Health consequences of COVID infection may be both immediate and long-term. The most serious immediate consequence is obviously death. COVID infective surges in various countries with highly-organised health systems have now resulted in much lower mortality rates.

A higher proportion of the infected are now younger people whose immune system is far more efficient at dealing with the virus. Serious complications in children are very rare but they can transmit it to susceptible adults. Doctors have also learned to treat seriously ill patients much better.

Autopsies overseas have found there are two main potentially fatal pathologies of COVID infection. One is a pneumonia caused by viral damage to vital parts of the lungs where oxygen enters and carbon dioxide leaves the blood. The second is viral damage to the inner lining of blood vessels, causing blood clotting (thrombosis) in various vital organs.

Unlike other coronaviruses, COVID has the ability of damaging blood vessels and setting off this dangerous complication of blood clotting which can knock out the functioning of vital organs and cause strokes. An ‘overreaction’ of the immune system (‘cytokine storm’) may also make matters worse by ‘self-harm’.

Learning all this, doctors have fine-tuned ventilator protocols to cause less damage to lungs, and to try and anticipate and treat with anti-coagulants virus-induced blood-clotting.

A UK trial of Dexamethasone versus placebo found this old, cheap, anti-inflammatory corticosteroid reduced the death rate in the seriously ill by about 30 per cent, presumably by reducing lung damage and dampening immune system overreaction.

No other claimed treatments have been proven by clinical trial to substantially reduce mor­tality, although an American pharmaceutical company is claiming their new monoclonal antibody drug can halt COVID viral spread in the body and hasten recovery. It may be expected to be expensive and has already gained global awareness with the broadcasting of the US presi­dent’s treatment regime.

Such drugs raise a serious ethical problem – the rationing of medical services. Whom do we offer a potentially life-saving, but relatively ‘scarce’, medication?

Besides lung damage and blood-clotting problems, another early serious COVID complication, fortunately uncommon, is a direct viral inflammatory damage to heart muscle (myocarditis), resulting in heart failure. This potentially fatal myocarditis may occasionally occur with other viruses.

I remember carrying out an autopsy in London in the 1970s on an unfortunate Boeing 747 captain who went into intractable heart failure following a claimed feverish flu-like episode. His heart muscle was completely withered and scarred – end-stage myocarditis.

Susceptibility to COVID complications has highlighted obesity as a disease state in its own right

COVID infection may also have longer-term complications. These have tended to occur in previously seriously ill patients who took a long time to recover, but they apparently have also been recorded in some patients with mild symptoms.

Fatigue and mental fog is one such occurrence. It may occur with other viral infections. The symptoms are very similar to those of so-called ‘chronic fatigue syndrome’, a condition many doctors previously attributed to a psychiatric condition, but which is now regarded as almost certainly a post-viral consequence, as it is usually preceded by a feverish flu-like illness.

Other longer-term complications have been various aches and pains, lingering breathlessness and, sometimes, lung scarring. The overall frequency of these sequelae has been estimated at around one in a hundred infected individuals.

A further worrying prospect for this autumn and winter is possible double infections, with flu and COVID viruses, which it is estimated would more than double the risk of death. Flu alone contributes to anything between 15,000 and 70,000 deaths in Europeans, depending on the severity of the virus that year. The flu vaccine is, therefore, especially recommendable this year, particularly so for vulnerable groups, the elderly, those whose immune system is depressed due to disease or medi­cation, diabetics and the overweight or outright obese.

The overweight and obese are a vulnerable group at any age. In the UK, one of the extremely small number of children who have died from COVID complicating their pre-existing condition, was a ‘normal’ child whose only abnormality was obesity.

Overweight/obesity is very frequently associated with dia­betes, a complex metabolic alteration negatively affecting  many body systems. Susceptibility to COVID complications has again highlighted obesity as a disease state in its own right and, even more serious, that it is the ‘mother’ of the most important life-shortening pathologies, being a very significant risk factor for heart attacks, strokes and several cancers.

It has been debated whether ethnicity or poverty is responsible for increased susceptibility to a bad COVID infection outcome. A German academic genetics institution recently claimed that the more Neanderthal genes a population group has, the less efficient is its immune system to deal with COVID infection. It claimed that Europeans tend to have about four per cent Neanderthal genes but Southeast Asians, in particular, have more. Africans would be expected to have none as modern man has emerged from Africa. This might account for the rela­tively low death rate from COVID in Africa, where health services are not the most advanced in the world.

A study in the US, however, claims that poverty is more important than ethnicity in COVID infection outcomes. The crammed living conditions of the poor and, for example, their more frequent use of public transport and the more frequent front-line high risk of infection jobs they are assigned to, are claimed to be the main factors for high COVID infective and mortality rates in non-whites.

In spite of all the above considerations, until we have an effective vaccine against COVID, our only armamentarium against getting infected is the mask (properly applied), social distancing and frequent hand-washing. This will also protect us from flu infection, hitting two birds with one stone.

Are there any food supplements that could improve our immune system? There is now some published evidence and recommendation to take a daily vitamin D3 supplement of about 2,000 iu (over-the-counter from pharmacist). Taking a substantially larger daily dose in postmenopausal women may make osteoporosis worse and raise blood calcium levels. The calcium may end up in coronary arterial walls, so these women should not exceed that dose.

Vitamin C and zinc supplementation has also been recorded in the past to shorten the course of viral respiratory infections.

Pure fish oil capsules are probably the number one food supplement for overall health. Marine omega-3 supple­mentation offers anti-inflammatory, blood triglyceride- lowering and anti-coagulant benefits. It would need to be used with caution in patients on warfarin. That’s all we presently know about this area of nutritional medicine.

Albert Cilia-Vincenti is a patholo­gist and a former London and Malta medical school teacher and scientific delegate to the European Medicines Agency.  

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