(Review by Dr Craig Roberts)

 Effects of COVID-19 infection

COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person’s immune system, age, and comorbidities. Symptoms can range from mild, such as cough, shortness of breath, and fevers, to critical disease, including respiratory failure, shock, and multi-organ system failure.

Although COVID-19 is seen as a disease that primarily affects the lungs, it can damage many other organs as well. This organ damage may increase the risk of long-term health problems.

Body systems that may be affected by COVID-19 include:

Heart: Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscle, even in people who experienced only mild COVID-19 symptoms.

Blood clots and blood vessel problems: COVID-19 can make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from very small clots that block tiny blood vessels (capillaries). Parts of the body affected by blood clots include the lungs, legs, liver, and kidneys.

Lungs: The type of pneumonia often associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue and fibrosis can lead to long-term breathing problems. A major issue with COVID-19 is with gas exchange in the alveolus. 

Brain: Even in young people, COVID-19 can cause strokes, seizures, and Guillain-Barre syndrome — a condition that causes temporary paralysis. COVID-19 may also increase the risk of developing Parkinson’s disease and Alzheimer’s disease.

Long term effects of COVID-19 infection

People who have severe symptoms of COVID-19 often have to be treated in a hospital’s intensive care unit, with mechanical assistance such as ventilators to breathe. Simply surviving this experience can make a person more likely to later develop post-traumatic stress syndrome, depression, and anxiety.

Many long-term effects of COVID-19 are still unknown. Several surveys conducted in the U.S. and Italy are showing that only 39% of those who had been hospitalized reported a return to baseline health by 14-21 days after diagnosis. Similarly, in a study of 143 patients hospitalized for COVID-19, only 13% were symptom-free after a mean of 60 days following disease onset.

The most common symptoms were shortness of breath (43%) and fatigue (53%). Even with milder infections, patients can still have prolonged symptoms. At this stage scientists are still unsure as to if COVID-19 infection can cause long term lung damage; data from severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS) suggests that as many as 50% of people who have had COVID-19 may have some permanent residual lung damage and reduction in lung function.

Rehabilitation from COVID-19 infection

The short-term goal of pulmonary rehabilitation is to alleviate dyspnoea (shortness of breath) and relieve anxiety and depression, while the long-term goal is to preserve the patient’s function to the maximum extent, improve his/her quality of life, and facilitate his/her return to society.

Early ground-breaking research at Oxford and Sheffield University using hyperpolarised xenon MRI to measure gas transfer in the lungs suggests that the ability to transfer oxygen from the lungs into the bloodstream when breathing is visibly impaired for some time, even after hospital discharge following COVID-19 pneumonia. Therefore, it is not surprising that a cornerstone of long post-COVID-19 rehabilitation has been identified around the world (Mayo Clinic, British Thoracic Society, World Health Organisation) to include a dedicated respiratory muscle and lung function conditioning program.

The X-lung® is ideally suited to facilitate this as part of a post-COVID-19 respiratory training program. It has a direct effect on respiratory muscle training through the resistance filters and the magnetic energy transfer through the inhaled oxygen in the air has potential benefits on trans-alveolar oxygen transfer, and research has shown increased red blood cell count and haemoglobin concentration in a significant number of research participants. Many post- COVID-19 patients have reported significant improvement in breathlessness and lung function after using the X-lung® as part of their rehabilitation program.

Post-COVID-19 or “long COVID-19” patients who struggle with persistent dyspnoea, usually due to lung fibrosis or scarring, are often at their maximum respiratory threshold even at rest. Even small percentage gains in respiratory function and cardiovascular health by using the X-lung® may be enough to move them out of a state of persistent dyspnoea to a much more functional state of health. The principals are the same as improving athletic function and we anticipate seeing these changes in our post-COVID-19 rehabilitation studies.

In addition, we are also in the process of setting up studies to investigate the benefits of using the X-lung® as an in-line device when delivering oxygen to respiratory compromised COVID-19 patients, as the theoretical benefits of the paramagnetic oxygen moving into the lungs and alveolar gas transfer may be substantial.

Risk mitigation/COVID-19 severity reduction

Although we are still unsure why certain patients are more susceptible to severe COVID-19 Infection, it is very clear that patients who have underlying lung disease or poor residual lung function are far more susceptible to developing severe complications from COVID-19. This is largely due to the fact they have very little reserve lung capacity when their lung function is compromised through COVID-19 infection. Regular use of the X-lung® has been shown to improve lung capacity and function. This is an area that needs further research, but the possibility exists that the X-lung® may increase lung function enough to assist in cases of “Long Covid”.