Post-acute Sequelae in COVID-19 Survivors: an Overview

Abstract

In the acute phase of SARS-CoV-2 infection, varying degrees of clinical manifestations have been noticed in patients. Some patients who recovered from the infection developed long-term effects which have become of interest to the scientific and medical communities, as it relates to pathogenesis and the multidisciplinary approach to treatment. Long COVID (long-term or long-haul) is the collective term used to define recovered individuals of SARS-CoV-2 infection who have presented with persistent COVID symptoms, as well as the emergence of disorders and complications. Following the review of literature from major scientific databases, this paper investigated long COVID and the resulting post-sequela effects on survivors, regardless of initial disease severity. The clinical manifestations and multisystem complications of the disease specifically, cardiovascular, neurologic and psychologic, hematologic, pulmonary, dermatologic, and other ailments were discussed. Patients with chronic COVID-19 were found to experience heart thrombosis leading to myocardial infarction, inflammation, lung fibrosis, stroke, venous thromboembolism, arterial thromboembolism, “brain fog”, general mood dysfunctions, dermatological issues, and fatigue. As the disease continues to progress and spread, and with the emergence of new variants the management of these persisting symptoms will pose a challenge for healthcare providers and medical systems in the next period of the pandemic. However, more information is needed about long COVID, particularly concerning certain patient populations, variability in follow-up times, the prevalence of comorbidities, and the evolution of the spread of infection. Thus, continued research needs to be conducted concerning the disease pathology to develop preventative measures and management strategies to treat long COVID.

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“…Long-lasting neurological consequences after SARS-CoV-2 infection negatively impacts the brain and CNS in anatomical regions known to be targeted by neurodegenerative events, as is observed throughout all phases of the AD continuum (Lingor et al, 2022;Lukiw et al, 2022;Piekut et al, 2022;Sirin et al, 2022;Szabo et al, 2022). Pre-existing neurological conditions and pathological interactions among the brain, central and peripheral nervous systems (CNS, PNS) and respiratory, cardiovascular and endocrine systems further modulate and/or impact the severity and long-term sequelae of the post-COVID-19 syndrome period (Kallet et al, 2019;Horn et al, 2021;Zuin et al, 2021;Molina-Molina and Hernández-Argudo, 2022;Sanyaolu et al, 2022;Stefanou et al, 2022;Visco et al, 2022). Our recent appreciation that many intractable and invariably fatal neurodegenerative disorders including AD that involve protein misfolding, aggregation and spread are prion disorders provides another dimension for the invasion of SARS-CoV-2, however the interaction between viral structure and infectivity and changes in protein conformation and aggregation are not well understood (Carlson and Prusiner, 2021;Lukiw, 2022b).…”

“…COVID-19 associated ocular manifestations have been also documented to include a wide range of ophthalmic symptoms associated with eye irritation (chemosis), conjunctivitis, conjunctival hyperemia, anterior uveitis, retinitis, and optic neuritis and in advanced COVID-19 infection with visual and perception disturbances including visual disorientation and hallucinations, especially in elderly COVID-19 patients (Hill et al, 2021;Hixon et al, 2021;Lin et al, 2021;Reinhold et al, 2021;Al-Namaeh, 2022;Lukiw, 2022a,b). Accumulating evidence indicates an especially high prevalence of prolonged neurological symptoms among COVID-19 survivors and most of these afflictions and neurological disruptions persist as the long-term neurological sequelae of COVID-19 also known as "long COVID" or "post-COVID-19 syndrome" (Nepal et al, 2020;Song et al, 2020;Ahmed et al, 2022;Sanyaolu et al, 2022;Visco et al, 2022; Figure 1).…”

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“…Persistent symptoms may include hypotension, tachycardia, palpitations, dyspnoea and arrhythmias 47 , 48 , 49 , 50 , with some requiring hospital readmission 51 . There are increased risks of incident cardiovascular disease, such as cerebrovascular disorders (stroke/transient ischaemic attacks), dysrhythmia (atrial fibrillation/sinus tachycardia), ischaemic heart disease (acute coronary disease/myocardial infarction/angina), thromboembolic disease (pulmonary embolism/deep vein thrombosis), heart failure, pericarditis, myocarditis, cardiac arrest and cardiogenic shock 49 , 52 , 53 , 54 , 55 , 56 . Long-term sequelae may include increased cardiometabolic demand, myocardial fibrosis or scarring, arrhythmias, tachycardia and autonomic dysfunction, as in POTS described above 6 .…”

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“…According to a meta-analysis, pandemic sufferers continue to have poor quality of life with immunodeficient, oncologic patients and patients with co-morbidities more prone to stress [ [7] , [8] , [9] , [10] ]. Till now, Long COVID-19 has been referred to occurrence of persistent mild symptoms for up to six months or beyond as dyspnea, fatigue and anosmia while severe complications including lung fibrosis, MI, arterial/venous thrombosis and dermatological issues in COVID-19 recovered individuals [ 11 , 12 ].…”