7 Months, 40 Studies, 5 COVID-19 Lessons Learned

Throughout the COVID-19 pandemic, healthcare, as a whole, has faced a great deal of uncertainty. The one constant has been that what providers know can – and will – change from day-to-day. In a statement released this week, one of radiology’s experts who has followed the pandemic most closely shared the insights he has learned from his investigations.

Since March, Ali Gholamrezanezhad, M.D., a clinical emergency radiologist with the Keck School of Medicine at the University of Southern California, has published 40 papers focusing on the virus with his colleagues. Below are five of his lessons learned.

Do Not Bank on Expected Symptoms

Cough, shortness of breath, fatigue, and lung inflammation – at the beginning of the pandemic, those are the signs everyone looked for. Most CT or X-ray scans do, in fact, show those tell-tale scattered patchy areas of lung inflammation in COVID-19-positive patients who typically also present with those clinical symptoms. But, that will not always be the case, Gholamrezanezhad advised.

Instead some patients, who still have COVID-19 evidence on their lung scans, have none of those clinical symptoms, presenting instead with abdominal pain or a stroke or eye inflammation. And, in some cases, he said, patients come in with the classic cough and fever, but they show no viral signs in their lungs.

“This may have to do with the fact that COVID-19 affects almost every organ in the body,” he said, “not just the lungs as was originally thought when the pandemic first began.”

Lung Damage Can Linger

Recovering from the virus does not necessarily mean a patient will be free of any long-term impacts. In fact, Gholamrezanezhad said, his research revealed that up to 30 percent of patients who are hospitalized due to the virus still have lung scarring months post-recovery. For those with mild cases, the risk of scarring is low. The risk is high, he said, for patients who had severe disease. And, if the scarring covers a large portion of the lungs, patients will experience difficulty breathing during exercise or if they get sick in the future.

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“We don’t yet know if lung scarring due to COVID-19 will disappear over time,” he said. “However, a study of severe acute respiratory syndrome (SARS), which is caused by another type of coronavirus, revealed that patients with SARS still had lung scarring 15 years after contracting the illness.”

Pregnancy is a Complicator

Based on the results of a different study where Gholamrezanezhad and his colleagues examined 450 CT scans from COVID-19-positive pregnant women, 30 percent of the study participants had fluid in the pleural cavity surrounding the lungs, impeding their breathing. Among the general COVID-19-positive population, only 5 percent experienced this issue.

“This condition probably has to do with the body’s propensity to retain fluid during pregnancy,” he explained, “and is something obstetricians need to be aware of because it can lead to complications during delivery.”

Social Distancing Has Been Critical

The timing behind when a geographic area implemented social distancing mandates has played a significant role in the rates of viral infection, he said.

In yet another study, Gholamrezanezhad and his colleagues examined 20 variables in 40 countries, comparing healthcare-related factors, as well as a country’s wealth, education levels, and rates of obesity, air travel, tobacco use, and air pollution. They found social distancing was the biggest factor that affected mortality rates.

"The later a country started the practice of social distancing, the higher the death rate during the first wave of the pandemic,” he said. “In fact, our model revealed that even a 14-day delay in the implementation of social distancing significantly increased a country’s death rate.”

New Information Is Around Every Corner

Anticipate surprises, and expect the unexpected, he said. There is nothing routine about this virus.

“Every day we are learning something new about COVID-19,” he said. “What we know about this disease and how we treat it now may be dramatically different in six months to a year. As with all diseases, but never truer than with COVID-19, the learning phase in medicine never ends.”