Here's What We Know (And Still Don't) Know About COVID's Effect On The Body

Speaker 1: 00:00 As we continue to learn more about the Corona virus, how it transmits and how it mutates. There are still many questions about what happens to the human body. During an infection, from inflammation to blood clotting, the symptoms affect people in various ways. It's something researchers are still learning about. Joining me is Dr. Michelle Ritter and infectious disease specialist with UC San Diego health. Dr. Ritter. Welcome. Speaker 2: 00:25 Thank you so much for having me. I appreciate it. Speaker 1: 00:29 COVID-19 first emerged. Many researchers believed the coronavirus caused a respiratory infection that could result in permanent lung scarring. Since then though, we've, we've seen other serious longterm side effects stemming from COVID infections. How much has our understanding of how this virus impacts the body during infection changed? Since then? Speaker 2: 00:49 I think the difficulty is we still don't know a lot. Um, as we've followed more and more patients, we started to see what symptoms patients can develop and which ones seem to last a little longer. I will say that what we've realized is that this virus seems to affect many more parts of the body. Then just the lungs, um, neurologic, um, uh, heart issues all over the body. We can see symptoms and I think what's get to be known as how, uh, how many long-term sequella will happen in, in each organ area. Um, and, and how much the virus is doing. How much is it just from recovering from the illness? It's a little hard to know at this point, Speaker 1: 01:26 Jen, long-term sequentially. Explain that. What is that? Speaker 2: 01:29 So we've been following patients since March with COVID and what we find is that, first of all, it behaves very differently in different people. Some people get no symptoms, some get very mild, some get one set of symptoms and others, another. And so the illness itself is incredibly variable. And then the other thing we find is how quickly people recover is, is very variable as well. So there are some people who at the end of their 10 days of isolation feel great, but there are a lot who don't feel quite like themselves yet. And, um, there's different symptoms that may linger in that. And some are fatigue, brain fog. We have patients then who also have home areas choose that linger a long time, a cough that doesn't seem to want to go away or shortness of breath that seems to linger longer than usual. Speaker 2: 02:15 And a lot of times we see these symptoms with normal imaging. So it's a little bit hard to pinpoint what is causing these ongoing symptoms. Um, more rarely we have issues with the neurologic symptom, um, system. We've had patients who have certain neurologic issues. Definitely those are a whole lot more rare to come by, um, but then cardiac issues as well. So I think what's difficult is that, um, whether or not someone has long-term sequella is, is unknown, um, when they first have their illness and what type of long-term sequella. And what we're trying to understand is what's causing these, um, and how to treat people, because at times it may be that some of the symptoms are not things that we're going to have a magic pill to get rid of. It's going to be, how do we help these patients cope, help them, um, do what they can to recover and regain their lives. Um, if they're the ones who happened to be unlucky enough to have these lingering system symptoms Speaker 1: 03:07 And, you know, everyone is different, but for the most part, the virus is still the same. So why do you think it affects people in such different ways during an active infection? Speaker 2: 03:17 So we're still trying to figure that out. I mean, the things we do know is that older patients definitely seem to get hit harder than younger patients. It's kind of amazing. And maybe as a parent, one of the few lucky things about COVID is that while I worry about my mother and, um, grandparents, I don't have to worry quite as much about my kids in general. Now there's definitely exceptions, but age definitely seems to correlate with severity of illness. Um, and again, these longterm sequella as well. Um, and then after that medical problems, so there are certainly high risk medical problems associated with having more severe disease such as, um, being significantly overweight, having a BMI greater than 35 diabetes immunosuppression. So, so we have an idea that certain medical problems in age definitely affect how someone responds to COVID Speaker 1: 04:06 While there's still a lot that we don't know. Um, can you talk about how much of a challenge that's been in terms of finding treatments for people during their infection? Speaker 2: 04:16 Yeah, I think it is hard to know. I think, uh, for us, um, we've had a few treatments that have shown promise, um, uh, they're in the hospital for quite a while now. There's, um, medications like rum, desert veer, and steroids like dexamethazone. And then, uh, another medication bear sitting there is being studied a lot in the outpatient setting. We've had some really good success with monoclonal antibodies, but currently the monoclonal antibodies are just being used in the high risk patients, not in everybody and the medications in the hospital are used only if you're severely ill enough. So we still have that group who doesn't quite meet the criteria who still are getting sick. If we could pinpoint further, um, what makes one person gets sicker over the other and find a way to prevent that cascade, whatever it is that puts that person into the amount of inflammation that causes such severe disease, that would be ideal, Speaker 1: 05:09 Has our ability to treat active cases of COVID-19 changed a great deal from when this pandemic first began? Speaker 2: 05:15 I think so. Well, not videos as significantly as we'd like, I will say, um, as an outpatient physician. So as a physician who generally is seeing the patients who are recovering at home from COVID-19, we've seen a significant difference since the, um, initiation, a monoclonal antibody therapy. Um, we've found that if we give it to some of the high risk patients who generally we would have been very concerned would have ended up in the hospital, the ICU just based on their medical problems and their age. Um, we found with monoclonal antibodies, we've had many of them do very well. Um, and it's something we are studying ourselves right now. Um, and across the country, everybody's looking more closely at that. That for has changed my ability to treat outpatients. And I've been very happy with that now, currently, not everybody has access to the monoclonal antibodies. Speaker 2: 06:06 Um, it's, they've not been studied long enough for everyone to embrace them. Either the infectious disease society of America still does not recommend routine use of them. And so we still are not at a point where we have a clear treatment. Um, but just for myself, I feel like that's given me some hope, um, and the inpatient treatments as well. Sometimes they seem to be effective. And then we have patients where they just still get horribly ill with, with those medications being given. We certainly do not have a magic bullet. We certainly do not have a perfect treatment for it right now, but there's been some improvements that I've seen that it has made me feel better Speaker 1: 06:41 A year into this pandemic. What is the biggest mystery to the medical community? Speaker 2: 06:47 I think part of it is understanding why this virus behaves so differently in different people. That's a big mystery still. That's not completely understood. I think, you know, and another big difficulty is what's going to happen going forward, especially with these variants. Is this going to be a virus that's going to stay with us for years to come? Is this going to be like an influenza where every year there's certain variants that appear, and we're going to need a new booster of a vaccine. Um, when are we going to reach that point where we really feel safe getting back to our normal meaning, not wearing masks everywhere, hugging people like we used to when you walk down the street and run into them. All of that I think is the big unknown. I think especially as of today, I would say for, for us in our clinic, trying to decide what's going to happen with COVID because our, um, our work is dependent on how many cases there are. Speaker 2: 07:40 And right now it's quiet as can be. So we're waiting to see what happens with these variants. Are they going to start spreading, are we going to end up with another surge just because of these variants and that is really unknown, right? So I think while a year ago, I, would've never predicted we would be in the same state that we are right now. Um, I think the hope is we won't have this continue, that we really have reached this point where things are significantly improved and we can move on with our lives. But I don't think we know yet. And I wish we did, but we're not quite there yet. Speaker 1: 08:13 I've been speaking with Dr. Michelle Ritter and infectious disease specialist at UC San Diego health. Dr. Ritter, thank you very much for joining us. Thank you. Uh,