AHA: Fauci Says Long-term Follow Up Needed to Understand COVID-19 Effects

Although 80% of those who develop coronavirus disease 2019 (COVID-19) have mild to moderate cases, this is no guarantee that a constellation of symptoms—from fatigue, to shortness of breath, to “brain fog,”—won’t linger for weeks or months after patients recover, the nation’s best-known infectious disease expert said today.

Understanding the symptoms patients feel—and the cardiac effects they can’t see—will be important going forward, according to Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, who spoke to the American Heart Association Scientific Sessions Tuesday.

Fauci, who is now serving his sixth US president, kicked off a symposium on COVID-19 and cardiovascular health with his talk, “COVID-19: Public Health and Scientific Challenges,” which traced where the SARS-CoV-2 virus fits in the framework of coronaviruses that experts have battled in recent decades, and how it has exploded across the globe with such potent ferocity.

“Here we are now with a global pandemic of historic proportions, the likes of which we have not seen in the last 102 years since the now-iconic outbreak of the pandemic of 1918,” he said. “Currently, there are close to 50 million cases with 1.2 million deaths worldwide. In the United States, we have been hit the hardest of any other country with close to 10 million cases.”

Good news in therapeutics—including remdesivir and dexamethasone, which now appear in clinical guidelines—as well lightning speed progress in vaccines offer hope, he said. Fauci appeared as news comes that both Pfizer and Moderna have messenger RNA vaccines that report efficacy rates of 90% or higher. More vaccines using different technologies are in the pipeline. Of great importance, he said, companies involved in Operation Warp Speed have adopted a common data and safety monitoring board and common end points to give FDA and other government officials the ability “to bridge one study to another.”

But despite the progress, Fauci’s frustration with the failure to use basic public health tools was obvious. Later in the day, he would say in an interview that he should have tried harder to “push the envelope” on mass COVID-19 testing early in the pandemic. He told a STAT forum that he raised the issue, but his advice was not needed.

The basics—wearing masks or cloth coverings, social distancing, avoiding crowds, conducting activities outdoors when possible, and hand-washing—would still work if adhered to, “universally and consistently across the country.”

Heart disease specialists are doing some of the most important work studying COVID-19’s effects, as they treat patients most at risk of severe disease, then track what happens them afterward. It’s clear that while age offers the biggest risk factor for severe illness from COVID-19, certain chronic conditions are equally dangerous.

“Paramount among this is obesity, and chronic obstructive pulmonary disease, as well as other conditions such as chronic heart conditions, and hypertension,” Fauci said. Being overweight, but not obese, still confers some risk.

COVID-19 damages organ systems and causes cardiovascular complications, including thromboembolic phenomena and cardiomyopathies. “If you look at the manifestations of severe COVID-19, they are plentiful.” Fauci said. “I mentioned the cardiac ones, but they're also acute respiratory distress syndrome. There is kidney injury, neurological injury, a hypercoagulable state manifested by microthrombosis in small vessels and acute thrombotic phenomenon, sometimes seen in otherwise well, young individuals.”

Inflammation is seen children and in previously healthy teens and young adults. Fauci highlighted several cardiology papers in reviewing the pandemic’s fallout in less obvious ways. He pointed to a German study that appeared in JAMA Cardiology, in which magnetic resonance imaging (MRI) found signs of myocardial inflammation in 78 of 100 patients recovered from COVID-19.

“This needs to be repeated in other labs and followed up,” Fauci said. “But if it’s true, it’s something we need long-term follow up, because this may be clinically inconsequential, or it could lead to chronic effects.”

A separate JAMA Cardiology study tested college athletes and found 15% had myocarditis, likely linked to SARS-CoV-2 exposure, he said.

The racial and ethnic disparities revealed in COVID-19 are “quite serious.” COVID-19 hospitalization rates are 3-4 times higher among Black and Latino populations compared with Whites, Fauci said, due to higher rates of comorbidities but also due to the types of jobs that minority workers tend to hold.

He emphasized the need for prevention until a vaccine is available, which Fauci said is coming. When vaccines are available, the first ones will go to high priority groups such as healthcare workers, “and then ultimately, to virtually everybody in the United States as we get several months into 2021.”