Post-acute COVID-19 syndrome - PubMed (original) (raw)

Review

. 2021 Apr;27(4):601-615.

doi: 10.1038/s41591-021-01283-z. Epub 2021 Mar 22.

Kartik Sehgal # 2 3 4, Aakriti Gupta 1 5 6, Mahesh V Madhavan 1 5, Claire McGroder 7, Jacob S Stevens 8, Joshua R Cook 9, Anna S Nordvig 10, Daniel Shalev 11, Tejasav S Sehrawat 12, Neha Ahluwalia 13, Behnood Bikdeli 14 5 6 15, Donald Dietz 16, Caroline Der-Nigoghossian 17, Nadia Liyanage-Don 18, Gregg F Rosner 1, Elana J Bernstein 19, Sumit Mohan 8, Akinpelumi A Beckley 20, David S Seres 21, Toni K Choueiri 22 23 14, Nir Uriel 1, John C Ausiello 9, Domenico Accili 9, Daniel E Freedberg 24, Matthew Baldwin 7, Allan Schwartz 1, Daniel Brodie 7, Christine Kim Garcia 7, Mitchell S V Elkind 10 25, Jean M Connors 14 26, John P Bilezikian 9, Donald W Landry 8, Elaine Y Wan 27

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Review

Post-acute COVID-19 syndrome

Ani Nalbandian et al. Nat Med. 2021 Apr.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.

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Figures

Fig. 1 |

Fig. 1 |. Timeline of post-acute COVID-19.

Acute COVID-19 usually lasts until 4 weeks from the onset of symptoms, beyond which replication-competent SARS-CoV-2 has not been isolated. Post-acute COVID-19 is defined as persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. The common symptoms observed in post-acute COVID-19 are summarized.

Fig. 2 |

Fig. 2 |. Interdisciplinary management in COVID-19 clinics.

Multidisciplinary collaboration is essential to provide integrated outpatient care to survivors of acute COVID-19 in COVID-19 clinics. Depending on resources, prioritization may be considered for those at high risk for post-acute COVID-19, defined as those with severe illness during acute COVID-19 and/or requirement for care in an ICU, advanced age and the presence of organ comorbidities (pre-existing respiratory disease, obesity, diabetes, hypertension, chronic cardiovascular disease, chronic kidney disease, post-organ transplant or active cancer). The pulmonary/cardiovascular management plan was adapted from a guidance document for patients hospitalized with COVID-19 pneumonia. HRCT, high-resolution computed tomography; PE, pulmonary embolism.

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