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COVID Lung: Are COVID-19 patient's lungs worse than smokers?

A pulmonary critical care doctor breaks down how lung damage of recovering COVID-19 patients compares to lung damage from habitual smoking.

SAN DIEGO — We are a year into the coronavirus pandemic and researchers are still learning more about the long-term effects of the virus. One of the effects  is often referred to as “COVID lung.”

Some are comparing the lungs of COVID-19 patients to that of long-time smokers.

Recently, a tweet from a woman who says she's a trauma surgeon and ICU doctor got a lot of buzz online. "I don't know who needs to hear this, but 'post-Covid' lungs look worse than any type of terrible smoker's lungs we've seen," she wrote. "And they collapse. And they clot off. And the shortness of breath lingers on... & on... & on." 

Do people who recover from COVID have worse lung damage than long-time smokers?

They can be, but not in all cases.

Scott Eisman is a pulmonary critical care doctor and chief operating executive at Scripps Memorial Hospital Encinitas.

"We've had a number of patients who have had this. Typically it happens more commonly in patients who had a more severe version of COVID. For example, people who were on a ventilator for a long time or people who were on high levels of oxygen, which is what we call high flow oxygen," Eisman said.

An x-ray of healthy lungs shows mostly black, which is air. In a smoker's lungs, white lines are signs of scarring and congestion. Meanwhile, an x-ray of Covid lungs looks almost completely white.

Dr. Eisman noted that smoking versus COVID causes two different types of injuries. "And it's both this ongoing problem with the blood clotting and the structure of the lung being affected that is thought to create a long-term effect with COVID," he said.

In some cases, Dr. Eisman said that while a patient's x-ray may look bad, they feel fine. "It is true that in a certain number of people with COVID, they actually feel a lot better than their x-rays and they're not as symptomatic as you might think for that kind of radiographic abnormality but we've also had it the other way where people are very short of breath, very low on oxygen levels, and their x-ray is not all that overwhelming," he said.

For those with COVID  lung, can the condition be reversed?

"Yes, they can repair themselves. We don't know how frequently that happens or what the optimal therapy is for that," Eisman said.

Meanwhile, with smokers, it's a permanent condition. "A person who has had damage to their lung from chronic cigarette inhalation, that will not get better," he said.

Credit: Panagis Galiatsatos
Dr. Panagis Galiatsatos emailed the Verify team an example of what normal lungs, COVID-19 lungs and Smoker's lungs look like with an x-ray

Keep in mind, researchers are learning more daily. The doctor who posted the COVID lung tweet followed up with another tweet. “A reminder-this is my personal experience, not a trial or nationwide data. ”

Still, Dr. Eisman says it's a good reminder to not just think about whether you'll survive COVID-19, but also the long-term effects of it. "We hear people focusing on things like the mortality of COVID and saying, well it's low in younger people," Eisman said. "It is true.  But the consequences if you develop one of these long-term conditions can be really devastating for you and your family."

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