BackgroundThe COVID-19 pandemic follows SARS and MERS coronavirus epidemics. Some survivors of COVID-19 infection experience persistent respiratory symptoms, yet their cause and natural history remains unclear. Follow-up after SARS and MERS may provide a model for predicting the long-term pulmonary consequences of COVID-19.MethodsThis systematic review and meta-analysis aims to describe and compare the longitudinal pulmonary function test (PFT) and computed tomography (CT) features of patients recovering from SARS, MERS and COVID-19. Meta-analysis of PFT parameters (DerSimonian and Laird random effects model) and proportion of CT features (Freeman-Tukey transformation random effects model) were performed.FindingsPersistent reduction in the diffusing capacity for carbon monoxide (DLco) following SARS, and COVID-19 infection is seen at 6 months follow-up and 12 months after MERS. Other PFT parameters recover in this time. 6 months after SARS and COVID-19, ground-glass opacity (GGO), linear opacities and reticulation persist in over 30% of patients; honeycombing and traction dilatation reported less. Severe/ critical COVID-19 infection leads to greater CT and PFT abnormality compared to mild/ moderate infection.InterpretationPersistent diffusion defects suggestive of parenchymal lung injury occur after SARS, MERS and COVID-19 infection, but improve over time. After COVID-19 infection, CT features are suggestive of persistent parenchymal lung injury, in keeping with a post-COVID-19 interstitial lung syndrome (PCOILS) – it is yet to be determined if this is a regressive or progressive disease.

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