Q&A: UC Davis’ Dr. Miriam Nuno On COVID-19’s Long-Term Health Impacts

Jun 24, 2020

Dealing with a new and deadly disease, physicians and scientists are both fighting COVID-19 and at the same time, trying to learn all they can about it to better our odds. Still there’s much we don’t know about its behavior and lethality. 

For a closer look at the statistics and what we’re learning about COVID-19’s long-term impacts, NSPR’s Marc Albert reached out to Dr. Miriam Nuno, an associate professor of biostatistics with a joint appointment in the department of surgery at UC Davis. 

Here are highlights from their conversation. You can also listen at the top of the page.

Interview Highlights

On why there’s a seemingly wide variation in the daily death toll from the coronavirus in California, while the number of new infections is much more stable

With death, the way deaths are captured, there's typically a one- to two-week delay from documentation to when the data is reported. Typically deaths are counted earlier and continuously revised over time for a couple weeks, and so there's quite a bit of variability in some of the way the data is captured.

On long-term health impacts of COVID-19

Most of the data that we have about the long-term impact from COVID-19 is coming from China, because they've seen this before. In general, most people recover completely with some residual coughs or shortness of breath. But there is a certain group of the population that has been reported to experience quite poor, long-term outcomes. Specifically individuals that experience and develop these acute Respiratory Distress Syndrome, a condition that describes an excessive lung damage. A couple of studies that come out of Wuhan, China, have shown that individuals that develop RDS tend to also experience what they call pulmonary fibrosis — which pretty much is holes in their lungs. And these complications from COVID-19 tends to have long-term effects. The severity of the symptoms vary across individuals, but some of the symptoms involves shortness of breath, cough, fatigue, you know, achy muscles and, in the older population, the symptoms are even more dramatic. 

On long-term consequences for those who have long ICU stays and those who live in nursing homes

Some other long-term consequences, a lot of individuals that go on extensive ICU care, there seems to be high level of reporting for mental health issues like PTSD, anxiety, depression, and clearly diminished physical abilities and cognitive impairment. There was one study that also looked at brain functioning as a result of prolonged ICU stay, and 30% of patients had neurological complications. For the US, individuals that we're seeing, we're just at the point of starting to look at that. But the impact these will have in the US population is still out in the air, but we're gonna expect that we're going to see high levels of impact. 

On long-term consequences for those who live in nursing homes

I do a lot of work on COVID-19 specifically for elderly individuals who live in long-term care facilities, and the long-term impact is going to be particularly very impactful in individuals living in these nursing homes. A lot of individuals that live in these nursing homes tend to have higher rates of chronic lung disease, heart disease, kidney and so many comorbidities that, you know, even though they survive their experience, that they have a path ahead of themselves. Being in these nursing homes just really puts them at a higher risk for long-term complications. So I think 65-plus individuals in nursing long-term care facilities are particularly vulnerable for the long-term impact of COVID-19. And I hope ourselves and some of our colleagues will be looking at that.

On indications that the virus will be worse in winter

I think there are some studies that have been pretty solid about the viability of the virus in cold conditions. But I think everyone that we've been chatting with, I think that winter is going to be probably the harder time to deal with this, because primarily, we know we definitely will have a lot of activity of flu-like illness, and there's a lot of seasonal variability that we see. 

But one of the things that we typically think of the winter is there's a lot of indoors contact, right. So one of the things of the summer is, I know, although people are connecting more, that at least we're in open spaces, but you know, when it gets cold, people tend to be more indoors. And so I would say, what I have been doing myself is trying to do as much as I can get in my outdoor activity out, because I do feel that we have to sort of prepare for probably that winter where most of us by that time will be tired of being isolated, we'll be tired of doing all these control measures. 

So you put all the pieces together and people just giving out on distancing, face mask, and then being indoors and then the flu season, and so I think there will be not weather alone, but multiple factors that are just going to probably make is a bit worse. I do think temperature is one of them. But it is a combination of factors that just all will convene to make this a worse situation, I believe.

On failing to meet prevention standards

When I think about the future and I look around myself, I was actually this past week, I visited my family in Riverside in a very contained environment. And I was shocked to see that in grocery stores, you have people walking around with no mask. I was shocked to see that there was a set of four firemen that came into the grocery store with no face mask. I was shocked. I live in Davis and I know in Davis we have a very different picture, but when we think about the future, I think this is where people are that — I do a lot of modeling and a lot of the modeling is based on people's behaviors, which is really, you know, impossible to predict. And so, I was watching my phone over the weekend when I was up there, and there's these continuous reports, cases in Riverside increase by 20-30% within a couple days, and then you go to the store and everyone is walking around with no masks. So I do think that there's just so many pieces to it that in the US we're just kind of failing to keep up with highest standards. 

On Taiwan’s success in limiting the spread of the virus

One example that I can think of, Taiwan is the one country that I believe has done things amazingly well from the very beginning. Fortunately, or unfortunately, they had a very bad SARS pandemic in 2003. So they had the opportunity to learn how to do things better. This time around with COVID-19, a population of 23 million individuals, they had 446 cases, seven deaths. And from day one, they say we're going to do mass, they had a lot of plastic barriers, they had sentences and fines for individuals that were ordering PPEs en masse, and they really have done super well in controlling them. 

It's been for a couple months where they have restaurants open, they're having a normal life, but they have continued to really follow each of the measures for prevention and I feel like we could do half of what they're doing. It's kind of amazing how they are just having a normal life with very, very small impact. But I think everyone's in a sort of, very high levels of solidarity and just doing everything that they need to be doing to prevent the infections. 

On why we’re seeing people become fatigued with following health guidance

I think it's lack of belief, which is hard to... I mean, I'm struggling myself to be able to answer this because like I mentioned I went to Riverside this past weekend, and I hear yesterday from my sister that my mom was in a casino. And I'm like, does she ... I mean, enclosed places are just very difficult, you know, movie theaters, bars, casinos. Those are the places we don't want to be. If we can move some of the restaurants to have food outdoors, I think that's fine. There's just so much variability in how people behave. And unfortunately, I think, as you mentioned, people are fatiguing and it's impossible to understand and I think part of this is that there's such mixed messaging from the very top, starting with our president, that there is just no consistent message and people are just fed up. And I think all of that has an impact on how effective we could be. 

This interview has been edited for brevity and clarity. Click the “play” button to listen to the entire interview.