An Irish doctor on the journey from Aids to long Covid: ‘The suffering was monumental’

Mario Kinsella left Ireland in 1986 to get further training and experience in pulmonary medicine in Vancouver, on Canada's Pacific coast. He went with his wife, Deirdre, who is originally from Mallow, Co Cork, and their six-week old daughter, Caroline. Their son, Mark, was born in Vancouver. Deirdre has now retired, Caroline is a corporate lawyer in New York and Mark also lives in New York, where he is a banker.

After going to Pittsburgh, in the United States, where he worked for 23 years in private practice as a pulmonary, sleep and critical-care physician, Kinsella went to Erie, on the shores of the Great Lake of the same name, in 2015. There he set up a new pulmonary program at UPMC Hamot, a 429-bed teaching hospital affiliated with the University of Pittsburgh. The hospital now has four physicians, two nurse practitioners and two physician assistants covering a variety of pulmonary, critical-care and sleep disorders.

Kinsella knows five physicians who have contracted Covid-19. One, in his 40s, had a double lung transplant last week. Another, a heart surgeon who is originally from Limerick, made a full recovery

In the US most hospital patients are cared for by a “hospitalist”, a specialist in hospital medicine. As a result, most Covid-19 patients are not seen by pulmonary specialists, unless they become very ill, in which case they are sent to ICU and taken care of by ICU specialists. Consequently, Kinsella’s exposure to acutely ill patients with Covid-19 has been limited. What he is seeing, however, is a “greatly increasing number of patients with residual disease secondary to Covid”. This is now one of the most common reasons for referral to a pulmonary physician in Erie, he says. He has seen a dramatic increase in this patient group since the beginning of the year. Kinsella believes this will be the most common reason patients are referred to his practice by this summer.

Although the number of acute Covid-19 cases is declining in northwest Pennsylvania, he says, the number of chronic Covid-19 patients – those with so-called long Covid – is increasing dramatically. Not much long-term data is available, as the disease is only a year old, but Kinsella knows five physicians who have contracted Covid-19. One, who is in his 40s, received a double lung transplant last week, he says. Another, a heart surgeon who is originally from Limerick, made a full recovery. An ICU physician has persistent shortness of breath several months in, and two hospitalists have recovered fully.

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This is a rapidly evolving situation, says Kinsella. “The disease and its long-term consequences are changing as we learn new information and gain new experience and insights into this disease.”

If we suspect we are halfway through this pandemic, then we can expect 60 million infections, so 20 million people in the US may have some long-term symptoms

Kinsella and his team think that Covid patients who have persistent lung symptoms may have some degree of recovery after a year, but “we don’t really know”. He thinks it may take up to a year, because the lungs of patients who have had acute respiratory distress syndrome, or Ards, can improve for up to a year afterwards. The severe lung inflammation and destruction from Covid-19 are like those seen in Ards, he says.

It is not known what percentage of patients will develop long-term symptoms after Covid-19 infection, but recent data suggests up to one-third may do, he says. So far, the United States has had 30 million people infected with Covid-19. “If we suspect we are halfway through this pandemic, then we can expect 60 million infections, so 20 million people in the US may have some long-term symptoms.”

Kinsella thinks this area will provide great opportunities for young researchers, and he is sure that it would be “a fascinating area of research for a young investigator with an interest in pulmonary medicine”.

When he lived in Vancouver, from 1986 to 1989, the Aids epidemic was at its height in Canada, and Vancouver was its epicentre. "That was a new disease at the time, and there were no effective treatments or preventive measures available once one got infected. The suffering and sadness experienced by those infected, and their loved ones, was monumental and stirred research into prevention, treatment and control. Aids is now controllable, like other chronic diseases such as diabetes."

He thinks the same will eventually be true for Covid-19, but “the lingering effects, suffering and long-term disability will be on a massive scale. This will likely last for about 30 to 40 years, until all those infected have died,” he says.

There is no effective public-health system in the US, which was one reason for the disastrous response to the pandemic by the Trump administration. Americans like to see themselves as individuals, not as a community

Kinsella does not think the American health system is equipped to deal with public-health issues or chronic disease. “There is no effective public-health system in the US, which was one reason for the disastrous response to the pandemic by the Trump administration. There is no centralised planning for emergencies such as Covid-19. There is a good health system for individuals, but not for the community. Americans like to see themselves as individuals, not as a community.”

Kinsella and his team are giving Covid patients breathing-function tests, using radiology imaging and enrolling those with residual lung impairment in aggressive outpatient pulmonary-rehabilitation programmes. “Such programmes consist primarily of controlled exercise and education, to return the patient to as good a functional state as possible.”

No known medications are yet available for long-term disease caused by Covid-19, he says, but he is confident these will emerge within the next couple of years.

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