Post Acute Coronavirus (COVID-19) Syndrome

Link to article at PubMed

2021 May 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.


Coronavirus disease 2019 (COVID-19), the viral illness caused by the novel coronavirus SARS-CoV-2 has resulted in significant morbidity and mortality across the world since the first cases were identified in Wuhan China, in December 2019. Although the majority of the patients who contract COVID-19 are asymptomatic or have mild to moderate disease, approximately 5% to 8% of infected patients develop hypoxia, bilateral lung infiltrates, decreased lung compliance requiring non-invasive ventilation(NIV) or mechanical ventilatory support. The management of COVID-19 infection is mainly supportive. Although many therapeutics such as antiviral drugs (remdesevir), monoclonal antibodies (e.g., bamlanivimab/etesevimab, casirivimab/imdevimab), anti-inflammatory drugs (e.g., dexamethasone), immunomodulatory agents (e.g., baricitinib, tocilizumab) is available under emergency use authorization(EUA) for the management of COVID-19, the utility of these treatments varies based on the timing and severity of illness and/or certain risk factors.

The previous epidemics of SARS-CoV and MERS-CoV left individuals who recovered from these viral illnesses with persistent symptoms of severe fatigue, decreased quality of life (QOL), persistent shortness of breath, and behavioral health problems that resulted in a significant burden on local healthcare systems where the epidemics occurred. Similarly, a constellation of various clinical symptoms termed post-acute COVID-19 syndrome has been described in a minor proportion of patients who recovered from SARS-CoV-2 induced COVID-19 despite biochemical evidence that the replication of SARS CoV 2 ceases to exist after four weeks after the initial infection (based on the sampling of viral isolates from the respiratory tract and not the nasopharyngeal/oropharyngeal specimen).

Post-acute COVID-19 is a syndrome characterized by the persistence of clinical symptoms beyond four weeks from the onset of acute symptoms. The Center for Disease Control (CDC) has formulated "post-Covid conditions" to describe health issues that persist more than four weeks after being infected with COVID-19. These include

  1. Long Covid (which consists of a wide range of symptoms that can last weeks to months) or persistent post-Covid syndrome (PPCS)

  2. Multiorgan effects of COVID-19

  3. Effects of COVID-19 treatment/hospitalization

The typical clinical symptoms in "long covid" are tiredness, dyspnea, fatigue, brain fogginess, autonomic dysfunction, headache, persistent loss of smell or taste, cough, depression, low-grade fevers, palpitations, dizziness, muscle pain, and joint pains.

Multiorgan effects of COVID-19 include clinical manifestations pertaining to the cardiovascular, pulmonary, renal, and neuropsychiatric organ systems, although the duration of these multiorgan system effects is unclear.

Long-term "effects of COVID-19 treatment or hospitalization" are similar to other severe infections. They include post-intensive care syndrome(PICS), resulting in extreme weakness and posttraumatic stress disorder. Many of the patients with these complications from COVID-19 are getting better with time. Post COVID-19 care clinics are being opened at multiple medical centers across the USA to address these specific needs.

Based on the chronicity of symptoms post COVID-19 infection, Nalbandian et al. classified post-acute COVID-19 as follows-

  1. Subacute or persistent symptomatic COVID-19 symptoms (up to 12 weeks from the initial acute episode).

  2. Chronic or post-Covid syndrome, symptoms present beyond 12 weeks. However, it should not be attributable to an alternative diagnosis.

This review article describes the prevalence, system-based manifestations, relevant clinical investigations, treatment, and importance of an interprofessional team approach in the management of patients with post-acute COVID-19 syndrome.

PMID:34033370 | Bookshelf:NBK570608

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