As the COVID-19 pandemic moves into the survivorship phase, questions regarding long-term lung damage remain unanswered. Previous histopathological studies are limited to autopsy reports. We studied lung specimens from COVID-19 survivors who underwent elective lung resections to determine whether post-acute histopathological changes are present.
In this multicenter observational study, we included adult COVID-19 survivors (n=11) who had recovered but subsequently underwent unrelated elective lung resection for indeterminate lung nodules or lung cancer. We compared these to an age- and procedure-matched control group who never contracted COVID-19 (n=5), and an end-stage COVID-19 group (n=3). A blinded pulmonary pathologist examined the lung parenchyma focusing on four compartments: airways, alveoli, interstitium, and vasculature.
Eleven COVID-19 survivors with asymptomatic (n=4), moderate (n=4), and severe (n=3) COVID-19 infections underwent elective lung resection at a median 68.5 days (range 24-142) after COVID-19 diagnosis. The most common operation was lobectomy (75%). On histopathological examination, no differences were identified between the lung parenchyma of COVID-19 survivors and controls across all compartments examined. Conversely, patients in the end-stage COVID-19 group showed fibrotic diffuse alveolar damage with intra-alveolar macrophages, organizing pneumonia, and focal interstitial emphysema.
In this first study to examine the lung parenchyma of COVID-19 survivors, we did not find distinct post-acute histopathological changes to suggest permanent pulmonary damage. These results are reassuring for COVID-19 survivors who recover and become asymptomatic.

Copyright © 2021. Published by Elsevier Inc.