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This review describes the epidemiology, pathophysiology, and knowledge gaps of post–acute coronavirus 2019 (COVID-19) syndrome, defined as persistent and/or delayed long-term complications beyond 4 weeks from the onset of symptoms.
Highlights of the authors' findings regarding post–acute COVID-19 syndrome include a significant association between severity of acute COVID-19 disease and development of the post-acute syndrome, fatigue and dyspnea comprising the most common of multiple possible symptoms, consistent reports of significant impacts on quality of life and functional capacity, and the need for more specific objective data (such as imaging findings and serologic markers) to define the syndrome and its phases.
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.
Nat. Med. 2021 Mar 22;[EPub Ahead of Print], A Nalbandian, K Sehgal, A Gupta, MV Madhavan, C McGroder, JS Stevens, JR Cook, AS Nordvig, D Shalev, TS Sehrawat, N Ahluwalia, B Bikdeli, D Dietz, C Der-Nigoghossian, N Liyanage-Don, GF Rosner, EJ Bernstein, S Mohan, AA Beckley, DS Seres, TK Choueiri, N Uriel, JC Ausiello, D Accili, DE Freedberg, M Baldwin, A Schwartz, D Brodie, CK Garcia, MSV Elkind, JM Connors, JP Bilezikian, DW Landry, EY Wan