Covid and Heart Damage, Revisited

I wrote about this in a post (3 December 2021) and there is new information out today from a study conducted by researchers at the Washington University in St. Louis and the Veterans Administration St. Louis Healthcare System.

The December analysis suggested that there was a low incidence of heart damage from Covid-19. I questioned whether we actually had enough data to support that statement, and the new research seems to differ on that point as well.

“What we’re seeing isn’t good,” Dr. Al-Aly says. “COVID-19 can lead to serious cardiovascular complications and death. The heart does not regenerate or easily mend after heart damage. These are diseases that will affect people for a lifetime.”

Dr. Ziyad Al-Aly, chief of research and development service at the VA St. Louis Health Care System and clinical epidemiologist at Washington University(1)

The research is based on medical records of 153,760 veterans who survived the first 30 days of Covid infection, and two control groups each containing more than 5 million VHA patients not known to be infected.

In fact, Covid can cripple the heart in a variety of ways:

  • cerebrovascular disease
  • dysrhythmias
  • ischemic and nonischemic heart disease
  • pericarditis (inflammation of the heart’s covering)
  • myocarditis (inflammation of heart muscle)
  • heart failure
  • thromboembolic disease (blood clotting)
Patient versus control group results for heart conditions (2)

Covid-19 blood clots differ from clots caused by other viruses in that they include a much higher quantity of a specific type of white blood cell than is found in clots from other causes. This may be due to the virus attacking the lining of blood vessels and triggering the release of these cells. (Discussed in a separate post in inflammation.) In any case, there is a distinct “signature” for a Covid-19 clot.

The damage exists regardless of the intensity of the original infection. People with very mild symptoms can show heard damage. Heart damage appears among all age groups, from children to the elderly, and among all ethnic and racial groups, and among both smokers and nonsmokers. This damage is permanent.

The post-infection symptoms that should trigger a consult with a doctor include:

  • Unusual fatigue
  • Exercise intolerance
  • Chest pain
  • Shortness of breath
  • Palpitations
  • Fainting spells

Of course, there are other causes for these symptoms, but if the symptoms persist over time, you need to see a doctor. Seriously. You can die from this, and people who have had Covid are at an increased risk of death for at least one year after infection — whether they knew that they had the virus or not.

Overall, the study estimates that approximately 4.5% of people who have been infected by the SARS virus will develop some form of heart disease due to the virus. Now that seems like a small number, at least until you look at the Johns Hopkins figure of 78.423,462 confirmed infections. (By the way, I was one of the early cases, infected in January 2020, who did not see a doctor.) Do the math. That’s 3.5 million new heart patients.

This feeds into the entire discussion of how we care for a cohort of people with heart of brain damage from the virus — and how we pay for that care. Prior to the pandemic, an estimated 18.2 million Americans had coronary artery disease, the most common form of heart disease. The US was spending $363 billion on treating those cases.(4) Covid is boosting both the number of cases and spending.

Maybe the society opts to let old people like me die. But, what do you do with a group of teens or 20-somethings who go from athlete to fully disabled due to heart or brain disease?



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