250 days and counting: Waiting on new lungs after Covid

While most Americans are shedding their masks and returning to their pre-pandemic lives, Marie Jackson remains in a Chicago hospital room.

She has been there for more than 250 days.

There is no indication yet when Jackson, 53, will be able to go home. She’s waiting on a new pair of lungs; hers were irreversibly scarred when she was sickened by Covid-19 last July.

While new Covid hospitalizations are down to their lowest point in the pandemic, Jackson is one of the estimated hundreds of patients who, despite getting sick months ago, remain hospitalized. Their lungs simply cannot heal without mechanical ventilation or other intensive care, such as extracorporeal membrane oxygenation.

ECMO, as it’s called, does the work of the heart and lungs for patients too sick to pump blood and breathe on their own.

Such technology can sustain patients for months, and indeed, many patients have been on ECMO since last summer’s delta wave — at least 10 months in some cases.

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But it’s not a permanent solution. ECMO can cause complications, such as infection and blood clots. ICU clinicians work to wean their patients off of ECMO, but sometimes the patient’s body is unable to sustain itself without it. When a patient cannot be weaned from ECMO, new lungs from a donor are necessary.

“You can’t go home on ECMO. You can’t even leave the ICU,” said Dr. Hugh Cassiere, medical director for the cardiothoracic intensive care unit at North Shore University Hospital, part of Northwell Health in New York.

“If you require ECMO for respiratory failure, your only ticket out is through lung transplantation,” he said.

As of February, more than 10 percent of new patients on the lung transplant waiting list wound up there because of Covid, according to data from the United Network for Organ Sharing.

And just over 10 percent of 2,510 lung transplants performed from March 2021 to February have been Covid-related, according to the UNOS data, collected on behalf of NBC News.

Historically, lung transplants have been limited to chronic lung diseases, such as cystic fibrosis, rather than viral infections.

“The need for lung transplantation from patients who have had Covid is really striking,” Dr. David Klassen, chief medical officer for UNOS, said, particularly “for a disease that hasn’t been here very long.”

Covid, it seems, is leading to the need for lung transplantation in two ways. One is a severe complication called acute respiratory distress syndrome, which generally lands people in the ICU early on and can lead to ECMO.

The other is a condition called pulmonary fibrosis. These are often Covid patients who had some degree of lung damage, but who never needed hospitalization.

In these cases, the lung damage persists and progresses over time, sometimes for months. That’s worrisome to Klassen.

“This suggests that there could be a developing need out there that we have yet to appreciate,” Klassen said. “That may increase substantially over time as the millions of people who have Covid continue to recover or not from their illness.”

The vast majority of people currently on the lung transplant waiting list because of Covid are relatively young, between 35 and 64, according to UNOS.

Anecdotally, intensive care physicians still taking care of such patients say their lungs were healthy before their Covid diagnosis.

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