Medical imaging shows the true scope of long-term effects caused by COVID-19

LOS ANGELES - Radiological images from researchers at Northwestern University detailed the various types of long-term effects of COVID-19 including rheumatoid arthritis flares, autoimmune myositis or "COVID toes," and more.

In a study published on Feb. 17 in the journal Skeletal Radiology, the collections of images included ultrasounds, x-rays, MRIs, and CT scans which confirmed and illustrated the causes of various COVID-19 symptoms. 

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"We’ve realized that the COVID virus can trigger the body to attack itself in different ways, which may lead to rheumatological issues that require lifelong management," said corresponding author Dr. Swati Deshmukh.

Researchers say they hope the use of these images will allow radiologists to successfully suggest a COVID-19 diagnosis based on musculoskeletal imaging, which uses x-rays to diagnose injuries and diseases using medical images of bones, joints, and other soft tissues.

"Many patients with COVID-related musculoskeletal disorders recover, but for some individuals, their symptoms become serious, are deeply concerning to the patient or impact their quality of life, which leads them to seek medical attention and imaging," said Deshmukh, an assistant professor of musculoskeletal radiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine musculoskeletal radiologist. "That imaging allows us to see if COVID-related muscle and joint pain, for example, are not just body aches similar to what we see from the flu — but something more insidious." 

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Currently, several symptoms identified in the study are not recognized by the U.S. Centers for Disease Control and Prevention.

Symptoms like "COVID toes" and "rheumatoid arthritis" aren’t listed on the CDC’s website detailing long-term effects of the coronavirus.

According to the CDC, the most commonly reported long-term symptoms include:

• Fatigue
• Shortness of breath
• Cough
• Joint pain
• Chest pain

Other reported long-term symptoms include:

• Difficulty with thinking and concentration (sometimes referred to as "brain fog")
• Depression
• Muscle pain
• Headache
• Intermittent fever
• Fast-beating or pounding heart (also known as heart palpitations)

More serious long-term complications appear to be less common but have been reported. These have been noted to affect different organ systems in the body. These include:

• Cardiovascular: inflammation of the heart muscle
• Respiratory: lung function abnormalities
• Renal: acute kidney injury
• Dermatologic: rash, hair loss
• Neurological: smell and taste problems, sleep issues, difficulty with concentration, memory problems
• Psychiatric: depression, anxiety, changes in mood

The medical images presented by Northwestern researchers present a clearer picture of the devastating long-term effects of COVID-19 that still baffle medical experts more than a year after the onset of the pandemic.

Outside of the study, many others have reported long-term symptoms as well. Since the first reported cases of COVID-19, several support groups have emerged on Facebook consisting of thousands of members calling themselves "long haul survivors."

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"Today is day 93," said Amy Watson, a preschool teacher who lives in Portland, Oregon as she shared a photograph of her thermometer that read 100.3 on June 18, 2020. She first tested positive for COVID-19 on April 11, 2020 after falling ill with flu-like symptoms in mid-March. 

On Sept. 15., Watson posted an update of her condition on Facebook writing "Six months. 185 days. I still have a fever."

"I also have a diagnosis: post-viral dysautonomia. My autonomic nervous system (ANS) was damaged by COVID-19. This controls things like breathing, heart function, digestion, perspiration, temperature regulation, and vision. I have brain damage," Watson wrote including a flurry of other long term and devastating symptoms.

She and many other "long haul survivors" are confused and frustrated and have said many medical workers who have treated them have been left with their hands in the air after their symptoms did not seem to subside.
 
The CDC said, "While most persons with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness."

But the CDC’s list still doesn’t cover certain byproducts of the coronavirus identified by other researchers.
 
According to a study from the National Institutes of Health, researchers found evidence to suggest that brain damage may be a product of COVID-19. Researchers uncovered blood vessel damage and inflammation in the brains of 19 deceased COVID-19 patients.

"We found that the brains of patients who contract infection from SARS-CoV-2 may be susceptible to microvascular blood vessel damage. Our results suggest that this may be caused by the body’s inflammatory response to the virus" said Avindra Nath, M.D., clinical director at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS).

Nath, the senior author of the study, added that while COVID-19 is most commonly known to be a respiratory illness, he hopes this study will help the medical community recognize the scope of complications that can arise out of contracting the deadly coronavirus.

 "We hope these results will help doctors understand the full spectrum of problems patients may suffer so that we can come up with better treatments," Nath said.

Current indications are that up to 30% of patients continue to have significant problems that intrude on daily life two to three weeks after testing positive. Perhaps as many as 10% are still afflicted three to six months later, according to Dr. Wesley Self, a Vanderbilt University emergency physician and researcher who co-wrote a July report from the CDC.

Long-term COVID-19 care has been launched in settings ranging from big research hospitals like New York’s Mount Sinai, which has over 1,600 patients, to St. John’s Well Child and Family Center, a network of community clinics in south Los Angeles.
 
There’s no proven cure for long-term COVID problems, but clinics aim to offer relief, not least by giving patients somewhere to turn if their usual doctor can’t help.

"We wanted to create a place that patients could get answers or feel heard," even if there are still unanswered questions, said Dr. Denyse Lutchmansingh, the clinical lead physician at Yale Medicine’s Post-COVID Recovery Program.

At the Jamaica Hospital Medical Center, in New York, a clinic specifically for post-COVID-19 care, patients get mental health assessments, a lung specialist’s attention and physical exams that delve deeper than most into their lifestyles, personal circumstances and sources of stress. Several hundred people have been treated so far, according to Dr. Alan Roth, who oversees the clinic.
 
The idea is to help patients "build their own healing capacity," said Dr. Wayne Jonas, former director of the National Institutes of Health’s Office of Alternative Medicine. He is now with the Samueli Foundation, a California-based nonprofit that works with the hospital on marrying alternative ideas with conventional medicine.

The long-haulers get exercise and diet plans and group or individual mental health sessions. Recommendations for supplements, breathing exercises and meditation are also likely. That’s in addition to any prescriptions, referrals or primary care follow-ups that are deemed necessary.

"We’re not just saying, ‘It’s all in your head, and we’re going to throw herbs and spices at you,’" Roth said. With no tidy, proven answer for the complex of symptoms, "we do a common-sense approach and take the best of what’s out there to treat these people."

The Associated Press contributed to this story.