{"id":2461,"date":"2021-08-19T13:52:52","date_gmt":"2021-08-19T13:52:52","guid":{"rendered":"http:\/\/wp.cov19longhaulfoundation.org\/?p=2461"},"modified":"2021-08-19T13:52:52","modified_gmt":"2021-08-19T13:52:52","slug":"post-acute-covid-19-syndrome","status":"publish","type":"post","link":"https:\/\/cov19longhaulfoundation.org\/?p=2461","title":{"rendered":"Post-acute COVID-19 syndrome"},"content":{"rendered":"\n<ul class=\"wp-block-list\"><li>Authors: <a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#auth-Ani-Nalbandian\">Ani Nalbandian<\/a>,&nbsp;<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#auth-Kartik-Sehgal\">Kartik Sehgal<\/a>,&nbsp;<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#auth-Elaine_Y_-Wan\">Elaine Y. Wan<\/a>&nbsp;<a href=\"https:\/\/www.nature.com\/nm\"><em>Nature Medicine<\/em><\/a>&nbsp;<strong>volume&nbsp;27<\/strong>,&nbsp;pages601\u2013615 (2021)<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Abs1\">Abstract<\/h2>\n\n\n\n<p style=\"font-size:24px\"><strong>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\u2009weeks 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.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Sec1\">Main<\/h2>\n\n\n\n<p style=\"font-size:24px\"><strong>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen responsible for coronavirus disease 2019 (COVID-19), has caused morbidity and mortality at an unprecedented scale globally<sup><a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR1\">1<\/a><\/sup>. Scientific and clinical evidence is evolving on the subacute and long-term effects of COVID-19, which can affect multiple organ systems<sup><a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR2\">2<\/a><\/sup>. Early reports suggest residual effects of SARS-CoV-2 infection, such as fatigue, dyspnea, chest pain, cognitive disturbances, arthralgia and decline in quality of life<sup><a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR3\">3<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR4\">4<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR5\">5<\/a><\/sup>. Cellular damage, a robust innate immune response with inflammatory cytokine production, and a pro-coagulant state induced by SARS-CoV-2 infection may contribute to these sequelae<sup><a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR6\">6<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR7\">7<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR8\">8<\/a><\/sup>. Survivors of previous coronavirus infections, including the SARS epidemic of 2003 and the Middle East respiratory syndrome (MERS) outbreak of 2012, have demonstrated a similar constellation of persistent symptoms, reinforcing concern for clinically significant sequelae of COVID-19 (refs.\u00a0<sup><a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR9\">9<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR10\">10<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR11\">11<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR12\">12<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR13\">13<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR14\">14<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR15\">15<\/a><\/sup>).<\/strong><\/p>\n\n\n\n<p style=\"font-size:24px\"><strong>Systematic study of sequelae after recovery from acute COVID-19 is needed to develop an evidence-based multidisciplinary team approach for caring for these patients, and to inform research priorities. A comprehensive understanding of patient care needs beyond the acute phase will help in the development of infrastructure for COVID-19 clinics that will be equipped to provide integrated multispecialty care in the outpatient setting. While the definition of the post-acute COVID-19 timeline is evolving, it has been suggested to include persistence of symptoms or development of sequelae beyond 3 or 4\u2009weeks from the onset of acute symptoms of COVID-19 (refs.\u00a0<sup><a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR16\">16<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR17\">17<\/a><\/sup>), as replication-competent SARS-CoV-2 has not been isolated after 3\u2009weeks<sup><a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR18\">18<\/a><\/sup>. For the purpose of this review, we defined post-acute COVID-19 as persistent symptoms and\/or delayed or long-term complications of SARS-CoV-2 infection beyond 4\u2009weeks from the onset of symptoms (Fig.\u00a0<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#Fig1\">1<\/a>). Based on recent literature, it is further divided into two categories: (1) subacute or ongoing symptomatic COVID-19, which includes symptoms and abnormalities present from 4\u201312\u2009weeks beyond acute COVID-19; and (2) chronic or post-COVID-19 syndrome, which includes symptoms and abnormalities persisting or present beyond 12\u2009weeks of the onset of acute COVID-19 and not attributable to alternative diagnoses<sup><a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR17\">17<\/a>,<a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z#ref-CR19\">19<\/a><\/sup>. Herein, we summarize the epidemiology and organ-specific sequelae of post-acute COVID-19 and address management considerations for the interdisciplinary comprehensive<\/strong> <strong>care of these patients in COVID-19 clinics\u00a0<\/strong><\/p>\n\n\n\n<p class=\"has-large-font-size\">For More Information: <a href=\"https:\/\/www.nature.com\/articles\/s41591-021-01283-z\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nature.com\/articles\/s41591-021-01283-z<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Authors: Ani Nalbandian,&nbsp;Kartik Sehgal,&nbsp;Elaine Y. Wan&nbsp;Nature Medicine&nbsp;volume&nbsp;27,&nbsp;pages601\u2013615 (2021) 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 [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":2463,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59,988,92,107,990,169,289,882],"tags":[],"class_list":["post-2461","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-brain-fog","category-chest-pain","category-coagulation","category-cytokine-storm-covid-19","category-dyspnea","category-fatigure","category-long-haul-disease","category-myalgia-muscle-pain"],"_links":{"self":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/2461","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2461"}],"version-history":[{"count":0,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/2461\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/media\/2463"}],"wp:attachment":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2461"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2461"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2461"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}