By now we all know that the novel coronavirus severe acute respiratory syndrome 2 is the illness caused by the SARS-CoV-2 virus. By far, the SARS‐CoV‐2 is said to have affected over 15 million individuals across the globe. The virus typically affects the respiratory system with symptoms of high temperature, sore throat, coughing, and shortness of breath. But little did we know that COVID-19 has some serious implications on the hepatic health of a human being.
Since the liver is a prime organ for human immunity, those who have severe medical conditions, especially hepatic concerned with that of the liver, might have a greater risk of COVID-19, regardless of their age.
Recent liver tests following COVID-19 diagnosis have shown signs of liver abnormalities in a large number of patients which leads to suggesting that COVID-19 causes at least a low-level of hepatitis if not chronic.
While there may not be any jaundice, but lab tests show significant liver dysfunction. This may not cause severe liver disease in people who have a strong liver, but may cause hepatic failure in case the liver is already weak due to other morbidities.
Given the fact that the SARS-COV-1 (a coronavirus discovered in 2003) reportedly led to the liver impairment in up to 60% of patients, we can also deduce that the novel coronavirus (SARS-CoV-2) which has 80% genetic similarity to the preceding strain i.e. SARS-CoV-1 can harm the liver to a significant extent, if not fully. While COVID-19 may not show full-fledged symptoms at times, liver dysfunction and hepatitis are the only clues, because more than 4 in 5 people who have symptoms of COVID-19 get only mildly sick.
However, older-age people who are at a higher risk of COVID-19 and have comorbidities such as cardiovascular anomalies, metabolic abnormalities, diabetes, obesity, and hypertension may also be at a higher risk for underlying liver disease, especially the nonalcoholic fatty liver disease.
Hepatitis as Symptom of Coronavirus?
Such an instance of liver injury riding on top of COVID‐19–related ailment presents a significant challenge to the doctors. Firstly, because there is the ambiguity of an undiagnosed liver condition that has affected the patient prior to COVID. Secondly, due to the fact that most of the medications that are used to treat severe diseases can be toxic for the liver. Moreover, there can be many factors that determine how the liver injury will shape up, especially in patients who have undergone severe illness in the past.
People should know that hepatitis in any form should also be considered as the virus’ initial symptom, even prior to the respiratory symptoms showing up.
In such a scenario, those patients who show signs of hepatitis should also be tested for COVID-19 and kept in complete isolation under observation. Further, the observational data should be leveraged to analyse if this is really the case in SARS COV-2 too, and also ascertain the frequency of such occurrences of liver anomalies throughout the tenure of the pandemic.
Patients with a history of liver abnormalities such as fatty liver disease, or cirrhosis, should be very cautious and take necessary precautionary measures to protect themselves from a possible coronavirus infection.
They should also take a well-balanced diet with a mix of healthy food and good exercise, take necessary vaccinations as specified by their physicians and avoid the temptation of consuming alcohol.
(Dr Deepak Lahoti is the Director, Department of Gastroenterology, Max Super Specialty Hospital, Patparganj.)
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