Long-term Follow-up Needed to Understand Effects When COVID-19 Lingers, Fauci Says

Profound fatigue. Shortness of breath. Muscle aches. Sporadic fevers. And an inability to concentrate that patients describe as “brain fog.”

These are just some of the symptoms that Anthony S. Fauci, MD, the nation’s best-known expert on infectious disease, said up to a third of people will live with for weeks or months after contracting coronavirus disease 2019 (COVID-19). About 80% of those who test positive for COVID-19 have mild to moderate symptoms, with the rest having severe symptoms. But moderate symptoms can still leave a person with lingering effects, Fauci told the specialists gathered at the American Heart Association Scientific Sessions on Tuesday.

Fauci, now serving his sixth US president as director of the National Institute of Allergy and Infectious Diseases, kicked off a symposium on COVID-19 and cardiovascular health with his talk, “COVID-19: Public Health and Scientific Challenges,” which traced where the SARS-CoV-2 virus fits in the framework of coronaviruses that experts have battled in recent decades, and how it has exploded across the globe with such potent ferocity.

“Here we are now with a global pandemic of historic proportions, the likes of which we have not seen in the last 102 years since the now-iconic outbreak of the pandemic of 1918,” he said. “Currently, there are close to 50 million cases with 1.2 million deaths worldwide. In the United States, we have been hit the hardest of any other country with close to 10 million cases.”

Heart disease specialists are doing some of the most important work studying COVID-19’s effects, as they treat patients most at risk of severe disease, then track what happens to them afterward. It’s clear that although age offers the biggest risk factor for severe illness from COVID-19, certain chronic conditions are equally dangerous.

“Paramount among this is obesity, and chronic obstructive pulmonary disease, as well as other conditions such as chronic heart conditions and hypertension,” Fauci said. Being overweight, but not obese, still confers some risk.

COVID-19 damages organ systems and causes cardiovascular complications, including thromboembolic phenomena and cardiomyopathies. “If you look at the manifestations of severe COVID-19, they are plentiful.” Fauci said. “I mentioned the cardiac ones, but there is also acute respiratory distress syndrome. There is kidney injury, neurological injury, a hypercoagulable state manifested by microthrombosis in small vessels and acute thrombotic phenomenon, sometimes seen in otherwise well, young individuals.”

The multisystem inflammatory syndrome, seen in some children, is manifesting itself in many ways. Fauci highlighted several cardiology papers in reviewing the pandemic’s fallout in less obvious ways. He pointed to a German study that appeared in JAMA Cardiology, in which MRI found signs of myocardial inflammation in 78 of 100 patients recovered from COVID-19.

“This needs to be repeated in other labs and followed up,” Fauci said. “But if it’s true, it’s something we need long-term follow-up on, because this may be clinically inconsequential, or it could lead to chronic effects.”

Another study of Ohio State University athletes found myocarditis in 15%, which may be linked to SARS-CoV-2 exposure, he said.

The racial and ethnic disparities revealed in COVID-19 are “quite serious.” COVID-19 hospitalization rates are 3 to 4 times higher among Black and Latino populations compared with Whites, Fauci said, due to higher rates of comorbidities but also due to the types of jobs that minority workers tend to hold.

Good news in therapeutics—including remdesivir and dexamethasone, which now appear in clinical guidelines—as well as rapid progress in vaccines offer hope, he said. Fauci appeared as news comes that both Pfizer and Moderna have messenger RNA vaccines that report efficacy rates of 90% or higher. More vaccines using different technologies are in the pipeline. Of great importance, he said, companies involved in Operation Warp Speed have adopted a common data and safety monitoring board and common end points to give the FDA and other government officials the ability “to bridge one study to another.”

But despite the progress, Fauci’s frustration with the failure to use basic public health tools was obvious. Later in the day, he would say in an interview that he should have tried harder to “push the envelope” on mass COVID-19 testing early in the pandemic. He told a STAT forum that he raised the issue but his advice was not needed.

The basics—wearing masks or cloth coverings, social distancing, avoiding crowds, conducting activities outdoors when possible, and hand-washing—would still work if adhered to, “universally and consistently across the country.”