service at the VA St. Louis Health Care System, told the New York Times: “What was shocking about this when you put it all together was like ‘Oh my God,’ you see the scale. It’s still jarring, honestly.”
The authors noted in the abstract: “The results provide a roadmap to inform health system planning and development of multidisciplinary care strategies to reduce chronic health loss among COVID-19 survivors.’
Robert M. Califf, M.D., was not a part of the study published in Nature, but he also cautions about an onslaught of chronic conditions that could be possible due to COVID-19 cases. In his article, "Avoiding the Coming Tsunami of Common, Chronic Disease: What the Lessons of the COVID-19 Pandemic Can Teach Us," that appears in American Heart Association’s journal Circulation, Califf urges swift and comprehensive action to avoid the dramatic rise in chronic health conditions, particularly cardiometabolic disease, that are to be expected as a result of COVID-19. Three of the top 10 leading causes of death in the United States—cardiovascular disease, stroke and type 2 diabetes—are linked to cardiometabolic disease.
Califf is the head of clinical policy and strategy at Verily Life Sciences and Google Health, a former commissioner of the U.S. Food and Drug Administration, former vice chancellor for health data science at Duke University School of Medicine and the founding director of the Duke Clinical Research Institute.
He calls for critical shifts in the U.S. health care system to include universal health care, public health and research strategies that incorporate big data, and improved health data sharing that can inform more effective and efficient prevention and treatment protocols and programs across society.
Califf recommends more real time, in-depth tracking of chronic health conditions similar to the rapid data dashboards that were implemented to track COVID-19 cases, hospitalizations and deaths. With better information accessible more quickly, strategies to prevent and treat chronic health conditions can be measured and adapted accordingly.
Califf also proposes a new effort called Operation Warp Evidence, modeled after the rapid COVID-19 vaccine effort Operation Warp Speed, to be a speedy, prioritized clinical trial infrastructure that assesses the risks and benefits of new therapies compared to existing therapies for chronic health conditions. This would allow the vast pool of clinical trials to be more focused on immediate interventions that can improve prevention, care and outcomes.
In a second Circulation journal article, "Incremental Change versus Disruptive Transformation: COVID-19 and the Cardiovascular Community," author Nanette K. Wenger, M.D., FAHA, says that the U.S. has been experiencing three simultaneous pandemics: COVID-19, economic disruption and social injustice. She poses that the drive for COVID-19 research urgency to understand the disease, its course, treatments and vaccines opened the door for successful new public-private partnerships that realized rapid results and could be a model for future advancements.
Wenger is professor of medicine in the division of cardiology at Emory University School of Medicine, consultant to the Emory Heart and Vascular Center, founding consultant to the Emory Women's Heart Center and director of the Cardiac Clinics and Ambulatory Electrocardiographic Laboratory at Grady Memorial Hospital in Atlanta.
Health registries that were implemented quickly to track COVID-19 patients could be expanded to include cardiovascular disease measures, treatment and outcomes, particularly since many unknowns still exist about long-haul COVID and lasting cardiovascular effects, she suggests.
The disproportionate COVID-19 death rates in African American, Hispanic/Latino, American Indian/Alaska Native and Pacific Islander communities this past year brought to light social injustice and its correlation to poorer health outcomes, she writes.
Wenger writes; "The convergence of all of these issues, their impact on cardiovascular disease and care, presents unique opportunities for transformation in cardiovascular medicine, clinical care and research. We must remain focused and flexible during this unprecedented time to maximize innovation and achieve equity for all."