SALT LAKE CITY — An Intermountain Healthcare cardiologist on Tuesday estimated a large proportion of COVID-19 cases — including those who didn’t require hospitalization — could experience heart damage from the virus.

© Jeffrey D. Allred, Deseret News
University of Utah Health medical assistant Taylor Gilmore wears a cooling bandana around her neck as she tests for COVID-19 in Farmington on Friday, July 31, 2020. University of Utah Health is using cooling methods at its testing stations to keep employees comfortable during the extreme heat.

“Before reviewing some of the recent studies, I would’ve said maybe 10% have evidence of heart damage. But I think we’re going to elevate that estimate in the short term to maybe, my guess, 30-50%,” said Dr. Kirk Knowlton, director of cardiovascular research at Intermountain Healthcare and chairman of Intermountain Medical Center’s cardiovascular department.

“And long term, I hope it’s much less than that. I hope it’s back into the single-digit percent, but we don’t really don’t even know yet. People can recover from viruses, that’s one thing we’ve learned — even heart damage can recover from viral infection.”

Heart damage, including blood clots and inflammation, has been discovered in COVID-19 patients as early as the original outbreak in Wuhan, China, said Knowlton, whose research has focused on viruses that cause heart disease.

“Most viruses have been implicated in heart disease. The incidence varies, the severity varies, but viruses can cause heart disease,” he explained.

In a review of existing research, which was published in the Journal of Molecular and Cellular Cardiology, Knowlton found that heart damage has been identified in about 20-30% of hospitalized COVID-19 patients, he said.

“When they had heart disease (from COVID-19), their prognosis was much worse,” according to Knowlton, who noted they had a higher likelihood of requiring intubation and potentially dying.

The information comes as more Utahns who consider themselves “long-haulers” — those experiencing long-term effects after COVID-19 infections — are speaking out. They’ve described experiencing palpitations, elevated heart pressure and other symptoms months after they were considered recovered from COVID-19.

Extensive research on heart damage in COVID-19 patients, however, has been difficult “partly because I think people have not been anxious to necessarily perform sophisticated studies or even autopsies on people who are infected partly because of the risks of infection to other individuals,” Knowlton said.

Even after recovering from their infections, many patients have had blood clots in their lungs, legs, arteries and veins, Knowlton said. Clotting may occur due to an infection of the covering of the veins, or inflammation caused by the virus.

“When there’s generalized global inflammation … a lot of other organs get infected by it including the clotting system, perhaps the heart, the lungs, etc. And then there’s just the stress of having COVID-19, or if there’s some underlying heart disease that already exists,” he said.

The cardiologist says he’s helped a number of post-COVID-19 patients who weren’t hospitalized during their infections, but who are experiencing heart palpitations, reduced exercise capacity, and inflammation in the covering of the heart. Long-term monitoring will be needed to determine whether the heart damage in patients ends up being long term or resolves itself over time, Knowlton said.

“I think we’re just starting to see the tip of the iceberg of that population, because they don’t have access to all those tests, they’re just at home trying to get better from this disease process,” Knowlton said.

“I’d hate to think that half of everyone that has COVID-19 is going to end up with some myocardial damage. In the long run, we don’t know a year from now what that will look like, whether they’ll perfectly recover or not, but I think it adds a new dimension to this concept of COVID-19,” Knowlton said.

New York City’s Mount Sinai hospital system has created a post-COVID-19 clinic for those dealing with long-term symptoms. Knowlton called a similar measure a “long-term possibility” in Utah, but said he hopes the state won’t need it as the pandemic is “subsiding” in the state.

The long-term damage being discovered due to COVID-19 should encourage people to take the disease seriously, Knowlton said.

“Maybe there’s another parameter that we have to think about. And that is related to could there be long-term effects in other organs? … And we don’t know, truly, even the long-term effects on the lung. And so I think it gives us cause for pause to think about the importance of preventing the disease, which is mask-wearing, washing our hands, social distancing,” Knowlton said.

New cases

Utah health officials reported 263 new COVID-19 cases on Tuesday and five additional deaths.

The cases were confirmed out of 4,721 tests, with a 5.6% positive rate, according to the Utah Department of Health. They bring the state’s total since the pandemic began to 47,157 cases of 606,516 people tested, with an overall positive rate of 7.8%.

On Monday, the lowest number of daily new coronavirus cases were confirmed since early June, with just under 250.

The rolling seven-day average for new cases is 341 per day, and the average positive test rate is 8.8%. Currently, 134 patients in Utah are hospitalized with the disease, five fewer than on Monday.

The five deaths reported Tuesday bring the state’s toll to 369. They include: a Salt Lake County man between the ages of 25 and 44 who was hospitalized when he died; a Salt Lake County woman between 45-64, who was a long-term care resident; a Salt Lake County woman between 65-84, who was not hospitalized when she died; a Box Elder County man older than 85, who was a long-term care resident; and a Weber County woman between 65-84, who was hospitalized before she died.

About 38,500 of the state’s cases are considered recovered after surviving the three-week point since their diagnoses, meaning fewer than 10,000 now have active infections.

The latest breakdown of Utah cases, hospitalizations and deaths by health district:

Salt Lake County, 21,951; 1,429 hospitalized; 215 deaths. Utah County, 9,576; 441 hospitalized; 39 deaths. Davis County, 3,442; 196 hospitalized; 21 deaths. Southwest Utah, 3,358; 189 hospitalized; 26 deaths. Weber-Morgan, 3,019; 190 hospitalized; 26 deaths. Bear River (Box Elder, Cache, Rich), 2,405; 115 hospitalized; 8 deaths. Summit County, 758; 53 hospitalized; 1 death. San Juan County, 656; 88 hospitalized; 26 deaths. Tooele County, 623; 30 hospitalized; 0 deaths. Wasatch County, 600; 24 hospitalized; 4 deaths. Central Utah, 495; 26 hospitalized; 2 deaths. TriCounty (Uinta Basin), 192; 16 hospitalized; 0 deaths. Southeast Utah, 118; 7 hospitalized; 1 death.

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