Category: Covid-19 Vaccine

Infectious Diseases

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Published on December 6, 2021

Throughout the COVID-19 pandemic, several coronavirus variants have emerged as the virus, SARS-CoV-2, continues to mutate and evolve. Many of these variants mutations have little or no impact on how the virus affects humans. But others, such as the genetic changes in the delta variant, can make the coronavirus more transmissible contagious) than the original version of SARS-CoV-2 that was discovered in late 2019.

In November 2021, a variant of the SARS-CoV-2 coronavirus emerged, and was named omicron by the World Health Organization (WHO). WHO currently lists the omicron as a variant of concern. Stuart Ray, M.D., vice chair of medicine for data integrity and analytics, and Robert Bollinger, M.D., M.P.H., Raj and Kamla Gupta Professor of Infectious Diseases, are experts in SARS-CoV-2, and they address your questions about the omicron coronavirus variant.

President Kevin Sowers and Dr. Lisa Maragakis discuss the omicron variant, COVID-19 boosters and staying safe through the holidays.

Because of its recent emergence, scientists are just starting to learn about omicron, but intense research is quickly uncovering more insight on this variant and how its genetic changes might affect its spread and people who are infected with it. Bollinger and Ray say the next few weeks will provide even more clarity, and address some questions.

There is some preliminary evidence suggesting the omicron variant is more infectious than the delta variant, says Bollinger. But there is no evidence so far that the standard prevention strategies, including vaccination, masking, distancing, ventilation and hand-washing are not effective in reducing the risk of infection or transmission.

For omicron, there are very limited data on this, Bollinger says. But, so far, the answer appears to be no. We will know more about this in the coming weeks.

According to Bollinger and Ray, this is the most important question, and with so little data, a lot is still unknown.

My own expectation is that being fully vaccinated, including boosters, will still provide a reduced risk of hospitalization and death, Bollinger says. In the weeks ahead, we will learn more about how well the antibodies induced by the current vaccinations can neutralize the omicron variant in the laboratory. If they can, that will be good news.

I am also confident that if we find that the current vaccines are not providing optimal protection against severe disease or death due to this variant, we will be able to quickly modify the current vaccines to address omicron.

The available commercial diagnostic PCR (polymerase chain reaction) and antigen COVID tests still appear to work to identify the omicron variant. We will know more in the coming weeks about how well the rapid at-home tests perform to detect the new variant.

Some antiviral drugs work by limiting a virus ability to make copies of itself (replicate) in the body. Remdesivir is the only such antiviral drug currently authorized for emergency use by the Food and Drug Administration (FDA) to treat COVID-19. Two other antiviral drugs, one from Merck and one from Pfizer, are under FDA review to see if they, too, can be authorized.

I have not seen any data so far, Bollinger says, that would suggest that these drugs would work less well for omicron than for any of the other variants. However, continued studies will reveal more about these mutations and potential impact the drugs may have on their viral replication.

For other variants, providing high-risk infected and exposed patients with early access to MAbs reduces their risk of hospitalization and death by up to 70%.

We do not know yet how well the current MAbs will work for the omicron variant, but we will know very soon how well they neutralize omicron in the lab, Bollinger says. If they do, this will be reassuring. If they do not, I am confident that we will be able to quickly modify the current MAbs to address this, he says.

We still have a lot to learn about omicron, Ray says, but we have tools at hand that enable individuals to manage risk, including wearing a high-quality mask, or respirators. Those rated FFP2 or FFP3 are more protective than cloth masks, and often easier to wear. Getting vaccinated and getting a COVID-19 booster, hand-washing and avoiding large indoor gatherings, especially with unmasked people, are other ways to mitigate the risk of infection.

This new variant is a reminder that we should be using multiple tools for the safety of ourselves and those for whom we care.

Learn more about variants.

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COVID Omicron Variant: What You Need to Know - Hopkins Medicine

Mild or moderate COVID-19 lasts about two weeks for most people. But in some others, long-term effects of COVID-19 can cause lingering health problems and wreak havoc for months.

Tae Chung, M.D.,a specialist in neurology and physical medicine and rehabilitation;Megan Hosey, Ph.D., anexpert in rehabilitation psychology;Arun Venkatesan, M.D., Ph.D., a specialist in neurology;Amanda Morrow, M.D., an expert in pediatric rehabilitation medicine; andAnn M. Parker, M.D., Ph.D., who specializes in lung disease and critical care, discuss long-term COVID-19, what symptoms are most common and what those affected by them can expect.

Mild or moderate COVID-19 lasts about two weeks for most people. But others experience lingering health problems even after the fever and cough go away and they are no longer testing positive for the illness.

Parker notes that the World Health Organization has developed a definition for post-COVID-19 condition (the WHOs term for long COVID) as coronavirus symptoms that persist or return three months after a person becomes ill from infection with SARS CoV-2, the coronavirus that causes COVID-19. Those symptoms can include:

The symptoms can come and go, but have an impact on the persons everyday functioning, and cannot be explained by another health problem.

While its clear that people with certain risk factors (including high blood pressure, smoking, diabetes, obesity and other conditions) are more likely to have a serious bout of COVID-19, there isnt a clear link between these risk factors and long-term problems. In fact, long COVID can happen in people who have mild symptoms, although patients with more severe initial illness seem to be more likely to have long-term impairments.

More studies will shed light on why these stubborn health problems persist in some people.

SARS-CoV-2 can attack the body in a range of ways, causing damage to the lungs, heart, nervous system, kidneys, liver and other organs. Mental health problems can arise from grief and loss, unresolved pain or fatigue, or from post-traumatic stress disorder (PTSD) after treatment in the intensive care unit (ICU).

Doctors are seeing a spectrum of symptoms after acute COVID-19, some of which would be expected after other critical illnesses. Some are minor, but other people may need continuing care and even readmission to the hospital.

Similar, lingering problems can affect patients with other serious illnesses. But it is notable that post-COVID-19 syndrome is not just afflicting people who were very sick with the coronavirus: Some patients who were never severely ill with COVID-19 are experiencing long-term symptoms.

Getting vaccinated for COVID-19 lowers the risks of COVID infection. While breakthrough infections are possible, being fully vaccinated and boosted is effective in reducing the risk of hospitalization and death due to COVID. Research is ongoing about how long COVID affects people who had breakthrough COVID, but it is likely that being vaccinated reduces the risk.

A bad case of COVID-19 can produce scarring and other permanentproblems in the lungs, but even mild infections can cause persistent shortness of breath getting winded easily after even light exertion.

Lung recovery after COVID-19 is possible, but takes time. Experts say it can take months for a persons lung function to return to pre-COVID-19 levels.Breathing exercisesand respiratory therapy can help.

SARS-CoV-2 infection can leave some people withheart problems, including inflammation of the heart muscle. In fact, one study showed that 60% of people who recovered from COVID-19 had signs of ongoing heart inflammation, which could lead to the common symptoms of shortness of breath, palpitations and rapid heartbeat. This inflammation appeared even in those who had had a mild case of COVID-19 and who had no medical issues before they got sick.

If the coronavirus infection causedkidney damage, this can raise the risk of long-term kidney disease and the need for dialysis.

The senses of smell and taste are related, and because the coronavirus can affect cells in the nose, having COVID-19 can result in lost or distorted senses of smell (anosmia) or taste. Before and after people become ill with COVID-19, they might lose their sense of smell or taste entirely, or find that familiar things smell or taste bad, strange or different.

For about a quarter of people with COVID-19 who have one or both of these symptoms, the problem resolves in a couple of weeks. But for most, these symptoms persist. Though not life-threatening, prolonged distortion of these senses can be devastating and can lead to lack of appetite, anxiety and depression. Some studies suggest that theres a 60% to 80% chance that these people will see improvement in their sense of smell within a year.

NeurologistArun Venkatesan, M.D., Ph.D., says, Some individuals develop medium to long-term symptoms following COVID infection, including brain fog, fatigue, headaches and dizziness. The cause of these symptoms is unclear but is an active area of investigation.

Can COVID-19 increase a persons risk for anxiety, depression and cognitive issues? A study of COVID-19s impact on mental and emotional well-being conducted by Johns Hopkins experts in psychiatry, cognition (thinking, reasoning and remembering) and mental health found that these problems were common among a diverse sample of COVID-19 survivors.

Cognitive impairment after acute coronavirus infection can have a severe impact on a persons life. Long-haul COVID patients may experience changes in the way they think, concentrate, speak and remember, and these symptoms can affect their ability to work or even maintain activities of daily living.

After recovering from the coronavirus, some people are left with lingering anxiety, depression and other post-COVID mental health issues. Physical changes such as pain and weakness can be complicated by long periods of isolation, stress from job loss and financial difficulties, and grief from the deaths of loved ones and the loss of good health.

Patients who were hospitalized for COVID-19 treatment have a particularly challenging recovery. Experts note that post-intensive care syndrome, or PICS, puts COVID-19 survivors and other people who have spent time in the ICU at a higher risk for problems with mental health, cognition and physical recovery.

Megan Hosey, Ph.D.,a rehabilitation psychologist, says that prolonged time in the ICU can cause delirium. The strange surroundings, multiple mind-altering medications, isolation and loss of control can leave patients with lasting and recurrent sensations of terror or dread, including post-traumatic stress disorder (PTSD).

Many patients have hallucinations where they believe that medical providers are trying to harm them, Hosey says. We've had patients tell us things like I thought I was being buried alive when they were being put into an MRI.

Learn more about depression and anxiety associated with COVID-19.

Postural orthostatic tachycardia syndrome, or POTS, is a condition that affects blood circulation, and people who have survived COVID-19 may be more vulnerable to it.Tae Chung, M.D., who specializes in physical medicine and rehabilitation, says POTS can leave survivors with otherneurologic symptoms, including continuing headache, fatigue, brain fog, difficulties in thinking or concentrating, and insomnia.

Persistent post-COVID-19 insomnia, or COVID-somnia is an increasingly common complaint among COVID-19 survivors and can be a typical symptom of POTS.

The relationship between COVID-19 and diabetes, especially type 2 diabetes, is complex. Type 2 diabetes is a risk factor for serious cases of COVID-19, and some survivors of the illness seem to be developing type 2 diabetes signs after they recover from COVID-19.

Its not yet known whether children who have had COVID-19 are more or less likely than adults to experience continuing symptoms. But long-term COVID-19 in children is a possibility, showing up as fatigue, headaches, difficulty with school work, mood concerns, shortness of breath and other long-hauler symptoms.

Amanda Morrow, M.D., a specialist in physical medicine and rehabilitation, is part of the multidisciplinary team at Kennedy Krieger InstitutesPediatric Post COVID-19 Rehabilitation Clinic, which addresses lingering coronavirus symptoms in children and teens. She says it isn't clear why long COVID-19 symptoms affect some children and not others.

We are seeing patients who are often very high-functioning, healthy children who did not have any previous illnesses or medical conditions, she says, noting that many of the kids being treated at the clinic only had mild bouts of COVID-19.

Heart inflammation after COVID-19 is a concern, especially among young athletes returning to their sports after a mild or even asymptomatic case of the coronavirus. They should be screened for any signs of heart damage to ensure it is safe for them to resume activity.

Kids who have experienced the uncommon but serious complication of COVID-19 called multisystem inflammatory syndrome in children, or MIS-C, can be left with serious heart damage, and should be followed by a pediatric cardiologist.

Brigham says that the sheer scale of caring for patients with lingering COVID-19 symptoms is a serious challenge. She notes that clinicians saw post-viral symptoms in patients affected by two other coronavirus diseases severe acute respiratory syndrome (SARS)andMiddle East respiratory syndrome (MERS).

But, she says, outbreaks of those diseases were limited. Millions more people have had COVID-19 than SARS or MERS, so the potential problem of lingering health problems is huge, particularly in the context of the pandemic, with isolation, economic disadvantage, lack of access and changed daily routines further compounding the complexities of long-term COVID-19 care.

Doctors and therapists can work with you to address symptoms.The Johns Hopkins Post-Acute COVID-19 Team (JH PACT)is a special multidisciplinary clinic to support the recovery of people who have had COVID-19, and similar clinics are emerging at other hospitals.

Breathing exercises, physical therapy, medications and other treatments appear to be helpful.

Many clinical trials are being planned to test various drugs and interventions for long-haul COVID. For example, a clinical trial on a novel immune-modulating drug will be launched for patients who developed POTS as a post-COVID syndrome (PI: Tae Chung, MD) at Johns Hopkins POTS Clinic Program in the summer of 2022. More information will be updated in Johns Hopkins websites.

The best way to avoid post-COVID-19 complications is to prevent infection with the coronavirus in the first place. Practicingcoronavirus precautionsand staying up to date withCOVID-19 vaccinesand boosters are effective ways to avoid getting COVID-19.

Long-term COVID-19 symptoms can be similar to signs of other disease, so it is important to see your doctor and rule out other problems, such as cardiac issues or lung disease.

Dont ignore loss of smell, depression, anxiety or insomnia, or write these off as unimportant or all in your head. Any symptom that interferes with your daily life is worth a call to your doctor, who can help you address these problems and improve the quality of your life.

If you experience new chest pain, difficulty breathing, bluish lips or any other sign of a life-threatening problem, call 911 or emergency services right away.

SARS-CoV-2, the virus that causes COVID-19, was identified in December 2019. There is still a lot to learn about it, but our understanding of the virus and COVID-19 is evolving by the day.

Researchers will learn more about how and why the coronavirus affects different people in such a variety of ways, and why some people experience no symptoms at all while others have life-threatening organ damage or lasting disability. New insights will provide avenues for therapies and hope for people living with long-term COVID-19 effects.

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Long COVID: Long-Term Effects of COVID-19 - Hopkins Medicine

Infectious Diseases

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Updated on February 28, 2022

Like other respiratory illnesses, COVID-19 can cause lasting lung damage.

Panagis Galiatsatos, M.D., M.H.S., is an expert on lung disease atJohns Hopkins Bayview Medical Centerand sees patients with COVID-19. He explains some of the short- and long-term lung problems brought on by the new coronavirus.

As we continue to learn about COVID-19, were understanding more regarding how it affects the lungs during acute illness and afterward. And this is especially true with the virus ongoing variants, as well, Galiatsatos says.

COVID-19 can cause lung complications such aspneumoniaand, in the most severe cases,acute respiratory distress syndrome, or ARDS.Sepsis, another possible complication of COVID-19, can also cause lasting harm to the lungs and other organs. Newer coronavirus variants may also cause more airway disease, such as bronchitis, that may be severe enough to warrant hospitalization.

As we have learned more about SARS-CoV-2 and resulting COVID-19, we have discovered that in severe COVID-19, a significant pro-inflammatory condition can result in several critical diseases, complications and syndromes, Galiatsatos says.

In pneumonia, the lungs become filled with fluid and inflamed, leading to breathing difficulties. For some people, breathing problems can become severe enough to require treatment at the hospital with oxygen or even a ventilator.

The pneumonia that COVID-19 causes tends to take hold in both lungs. Air sacs in the lungs fill with fluid, limiting their ability to take in oxygen and causing shortness of breath, cough and other symptoms.

While most people recover from pneumonia without any lasting lung damage, the pneumonia associated with COVID-19 can be severe. Even after the disease has passed, lung injury may result in breathing difficulties that might take months to improve.

In COVID-19-related bronchitis, this is an issue of an excessive amount of sputum produced in the airways, resulting in coughing and chest congestion. The sputum also narrows the airways, making breathing more difficult, Galiatsatos explains.

As for the bronchitis, patients may experience a cough that stays with them for months after the initial infection, he notes. This frequent cough and ongoing chest congestion may have an impact on ones quality of life.

If COVID-19 pneumonia progresses, more of the air sacs can become filled with fluid leaking from the tiny blood vessels in the lungs. Eventually, shortness of breath sets in, and can lead to acute respiratory distress syndrome (ARDS), a form of lung failure. Patients with ARDS are often unable to breath on their own and may require ventilator support to help circulate oxygen in the body.

Whether it occurs at home or at the hospital, ARDS can be fatal. People who survive ARDS and recover from COVID-19 may have lasting pulmonary scarring.

Another possible complication of a severe case of COVID-19 issepsis. Sepsis occurs when an infection reaches, and spreads through, the bloodstream, causing tissue damage everywhere it goes.

Lungs, heart and other body systems work together like instruments in an orchestra, Galiatsatos says. In sepsis, the cooperation between the organs falls apart. Entire organ systems can start to shut down, one after another, including the lungs and heart.

Sepsis, even when survived, can leave a patient with lasting damage to the lungs and other organs.

Galiatsatos notes that when a person has COVID-19, the immune system is working hard to fight the invader. This can leave the body more vulnerable to infection with another bacterium or virus on top of the COVID-19 a superinfection. More infection can result in additional lung damage. And, Galiatsatos points out, strikingly, about one out of four patients who develop severe COVID-19 also have a superinfection, meaning these patients will take more time to heal.

Galiatsatos notes three factors that affect the lung damage risk in COVID-19 infections and how likely the person is to recover and regain lung function:

Disease severity.The first is the severity of the coronavirus infection itself whether the person has a mild case, or a severe one, Galiatsatos says. Milder cases are less likely to cause lasting scars in the lung tissue.

Health conditions.Galiatsatos says, The second is whether there are existing health problems, such as chronic obstructive pulmonary disease (COPD) or heart disease that can raise the risk for severe disease. Older people are also more vulnerable for a severe case of COVID-19. Their lung tissues may be less elastic, and they may have weakened immunity because of advanced age.

Treatment.Treatment is the third factor, he says. A patients recovery and long-term lung health is going to depend on what kind of care they get, and how quickly. Timely support in the hospital for severely ill patients can minimize lung damage.

There are things patients can do to increase their chances for less severe lung damage, Galiatsatos says.

If you have a health issue that puts you at higher risk, make sure youre doing everything you can to minimize the chance of contracting the virus. Also, make sure that your chronic health conditions are managed as well as they can be. For example, people living with diabetes, COPD or heart disease should be especially careful to manage those conditions with monitoring and taking their medications as directed.

Galiatsatos adds that proper nutrition and hydration can also help patients avoid complications of COVID-19. Staying well fed is important for overall health. Proper hydration maintains proper blood volume and healthy mucous membranes in the respiratory system, which can help them better resist infection and tissue damage.

Finally, he stresses, being vaccinated and boosted appropriately at the time of the infection helps ensure the best possible outcome.

While the vaccines immunity makes our immune systems smarter by having a play book to fight off the virus strategically with minimal collateral damage, the vaccines immunity may also help in the healing process as well. Abnormal healing is seen often in people who have not previously been vaccinated. So while they survived the infection, the scars left from the coronavirus may be permanent in these patients.

Our expert,Panagis Galiatsatos, M.D., M.H.S. discusses how smoking, vaping and air pollution might increase the severity of COVID-19. Learn about how each of these could affect a COVID-19 diagnosis.

After a serious case of COVID-19, a patients lungs can recover, but not overnight. Recovery from lung damage takes time, Galiatsatos says. Theres the initial injury to the lungs, followed by scarring. Over time, the tissue heals, but it can take three months to a year or more for a persons lung function to return to pre-COVID-19 levels.

Lung healing in of itself can produce symptoms, Galiatsatos says. It is similar to a leg bone breaking, needing a cast for months, and having the cast come off. No one would expect to begin to run right away with the newly-healed leg bone. As the leg strengthens and muscle re-grows, patients will experience discomfort from this healing. This is what our lungs go through, too!

He notes that doctors and patients alike should be prepared for continuing treatment and therapy.

Again, staying up to date with COVID-19 vaccines, including boosters is key, not only to surviving COVID-19, but potentially to ensure the scars to the lungs are not permanent. But while the lungs are healing, it is important that COVID-19 survivors touch base with physicians, who can help them recover efficiently.

Once the pandemic is over, there will be a group of patients with new health needs: the survivors. Doctors, respiratory therapists and other health care providers will need to help these patients recover their lung function as much as possible.

What you need to know from Johns Hopkins Medicine.

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COVID-19 Lung Damage | Johns Hopkins Medicine

Infectious Diseases

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Updated on January 24, 2022

Having COVID-19 varies greatly from one person to another. What happens if you are diagnosed with COVID-19? Lisa Maragakis, M.D., M.P.H., senior director of infection prevention, explains what to expect.

There are three general phases of infection with SARS-Cov-2, the coronavirus that causes COVID-19.

Incubation period. This is the time between getting infected and when symptoms appear. In general, you may see symptoms start two to 14 days after infection. The incubation period varies among individuals, and it varies depending on the variant. Even though you do not have symptoms in the incubation period, you can transmit the coronavirus to another person during this stage.

This is why, if you suspect you were exposed to someone with COVID-19, you should self-quarantine, watch for symptoms and consider getting tested four or five days following the exposure. This way, you can help prevent the spread of COVID-19. Please review Centers for Disease Control and Prevention (CDC) guidelines for isolation and quarantine.

Acute COVID-19. Once symptoms appear, you have entered the acute stage. You may have fever, cough and other COVID-19 symptoms. Active illness can last one to two weeks if you have mild or moderate coronavirus disease, but severe cases can last months. Some people are asymptomatic, meaning they never have symptoms but do have COVID-19.

If you develop symptoms or suspect you are asymptomatically infected, call your health care provider, follow testing guidelines, and follow all isolation and safety guidelines.

COVID-19 recovery. Post-COVID-19 symptoms, such as lingering cough, on and off fever, weakness, and changes to your senses of smell or taste, can persist for weeks or even months after you recover from acute illness. Persistent symptoms are sometimes known as long COVID-19.

Test results may remain positive for weeks to several months following infection, but this does not necessarily mean you are still infectious. Most people are no longer infectious beyond the recommended isolation precautions period. If you have conditions that cause severe immunosuppression, contact your health care provider to determine how long you should isolate and how to determine when you are no longer potentially infectious to others.

Symptoms can be severe, mild or absent altogether. Some people recover from COVID-19 with no problems, while others are left with lingering effects, and still others require hospitalization or die from complications due to COVID-19.

If you have any of the following symptoms, call your doctor. He or she will say whether you need a test and recommend what you should do.

You should call 911 or an emergency care facility if you experience any severe symptoms, including:

Be sure to tell the 911 dispatcher or emergency room if you have been exposed to or diagnosed with COVID-19.

Those with a mild case of COVID-19 usually recover in one to two weeks. For severe cases, recovery can take six weeks or more, and for some, there may be lasting symptoms with or without damage to theheart,kidneys,lungsandbrain.

Yes. Re-infection with the coronavirus, especially with one of the coronavirus variants, is possible if you previously had COVID-19.

The best protection is to get fully vaccinated and receive a booster when eligible, wear a face mask in public, practice physical distancing and wash your hands frequently.

Some patients with COVID-19 developpneumonia. Viral pneumonia, including that caused by COVID-19, cannot be treated with antibiotics. Some severe cases of COVID-19 may require ventilator support to ensure the body is getting enough oxygen. Other medications, including antivirals, may also be administered.

People over age 65 and those with certain health conditions are at a higher risk of developing pneumonia and may experience more severe cases of COVID-19. Studies show that in patients with COVID-19, pneumonia may progress into acute respiratory distress syndrome (ARDS), which can be fatal in some patients.

Treatment of COVID-19 involves addressing symptoms. If you are at risk for severe coronavirus disease, your doctor may recommend one or more COVID-19 treatments, but for most people with mild COVID-19, rest and drinking plenty of fluids are the best approach. Your doctor may also suggest you take over-the-counter medication for fever.

More severe cases require hospital care, including breathing support, mechanical ventilation, orother medical treatments.

If you are infected with COVID-19 or have been exposed to someone who is infected, it is very important to separate yourself from others so that you do not spread COVID-19 further. The CDC provides recommendations on isolation and quarantine.

There are several ways to help protect your family:

Here are additional precautions:

According to the CDC, the virus may spread from people to animals during close contact, so its best to follow the same safety measures with your pet as you would with people.

What you need to know from Johns Hopkins Medicine.

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Coronavirus Diagnosis: What Should I Expect? - Hopkins Medicine

COVID-19 is a very complex illness. The coronavirus that causes COVID-19 attacks the body in many different ways, ranging from mild to life threatening. Different organs and tissues of the body can be affected, including the blood.

Robert Brodsky, a blood specialist who directs the Division of Hematology, andPanagis Galiatsatos, a specialist in lung diseases and critical care medicine, talk about blood problems linked to SARS-CoV-2 the coronavirus that causes COVID-19 and what you should know.

Blood clots can cause problems ranging from mild to life threatening. If a clot blocks blood flow in a vein or artery, the tissue normally nourished by that blood vessel can be deprived of oxygen, and cells in that area can die.

Some people infected with SARS-CoV-2 develop abnormal blood clotting. In some people with COVID-19, were seeing a massive inflammatory response, the cytokine storm that raises clotting factors in the blood, says Galiatsatos, who treats patients with COVID-19.

We are seeing more blood clots in the lungs (pulmonary embolism), legs (deep vein thrombosis) and elsewhere, he says.

Brodsky notes that other serious illnesses, especially ones that cause inflammation, are associated with blood clots. Research is still exploring if the blood clots seen in severe cases of COVID-19 are unique in some way.

In addition to the lungs, blood clots, including those associated with COVID-19, can also harm:

The nervous system. Blood clots in the arteries leading to thebraincan cause a stroke. Some previously young, healthy people who have developed COVID-19 have suffered strokes, possibly due to abnormal blood clotting.

The kidneys. Clogging of blood vessels in thekidneywith blood clots can lead to kidney failure. It can also complicate dialysis if the clots clog the filter of the machine designed to remove impurities in the blood.

Peripheral blood vessels and COVID toe. Small blood clots can become lodged in tiny blood vessels. When this happens close to the skin, it can result in a rash. Some people who test positive for COVID-19 develop tiny blood clots that cause reddish or purple areas on the toes, which can itch or be painful. Sometimes calledCOVID toe,the rash resembles frostbite.

Brodskys researchis studying the intense inflammation that occurs in some patients who have the coronavirus, and the research may be homing in on a way to prevent the devastating organ damage that COVID-19 causes in some people.

Brodsky and his team have found that the spike protein on the coronavirus activates a part of the immune system known as complement, and hijacks the bodys immune system and turns it against healthy tissue. His group has shown that blocking the complement protein factor D could interrupt the cascade of events that lead to severe illness and organ damage.

What we discovered is how this coronavirus activates a series of reactions in the immune system that lead to inflammation and cell destruction, Brodsky says. Blocking this pathway can prevent that damage.

Other diseases affect the body using a similar pathway. Brodsky and his research team hope that medicines now in development to treat those conditions might help people with COVID-19.

COVID-19 inflammation can lead to dire consequences in people who have blood illnesses, including sickle cell disease, Galiatsatos says.

Sickle cell disease (SCD)is an inherited blood disorder. According to theU.S. Centers for Disease Control and Prevention, it affects one in about 365 Black Americans. It impacts the shape of red blood cells, which causes pain, organ damage and problems with blood flow. SCD also increases the risk for pneumonia and lung disease.

People with sickle cell disease, even those who are relatively young, seem to be at a high risk for severe COVID-19 and poor outcomes, including death. Since SCD mostly affects Black people, the higher rate of serious coronavirus infections could also be related to longstandinghealth disparitiesthat leave African Americans more vulnerable to severe illness from the coronavirus. More research will reveal the relationship between sickle cell disease and COVID-19.

No donating or receiving blood from a donor is not a risk factor for becoming infected with SARS-CoV-2. Likewise, there is no evidence that anyone has ever caught the virus from a mosquito bite.

Most people get sick from the coronavirus by inhaling droplets or virus particles from an infected person, especially in an enclosed area. If a person touches a surface with active coronavirus on it, and then touches their face and gets the virus in their nose, eyes or mouth, the person can become infected that way, but this is not as common.

Yes. Once you are completely better and your doctor says it is OK, you can safely donate blood. A part of your blood called plasma might even be useful to help other patients. If you have successfully recovered from COVID-19, your blood plasma may contain antibodies to the coronavirus that can be used to help another person fight off the virus.

Maybe, but if there are factors in blood type that make people more vulnerable or less vulnerable to COVID-19, the effects might not raise or lower the risk by much.

There are retrospective studies [comparisons of groups of people with COVID-19 and groups of people without it] that show a possible correlation between blood types O and B and a lower risk of catching SARS-CoV-2 or having a severe case of COVID-19, Galiatsatos says. Some of those studies show a pattern of more severe infection among people with type A or AB blood.

But these observations result in questions, not answers, Galiatsatos says, explaining that the research data does not mean a particular blood type is causing severe disease or making people more vulnerable or less vulnerable to the virus.

Brodsky says even if it turns out that different blood type can affect COVID-19 risk, the factor is likely to be very slight. For now, scientists advise not to assume anyone is at a lower or higher risk from the coronavirus due to their blood type.

This article was reviewed by Michael Streiff, M.D., medical director of the Johns Hopkins Special Coagulation Laboratory.

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What Does COVID Do to Your Blood? | Johns Hopkins Medicine

If you had COVID-19, you may wonder if you now have natural immunity to the coronavirus. And if so, how does that compare to protection offered by the COVID-19 vaccinations?

Lisa Maragakis, M.D., M.P.H., senior director of infection prevention, and Gabor Kelen, M.D., director of the Johns Hopkins Office of Critical Event Preparedness and Response, help you understand natural immunity and why getting a coronavirus vaccine is recommended, even if youve already had COVID-19.

Immunity is your bodys ability to protect you from getting sick when you are exposed to an infectious agent (germ) such as a bacterium, virus, parasite or fungus.

Immunity is a complex process that involves a lot of moving parts. Your body produces a variety of different cells that fight invading germs. Some of these release special proteins called antibodies into your blood stream. These antibody producing cells can remember a particular germ so they can detect its presence if it returns and produce antibodies to stop it.

Natural immunity is the antibody protection your body creates against a germ once youve been infected with it. Natural immunity varies according to the person and the germ. For example, people who have had the measles are not likely to get it again, but this is not the case for every disease. A mild case of an illness may not result in strong natural immunity. New studies show that natural immunity to the coronavirus weakens (wanes) over time, and does so faster than immunity provided by COVID-19 vaccination.

Vaccine-induced immunity is what we get by being fully vaccinated with an approved or authorized COVID-19 vaccine. Research indicates that the protection from the vaccines may wane over time so additional doses (boosters)are now authorized for certain populations. These boosters can extend the powerful protection offered by the COVID-19 vaccines.

Yes, the COVID-19 vaccines are recommended, even if you had COVID-19. At present, evidence from Johns Hopkins Medicine and the U.S. Centers for Disease Control and Prevention (CDC) supports getting a COVID-19 vaccine as the best protection against getting COVID-19, whether you have already had the virus or not.

Here are recent research studies that support getting vaccinated even if you have already had COVID-19:

Vaccines add protection.

Immunity varies for individuals: Immune response can differ in people who get COVID-19 and recover from the illness. The FDA-authorized and approved vaccines have been given to almost 200 million people in the U.S. alone, and have strong data supporting their effectiveness.

Delta variant and future coronavirus variants: Hospitalizations of people with severe COVID-19 soared over the late summer and into fall as the delta variant moved across the country. People infected with earlier versions of the coronavirus and who havent been vaccinated might be more vulnerable to new mutations of the coronavirus such as those found in the delta variant. To date, the authorized vaccines provide protection from serious disease or death due to all currently circulating coronavirus variants.

Holding off on getting vaccinated for COVID-19 is not a good idea. Heres why:

For the reasons above, the CDC recommends and Johns Hopkins Medicine agrees that all eligible people get vaccinated with any of the three FDA-approved or authorized COVID-19 vaccines, including those who have already had COVID-19.

Johns Hopkins has conducted a large study on natural immunity that shows antibody levels against COVID-19 coronavirus stay higher for a longer time in people who were infected by the virus and then were fully vaccinated with mRNA COVID-19 vaccines compared with those who only got immunized. (The results of the study were published in a letter to the Journal of the American Medical Association on Nov. 1, 2021.)

The data show that one month after they got their second shot, participants who had had COVID-19 more than 90 days before their first shot had adjusted antibody levels higher than those who had been exposed to the coronavirus more recently than 90 days. Three months after the second coronavirus vaccine, the antibody levels were even higher: 13% higher than those who were exposed to the virus less than or equal to the 90-day mark.

These study results suggest that natural immunity may increase the protection of the shots when there is a longer time period between having COVID-19 and getting vaccinated.

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COVID Natural Immunity: What You Need to Know - Hopkins Medicine

For people who have had COVID-19, lingeringCOVID-19 heart problemscan complicate their recovery.

Some of the symptoms common in coronavirus long-haulers, such as palpitations, dizziness, chest pain and shortness of breath, may be due to heart problems or, just from having been ill with COVID-19. How do you tell if your symptoms are heart-related, and what can you expect if they are?

Johns Hopkins cardiologistsWendy Post, M.D., and Nisha Gilotra, M.D., clarify which post-coronavirus symptoms may point to a heart issue, when to call your doctor, and other facts all long-term COVID-19 survivors should know.

Yes: Although COVID-19 is primarily a respiratory or lung disease, the heart can also suffer.

Temporary or lasting damage to heart tissue can be due to several factors:

Lack of oxygen.As the virus causes inflammation and fluid to fill up the air sacs in the lungs, less oxygen can reach the bloodstream. The heart has to work harder to pump blood through the body, which can be dangerous in people with preexisting heart disease. The heart can fail from overwork, or insufficient oxygen can cause cell death and tissue damage in the heart and other organs.

Myocarditis: inflammation of the heart.The coronavirus may infect and damage the hearts muscle tissue directly, as is possible with other viral infections, including some strains of the flu. The heart may also become damaged and inflamed indirectly by the bodys own immune system response.

Coronavirus infection also affects the inner surfaces of veins and arteries, which can cause blood vessel inflammation, damage to very small vessels and blood clots, all of which can compromise blood flow to the heart or other parts of the body. Severe COVID-19 is a disease that affects endothelial cells, which form the lining of the blood vessels, Post says.

Stress cardiomyopathy.Viral infections can causecardiomyopathy, a heart muscle disorder that affects the hearts ability to pump blood effectively. When attacked by a virus, the body undergoes stress and releases a surge of chemicals called catecholamines, which can stun the heart. Once the infection resolves, the stressor has ended and the heart can recover.

Most serious of all, Gilotra says, is the possibility of the immune system launching an attack on the invading virus that is so severe that it destroys healthy tissues.

When responding to infection with the coronavirus, the body releases a flood of proteins called cytokines that help cells communicate with one another and fight the invaders.

In some people, perhaps due to a genetic difference, this normal defensive event is exaggerated, leaving them vulnerable to acytokine storm. In a cytokine storm, the immune system response causes inflammation that can overwhelm the body, destroying healthy tissue and damaging organs such as the kidneys, liver and heart.

A cytokine storm and its resulting heart damage can also affect the hearts rhythm. Serious ventricular arrhythmias due to a cytokine storm can be catastrophic, Gilotra says.

A cytokine storm is difficult to survive. Current research is exploring the possible benefit of using immune-suppressing drugs to treat patients with COVID-19 who experience this serious complication.

After you have had COVID-19, if you are experiencing a rapid heartbeat or palpitations, you should contact your doctor. A temporary increase in heart rate can be caused by a lot of different things, including dehydration. Make sure you are drinking enough fluids, especially if you have a fever. Symptoms of a rapid or irregular heart rhythm may include:

In some people, heart rates can vary from fast to slow, unrelated to exertion, for no apparent reason. But, Post says, shortness of breath, chest pain or palpitations after having COVID-19 is a common complaint. Any of these problems could be related to the heart, but they could also be due to other factors, including the aftermath of being very ill, prolonged inactivity and spending weeks convalescing in bed.

You want to consult a doctor if any of your symptoms are severe, especially shortness of breath, Post says. She recommends using a commercially available O2 (oxygen) saturation monitor.

Shortness of breath by itself is not always a sign of a serious problem, but if you have that symptom along with low O2 (below 92%), that is a reason to be concerned. Sometimes people are short of breath with exertion after COVID-19 because they have been less active for a long time and need to gradually build their fitness level back up.

A diagnosis ofheart failureafter COVID-19 is rare. But if you have shortness of breath or leg swelling after COVID-19, you should contact your doctor, who may recommend evaluation by a cardiologist if tests indicate you are at risk.

What about lingering chest pain, another common post-COVID complaint? Chest pain may be nothing serious, but if you are having severe chest pain, get help, especially if it is persistent or if you are also having nausea, shortness of breath or lightheadedness: These could besymptoms of a heart attack.

If you have chest pain when you inhale, you might have lung inflammation. Sudden, severe chest pain could be ablood clot in the lung (pulmonary embolism), Post says.

People recovering from the coronavirus sometimes show symptoms of a condition known asPOTS (postural orthostatic tachycardia syndrome). Researchers are exploring whether or not there is a link.

POTS isnt directly a cardiac problem, but a neurologic one that affects the part of the nervous system that regulates heart rate and blood flow. The syndrome can cause rapid heartbeats when you stand up, which can lead to brain fog, fatigue, palpitations, lightheadedness and other symptoms.

Yes. People with COVID-19 can have symptoms similar to those of a heart attack, including chest pain, shortness of breath and changes on their echocardiogram (ultrasound of the heart) or EKG. But often when these patients are given an angiogram, there is no evidence of a major blockage in the hearts blood vessels, which would indicate a heart attack in progress.

Symptoms of myocarditis can also mimic those of a heart attack. Also, viral infections such as COVID-19 can cause very small blood clots to form, which can block tiny blood vessels and cause pain.

People with signs and symptoms of a heart attack should seek urgent medical attention and not manage these symptoms at home.

Symptom

When to call 911

When to call your doctor

Shortness of breath

Chest pain

If your symptoms are not severe but you want to be checked out, Post says a cardiologist doesnt need to be your first stop if youve never had heart problems before and are not at risk. For nonemergency post-COVID-19 symptoms, your primary care practitioner can advise you, she says.

That depends: Post says that heart attack has several different forms. A type 1 heart attack, caused by a blood clot blocking one of the hearts arteries, is rare during or after COVID-19 infection.

Type 2 heart attacks are more common with COVID-19, she says. This heart attack can be caused by increased stress on the heart, such as a fast heartbeat, low blood oxygen levels or anemia, because the heart muscle isnt getting enough oxygen delivered in the blood in order do this extra work. We have seen this in people with acute coronavirus disease, but it is less common in those who have survived the illness.

Blood tests have shown that during COVID-19, some people have elevated levels of a substance called troponin in their blood, along with EKG changes and chest pain. Elevated troponin levels are a sign of damaged heart tissue. Sometimes this is from a heart attack. This is less commonly seen after COVID-19.

During acute COVID-19, elevated troponin levels with an abnormal EKG are linked to higher mortality, but not in patients with a normal EKG, Post says.

In general, children who get sick with the coronavirus do not have serious problems as often as adults do. An uncommon but serious complication of COVID-19 calledmultisystem inflammatory syndrome in children, or MIS-C, can cause serious heart damage, cardiogenic shock or death.

Some children who survive MIS-C can be left with abnormal heart rhythms and stiffened heart muscle that prevents the heart from relaxing normally and beating properly. MIS-C has some similar characteristics to Kawasaki disease.

Post says that if symptoms are due to a cardiac cause, recovery depends on the severity of injury. Very few people have a severe heart attack, such as an acutemyocardial infarction, or MI, due to COVID-19, she says.

Still, heart imaging can reveal minor changes in the heart muscle of some COVID-19 survivors. Post notes that some studies on athletes recovering from the coronavirus have shown some scarring, but stresses that some of these studies did not compare these results with those who had not had COVID-19. How long these minor changes persist and how they affect heart health are not yet known. Experts are developing protocols and recommendations for which athletes should get cardiac testing before returning to play.

COVID-19 can also affect the strength of the heart pumping, Post says, but subtle abnormalities in heart pumping are not likely to cause people problems.

A person recovering from COVID-19 may benefit from physical therapy,breathing exercises and, most of all, time. Post advises anyone recovering from COVID-19 should expect a gradual course of recovery, and should not expect a rapid return to their normal activity levels.

A heart condition could be exacerbated by severe COVID, but not likely after mild or asymptomatic cases, Post says. But the effects of the coronavirus on preexisting heart disease are not yet known.

If you have had COVID-19, recovered and feel all right now, should you worry? Are heart problems likely to show up later on?

Post emphasizes that many of these questions do not have clear answers yet. SARS-CoV-2 was isolated in 2019, and a large number of COVID-19 survivors have only been recovering since 2020. It is hard to know exactly how the disease will affect peoples hearts long term, and this is just one area of intense concern among researchers, she says.

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Heart Problems after COVID-19 | Johns Hopkins Medicine

Although many people recover quickly from COVID-19, the disease caused by the coronavirus, others who recover may continue to experience symptoms for months. Researchers are still determining the cause of these extended symptoms, but some COVID-19 "long-haulers" may actually be dealing with a known condition, called postural orthostatic tachycardia syndrome. This condition, also called POTS, affects involuntary nervous system functions, such as heart rate and blood pressure, usually upon standing from a reclining position.

Tae Chung, M.D., is a neuromuscular specialist and rehabilitation physician, and director of the Johns Hopkins POTS Program. He explains what we know about post-COVID POTS and how to go about getting a diagnosis.

POTS can be triggered by a variety of conditions, including viral or bacterial infections. Some researchers believe that coronavirus can be a trigger for POTS, as an increased number of people who recovered from COVID-19 are now experiencing POTS-like symptoms, such as brain fog, tachycardia (increased heart rate) and severe chronic fatigue. This similarity in symptoms led doctors to start testing patients for POTS.

The autonomic nervous system regulates functions we dont consciously control, such as heart rate, blood pressure, sweating and body temperature. Malfunction in any of these areas can produce symptoms that can be shared by numerous conditions. Doctors who are not familiar with POTS may dismiss these symptoms as lingering effects of COVID-19 or even psychological symptoms. At the same time, POTS can be very debilitating and requires specific treatment, so an accurate diagnosis is vital.

The research in this area is still ongoing. So far, there have been reports of people with mild COVID-19 symptoms developing POTS as well.

You should talk to your doctor if you have had COVID-19 and are experiencing ongoing symptoms, including:

Your doctor will first try to rule out other complications. We are being very careful with regard to diagnosing our patients with POTS, as we know COVID-19 can cause blood clots or scars in the lungs, which can cause similar symptoms as POTS but would require very different treatment, explains Chung.

At Johns Hopkins, we consult a team of doctors from physical medicine and rehabilitation, pulmonary and critical care medicine, and neurology, who work together to carefully rule out various causes of long-lasting symptoms from a COVID-19 infection says Chung. Once other lingering conditions are ruled out, you may be referred to a specialist to start the process of getting diagnosed with POTS.

At this point, there is no one standard approach to post-COVID patients with POTS-like symptoms, and treatment should be personalized, based on the diagnosis. If POTS is confirmed, we generally start aggressive hydration, dietary modifications and certain medications, says Chung.

Eventually, physical therapy is key, but it often takes months before patients respond to treatment sufficiently to be ready for a physical therapy regimen. I think dont give up is probably one of the most important principles of the treatment, Chung explains.

As with any viral infection, COVID-19 can temporarily worsen POTS symptoms, which could make recovery harder. Because this is a new disease, the long-term effects of COVID-19 in patients with POTS are not well known.

If you have POTS and contract COVID-19, you should work with your doctor to manage your symptoms while you recover, says Chung. This might include a temporary dosage increase for certain medications, as well as dietary adjustments.

The COVID-19 pandemic has created a unique research opportunity for physicians interested in POTS. In many patients with POTS, it can be difficult to pin down the cause of the condition. In patients with POTS after COVID-19, the cause is clear, and researchers will be able to compare these patients with those who recovered fully from the virus. Theres hope that this cohort of patients will help further research into treatment for all people suffering from POTS.

One of the main reasons that I started a clinic to help people with post-COVID POTS is research, says Chung. I am planning to develop many different research projects out of our clinic experience, so we can better understand and treat the long-lasting symptoms after COVID-19 infection.

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COVID-19 and POTS: Is There a Link? | Johns Hopkins Medicine

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