Protocol needed to monitor COVID-19 disease course

Patients with pre-existing lung conditions may be especially vulnerable to lasting symptoms, writes a UW Medicine pulmonologist.

For many people who survive serious infections of the novel coronavirus, the day of discharge from the hospital is not the end of the story.

Patients with underlying conditions such as asthma or other lung problems should be checked on regularly by pulmonologists or primary-care doctors for at least six months. Some will need to be monitored for one to three years, according to a new opinion piece posted online today in The Lancet-Respiratory Medicine.

Dr. Ganesh Raghu, a UW Medicine pulmonologist and expert on interstitial lung disease and pneumonia, said his commentary outlines suggestions for survivors of COVID-19, especially patients with a moderate case requiring hospitalization. He hopes hospitals and clinics will adopt the practice of regular check-ins with vulnerable patients.

“This is the first initiative to attempt to bring the pulmonary community together and have a protocolized way to monitor the disease course and provide  standard of care,  but also might provide a foundation for research as well as clinical studies,” Raghu said. He directs the Center for  Interstitial Lung Disease at UW Medical Center – Montlake.

Follow-up is needed in a  “very structured manner because there are so many uncertainties. It is too soon to determine which patients with COVID-19 are at greatest risk for developing long-term pulmonary abnormalities” he said, “and if such symptoms will resolve, improve, or become permanent, and how the pulmonary abnormalities might be affected by therapeutics that are currently under investigation.”

Recent studies indicate that while some patients recover from their initial bouts with the virus, others continue struggle with shortness of breath and fatigue months later.

Most cases would only require six months of follow-up, Raghu proposed. People who spent time in a hospital ICU may require a year of follow-up of a year, and the most severe cases might merit checkups for three years, he said.

“These hypotheses need to be tested, which requires a systematic approach, People who have pre-existing lung disease are the ones we need to watch out for.”

Raghu proposed that attending pulmonologists collaborate with researchers to understand genetic and host-susceptibility factors of COVID-19, and encourage patients to participate in clinical studies.

“This  may help us begin to understand why some people manifest disease as mild, moderate and severe forms (and) resolve the illness quickly, and some manifest the SARS and unfortunately pass away despite aggressive supportive care, while others survive and  are left with long-term disabilities."

“If we do this proactively, we will make progress in understanding this disease,” he said.

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