Long term consequences of COVID-19

On March 11, 2020, the coronavirus disease-2019 (COVID-19) was declared a pandemic by World Health Organization (WHO). While mainly affecting the respiratory system to the point of causing severe acute respiratory syndrome (SARS), COVID-19 might also affect the cardiac, neurological, haematological and renal systems. With estimates indicating a fatality rate under 0.20%[[1]Ioannidis JPA Infection fatality rate of COVID-19 inferred from seroprevalence data.Bull World Health Organ. 2021; 99: 19-33Fhttps://doi.org/10.2471/BLT.20.265892Crossref PubMed Scopus (190) Google Scholar], the focus of the disease is shifting toward patients with COVID-19 who experience persistent symptoms for longer than 3-4 weeks (long COVID can also be found as post-acute COVID-19, chronic post-COVID and long-haul COVID)[[2]Callard F Perego E How and why patients made Long Covid.Soc Sci Med. 2021; 268https://doi.org/10.1016/j.socscimed.2020.113426Crossref PubMed Scopus (313) Google Scholar]. However, with new symptoms being dynamically added to the condition, the name and definition are bound to change [3Nath A Long-Haul COVID.Neurology. 2020; 95: 559-560https://doi.org/10.1212/WNL.0000000000010640Crossref PubMed Scopus (96) Google Scholar, 4Davis HE Assaf GS McCorkell L Wei H Low RJ Re'em Y et al.Characterizing long COVID in an international cohort: 7 months of symptoms and their impact.MedRxiv. 2020; (2020.12.24.20248802)https://doi.org/10.1101/2020.12.24.20248802Crossref Scopus (0) Google Scholar, 5The LancetFacing up to long COVID.Lancet. 2020; 396: 1861https://doi.org/10.1016/S0140-6736(20)32662-3Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar]. Long COVID can also affect most systems in the body, and thus requires a multifaceted approach to effectively manage the physical, cognitive, psychological and social components of this health condition. [6Carfì A Bernabei R Landi F Persistent symptoms in patients after acute COVID-19.JAMA - J Am Med Assoc. 2020; 324: 603-605https://doi.org/10.1001/jama.2020.12603Crossref PubMed Scopus (2311) Google Scholar, 7Mahase E Covid-19: What do we know about “long covid”?.BMJ. 2020; 370https://doi.org/10.1136/bmj.m2815Crossref Scopus (281) Google Scholar, 8Halpin S O'Connor R Sivan M Long COVID and chronic COVID syndromes.J Med Virol. 2021; 93: 1242-1243https://doi.org/10.1002/jmv.26587Crossref PubMed Scopus (85) Google Scholar]. In the UK, the Royal College of General Practitioners anticipates a continuous influx of patients with long COVID [[9]Greenhalgh T Knight M A'Court C Buxton M Husain L Management of post-acute covid-19 in primary care.BMJ. 2020; 370https://doi.org/10.1136/bmj.m3026Crossref Scopus (794) Google Scholar]. The most recent studies show that after acute COVID-19 infection, one in five people has persistent symptoms after 5 weeks and one in ten has symptoms for 12 weeks or longer. A Italian study reported that after recovering from COVID-19, 13% of 143 people were completely free of any symptoms, while one or two, or three or more symptoms persisted in 32% and 55% patients, respectively [[6]Carfì A Bernabei R Landi F Persistent symptoms in patients after acute COVID-19.JAMA - J Am Med Assoc. 2020; 324: 603-605https://doi.org/10.1001/jama.2020.12603Crossref PubMed Scopus (2311) Google Scholar]. Significantly, two fifths of patients reported a worsened quality of life [[7]Mahase E Covid-19: What do we know about “long covid”?.BMJ. 2020; 370https://doi.org/10.1136/bmj.m2815Crossref Scopus (281) Google Scholar]. A systematic review and meta-analysis published in this journal shows that post-covid symptoms, mainly fatigue and dyspnoea, are present in more than 60% of persons previously infected by SARS-CoV-2 [[10]Fernández-de-las-Peñas César Palacios-Ceña Domingo Gómez-Mayordomo Victor Florencio Lidiane Cuadrado Maria L Plaza-Manzano Gustavo Navarro-Santana M Prevalence of Post-COVID Symptoms in Hospitalized and Non-Hospitalized COVID-19 Survirvors: A Systematic Review and Meta-Analysis.Eur J Intern Med. 2021; https://doi.org/10.1016/j.ejim.2021.06.009Abstract Full Text Full Text PDF PubMed Scopus (191) Google Scholar]. Research in Long COVID regarding risk factors, pathophysiology, consequences and sequelae is increasing. Similarly, the number of guidelines written in collaboration with national institutions and patients’ associations is growing [[11]Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE n.d. https://www.nice.org.uk/guidance/ng188 (accessed May 18, 2021).Google Scholar]. These guidelines aim to be dynamic and comprehensive, periodically updating with results of new research.[[11]Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE n.d. https://www.nice.org.uk/guidance/ng188 (accessed May 18, 2021).Google Scholar,[12]Venkatesan P NICE guideline on long COVID.Lancet Respir Med. 2021; 9: 129https://doi.org/10.1016/S2213-2600(21)00031-XAbstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar] [[13]Nova guia clínica per atendre les persones amb COVID-19 persistent. gencat.cat n.d. https://web.gencat.cat/ca/actualitat/detall/Nova-guia-clinica-per-atendre-les-persones-amb-COVID-19-persistent (accessed May 18, 2021).Google Scholar] The voice of patients who report excellent health and good quality of life pre-Long COVID conveys desperation at worsening symptoms. The list of persisting and new symptoms described by patients is extensive, including persistent cough, breathing difficulty, chest tightness, cognitive dysfunction and extreme fatigue. Some describe the cyclic nature of the condition, where some symptoms improve while others worsen [[3]Nath A Long-Haul COVID.Neurology. 2020; 95: 559-560https://doi.org/10.1212/WNL.0000000000010640Crossref PubMed Scopus (96) Google Scholar]. Many can be considered neurological symptoms, namely: “brain's in fog”; “can't remember the name”; “can't concentrate”; “my head pounds”. Other non-specific neurological symptoms, which often occur with fatigue and breathlessness, include headaches, dizziness and cognitive blunting[3]. The psychological and psychiatric symptoms experienced by patients with Long COVID such as depression, anxiety, post-traumatic symptoms and cognitive impairment could be attributed to psychological factors and neurobiological injury. Symptoms such as anosmia, ageusia, dizziness, headache and seizures may persist for a long time after the acute COVID-19 illness [[14]Sher L COVID-19, anxiety, sleep disturbances and suicide.Sleep Med. 2020; 70: 124https://doi.org/10.1016/j.sleep.2020.04.019Crossref PubMed Scopus (201) Google Scholar,[15]Sher L The impact of the COVID-19 pandemic on suicide rates.QJM. 2020; 113: 707-712https://doi.org/10.1093/QJMED/HCAA202Crossref PubMed Scopus (535) Google Scholar]. Living with the stress of Long COVID has also affected the mental health of many patients, who have most commonly experienced insomnia and anxiety[[16]Kingstone T Taylor AK O'Donnell CA Atherton H Blane DN Chew-Graham CA Finding the ‘right’ GP: a qualitative study of the experiences of people with long-COVID.BJGP Open. 2020; 4: 1-12https://doi.org/10.3399/bjgpopen20X101143Crossref Scopus (112) Google Scholar]. In Spain, the most common symptoms have affected the ability to carry out activities of daily living: 75% find it difficult to spend time with friends, 72% working outside the home and 70% declare having difficulty attending family responsibilities. In Long COVID, mental Illness is strongly associated with the social determinants model, which underscores the negative impact of poverty, discrimination and social exclusion. Only a minority of patients have the opportunity of being referred to mental health services. It is thus crucial to strengthen mental health services, community resources and informal support groups. A recent report describes the importance of accessible care for patients with complex needs, mental health services and other social interventions such as financial advisers [[9]Greenhalgh T Knight M A'Court C Buxton M Husain L Management of post-acute covid-19 in primary care.BMJ. 2020; 370https://doi.org/10.1136/bmj.m3026Crossref Scopus (794) Google Scholar]. Patient organizations and patient participation are instrumental in defining and providing solutions to Long COVID. In Spain, these organizations have emphasized wellbeing, social connection, self-care, peer support and symptom control. Patient groups have also emerged in other countries such as Italy, France, England and the United States. Support groups have also been set up in the wider net to assist with physical, mental and social concerns (mostly legal and occupational-related, see https://www.wearebodypolitic.com/covid19). Currently, researchers use self-reported surveys internationally to collect data on this condition. There is an evidence to argue that Long COVID is the first illness to be described by patients on Twitter and other social media fora. Data from the patients’ perspective to better describe Long COVID syndrome are urgently needed [[5]The LancetFacing up to long COVID.Lancet. 2020; 396: 1861https://doi.org/10.1016/S0140-6736(20)32662-3Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar]. Large, long-term cohort studies should elucidate disease trajectory, complications, and biological mechanisms that underlie the long-term consequences of COVID-19. No conflict of interest has been declared by the author(s). We confirm that the manuscript has not been submitted or is not simultaneously being submitted elsewhere, and that no portion of the data has been published in proceedings or transactions of meetings or symposium volumes. The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysisEuropean Journal of Internal MedicineVol. 92PreviewThe world is suffering a dramatic situation of catastrophic proportions due to the rapid worldwide spread of the coronavirus disease 2019 (COVID-19) caused by the pathogen acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. Symptoms associated with SARS-CoV-2 infection are heterogeneous and affect different systems such as respiratory (cough, sore throat, rhinorrhea, dyspnea), musculoskeletal (myalgias), gastrointestinal (diarrhoea, vomiting), and neurological (headaches, myopathy, ageusia, anosmia) [2]. Full-Text PDF