1932

Abstract

An estimated 10–15% of those infected with SARS-CoV-2 may have post-COVID-19 condition. Common lingering signs and symptoms include shortness of breath, fatigue, high heart rate, and memory and cognitive dysfunction even several months after infection, often impacting survivors’ quality of life. The prevalence and duration of individual symptoms remain difficult to ascertain due to the lack of standardized research methods across various studies and limited patient follow-up in clinical studies. Nonetheless, data indicate post-COVID-19 condition may occur independent of acuity of initial infection, hospitalization status, age, or pre-existing comorbidities. Risk factors may include female sex and underlying respiratory or psychiatric disease. Supportive therapies to mitigate symptoms remain the mainstay of treatment. Reassuringly, most patients experience a reduction in symptoms by 1 year. The use of a universal case definition and shared research methods will allow for further clarity regarding the pervasiveness of this entity and its long-term health consequences.

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/content/journals/10.1146/annurev-med-043021-030635
2023-01-27
2024-04-26
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Literature Cited

  1. 1.
    Nalbandian A, Sehgal K, Gupta A et al. 2021. Post-acute COVID-19 syndrome. Nat. Med. 27:4601–15
    [Google Scholar]
  2. 2.
    WHO 2022. WHO Coronavirus (COVID-19) Dashboard Accessed Apr. 1, 2022. https://covid19.who.int/
  3. 3.
    Subbaraman N. 2021. US health agency will invest $1 billion to investigate ‘long COVID.. Nature 591:7850356
    [Google Scholar]
  4. 4.
    Natl. Inst. Health Care Excel. (NICE), Scott. Intercoll. Guidel. Netw. (SIGN), R. Coll. Gen. Pract. (RCGP) 2022. COVID-19 rapid guideline: managing the long-term effects of COVID-19. Ver 1.14, Jan. 3 Guidance, NICE, SIGN, RCGP https://www.nice.org.uk/guidance/ng188/resources/covid19-rapid-guideline-managing-the-longterm-effects-of-covid19-pdf-51035515742
  5. 5.
    Soriano JB, Murthy S, Marshall JC et al. 2022. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect. Dis. 22:4e102–7
    [Google Scholar]
  6. 6.
    Vehar S, Boushra M, Ntiamoah P et al. 2021. Post-acute sequelae of SARS-CoV-2 infection: caring for the “long-haulers. .” Cleveland Clin. J. Med. 88:5267–72
    [Google Scholar]
  7. 7.
    Huang L, Yao Q, Gu X et al. 2021. 1-Year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet 398:10302747–58
    [Google Scholar]
  8. 8.
    Fumagalli C, Zocchi C, Tassetti L et al. 2022. Factors associated with persistence of symptoms 1 year after COVID-19: a longitudinal, prospective phone-based interview follow-up cohort study. Eur. J. Intern. Med. 97:36–41
    [Google Scholar]
  9. 9.
    Taquet M, Dercon Q, Luciano S et al. 2021. Incidence, co-occurrence, and evolution of long-COVID features: a 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLOS Med 18:9e1003773
    [Google Scholar]
  10. 10.
    Vanichkachorn G, Newcomb R, Cowl CT et al. 2021. Post-COVID-19 syndrome (long haul syndrome): description of a multidisciplinary clinic at Mayo Clinic and characteristics of the initial patient cohort. Mayo Clin. Proc. 96:71782–91
    [Google Scholar]
  11. 11.
    Lund LC, Hallas J, Nielsen H et al. 2021. Post-acute effects of SARS-CoV-2 infection in individuals not requiring hospital admission: a Danish population-based cohort study. Lancet Infect. Dis. 21:101373–82
    [Google Scholar]
  12. 12.
    Seessle J, Waterboer T, Hippchen T et al. 2021. Persistent symptoms in adult patients one year after COVID-19: a prospective cohort study. Clin. Infect. Dis. 74:71191–98
    [Google Scholar]
  13. 13.
    Williams S, Wynford-Thomas R, Robertson NP. 2021. Long-COVID: neurological manifestations and management. J. Neurol. 268:124915–17
    [Google Scholar]
  14. 14.
    Zimmermann P, Pittet LF, Curtis N 2021. How common is long COVID in children and adolescents?. Pediatr. Infect. Dis. J. 40:12e482–87
    [Google Scholar]
  15. 15.
    Magnusson K, Skyrud KD, Suren P et al. 2022. Healthcare use in 700 000 children and adolescents for six months after covid-19: before and after register based cohort study. BMJ 376:e066809
    [Google Scholar]
  16. 16.
    Stephenson T, Pinto Pereira SM, Shafran R et al. 2022. Physical and mental health 3 months after SARS-CoV-2 infection (long COVID) among adolescents in England (CLoCk): a national matched cohort study. Lancet Child Adolesc. Health 6:4230–39
    [Google Scholar]
  17. 17.
    Zhao YM, Shang YM, Song WB et al. 2020. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. eClinicalMedicine 25:100463
    [Google Scholar]
  18. 18.
    Taboada M, Moreno E, Carinena A et al. 2021. Quality of life, functional status, and persistent symptoms after intensive care of COVID-19 patients. Br. J. Anaesth. 126:3e110–13
    [Google Scholar]
  19. 19.
    Augustin M, Schommers P, Stecher M et al. 2021. Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg. Health Eur. 6:100122
    [Google Scholar]
  20. 20.
    Montani D, Savale L, Noel N et al. 2022. Post-acute COVID-19 syndrome. Eur. Respir. Rev. 31:163210185
    [Google Scholar]
  21. 21.
    Torres-Castro R, Vasconcello-Castillo L, Alsina-Restoy X et al. 2021. Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis. Pulmonology 27:4328–37
    [Google Scholar]
  22. 22.
    Li X, Shen C, Wang L et al. 2021. Pulmonary fibrosis and its related factors in discharged patients with new corona virus pneumonia: a cohort study. Respir. Res. 22:1203
    [Google Scholar]
  23. 23.
    Wu X, Liu X, Zhou Y et al. 2021. 3-Month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir. Med. 9:7747–54
    [Google Scholar]
  24. 24.
    Morin L, Savale L, Pham T et al. 2021. Four-month clinical status of a cohort of patients after hospitalization for COVID-19. JAMA 325:151525–34
    [Google Scholar]
  25. 25.
    Al-Aly Z, Xie Y, Bowe B. 2021. High-dimensional characterization of post-acute sequelae of COVID-19. Nature 594:7862259–64
    [Google Scholar]
  26. 26.
    Ayoubkhani D, Khunti K, Nafilyan V et al. 2021. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 372:n693
    [Google Scholar]
  27. 27.
    Dani M, Dirksen A, Taraborrelli P et al. 2021. Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clin. Med. 21:1e63–67
    [Google Scholar]
  28. 28.
    Larsen NW, Stiles LE, Miglis MG. 2021. Preparing for the long-haul: autonomic complications of COVID-19. Auton. Neurosci. 235:102841
    [Google Scholar]
  29. 29.
    Puntmann VO, Carerj ML, Wieters I et al. 2020. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol 5:111265–73
    [Google Scholar]
  30. 30.
    Raman B, Bluemke DA, Luscher TF et al. 2022. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur. Heart J. 43:111157–72
    [Google Scholar]
  31. 31.
    Joy G, Artico J, Kurdi H et al. 2021. Prospective case-control study of cardiovascular abnormalities 6 months following mild COVID-19 in healthcare workers. JACC Cardiovasc. Imaging 14:112155–66
    [Google Scholar]
  32. 32.
    Vago H, Szabo L, Dohy Z et al. 2021. Cardiac magnetic resonance findings in patients recovered from COVID-19: initial experiences in elite athletes. JACC Cardiovasc. Imaging 14:61279–81
    [Google Scholar]
  33. 33.
    Daniels CJ, Rajpal S, Greenshields JT et al. 2021. Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: results from the Big Ten COVID-19 Cardiac Registry. JAMA Cardiol 6:91078–87
    [Google Scholar]
  34. 34.
    Moulson N, Petek BJ, Drezner JA et al. 2021. SARS-CoV-2 cardiac involvement in young competitive athletes. Circulation 144:4256–66
    [Google Scholar]
  35. 35.
    Moody WE, Liu B, Mahmoud-Elsayed HM et al. 2021. Persisting adverse ventricular remodeling in COVID-19 survivors: a longitudinal echocardiographic study. J. Am. Soc. Echocardiogr. 34:5562–66
    [Google Scholar]
  36. 36.
    Cassar MP, Tunnicliffe EM, Petousi N et al. 2021. Symptom persistence despite improvement in cardiopulmonary health—insights from longitudinal CMR, CPET and lung function testing post-COVID-19. eClinicalMedicine 41:101159
    [Google Scholar]
  37. 37.
    Singh I, Joseph P, Heerdt PM et al. 2022. Persistent exertional intolerance after COVID-19: insights from invasive cardiopulmonary exercise testing. Chest 161:154–63
    [Google Scholar]
  38. 38.
    Mancini DM, Brunjes DL, Lala A et al. 2021. Use of cardiopulmonary stress testing for patients with unexplained dyspnea post-coronavirus disease. JACC Heart Fail. 9:12927–37
    [Google Scholar]
  39. 39.
    Korompoki E, Gavriatopoulou M, Fotiou D et al. 2022. Late-onset hematological complications post COVID-19: an emerging medical problem for the hematologist. Am. J. Hematol. 97:1119–28
    [Google Scholar]
  40. 40.
    Davis HE, Assaf GS, McCorkell L et al. 2021. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. eClinicalMedicine 38:101019
    [Google Scholar]
  41. 41.
    Graham EL, Clark JR, Orban ZS et al. 2021. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers. .” Ann. Clin. Transl. Neurol. 8:51073–85
    [Google Scholar]
  42. 42.
    Robinson-Lane SG, Sutton NR, Chubb H et al. 2021. Race, ethnicity, and 60-day outcomes after hospitalization with COVID-19. J. Am. Med. Dir. Assoc. 22:112245–50
    [Google Scholar]
  43. 43.
    Nolen LT, Mukerji SS, Mejia NI. 2022. Post-acute neurological consequences of COVID-19: an unequal burden. Nat. Med. 28:120–23
    [Google Scholar]
  44. 44.
    Renaud M, Thibault C, Le Normand F et al. 2021. Clinical outcomes for patients with anosmia 1 year after COVID-19 diagnosis. JAMA Netw. Open 4:6e2115352
    [Google Scholar]
  45. 45.
    Lancet Neurol. 2021. Long COVID: understanding the neurological effects. Lancet Neurol. 20:4247
    [Google Scholar]
  46. 46.
    Renaud-Charest O, Lui LMW, Eskander S et al. 2021. Onset and frequency of depression in post-COVID-19 syndrome: a systematic review. J. Psychiatr. Res. 144:129–37
    [Google Scholar]
  47. 47.
    Bowe B, Xie Y, Xu E et al. 2021. Kidney outcomes in long COVID. J. Am. Soc. Nephrol. 32:112851–62
    [Google Scholar]
  48. 48.
    Chan L, Chaudhary K, Saha A et al. 2021. AKI in hospitalized patients with COVID-19. J. Am. Soc. Nephrol. 32:1151–60
    [Google Scholar]
  49. 49.
    Huang C, Huang L, Wang Y et al. 2021. 6-Month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 397:10270220–32
    [Google Scholar]
  50. 50.
    McMahon DE, Gallman AE, Hruza GJ et al. 2021. Long COVID in the skin: a registry analysis of COVID-19 dermatological duration. Lancet Infect. Dis. 21:3313–14
    [Google Scholar]
  51. 51.
    Mehta P, Bunker CB, Ciurtin C et al. 2021. Chilblain-like acral lesions in long COVID-19: management and implications for understanding microangiopathy. Lancet Infect. Dis. 21:7912
    [Google Scholar]
  52. 52.
    Natalello G, De Luca G, Gigante L et al. 2021. Nailfold capillaroscopy findings in patients with coronavirus disease 2019: broadening the spectrum of COVID-19 microvascular involvement. Microvasc. Res. 133:104071
    [Google Scholar]
  53. 53.
    Sollini M, Ciccarelli M, Cecconi M et al. 2021. Vasculitis changes in COVID-19 survivors with persistent symptoms: an [18F]FDG-PET/CT study. Eur. J. Nucl. Med. Mol. Imaging 48:51460–66
    [Google Scholar]
  54. 54.
    Garrigues E, Janvier P, Kherabi Y et al. 2020. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J. Infect. 81:6e4–6
    [Google Scholar]
  55. 55.
    Kim J, Hong K, Gómez Gómez RE et al. 2021. Lack of evidence of COVID-19 being a risk factor of alopecia areata: results of a national cohort study in South Korea. Front. Med. 8:758069
    [Google Scholar]
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