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Nature medicine: Pay attention to COVID-19 post-acute syndrome

 Last Update: 2021-04-14
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SARS-CoV-2 is the pathogen that caused the COVID-19 pandemic, leading to a global medical crisis and a shortage of health resources.

SARS-CoV-2 led to 19 COVID- COVID 19- pandemic pathogens, leading global medical crises and health resource constraints.

The scientific and clinical evidence for the subacute and long-term effects of COVID-19 is evolving, and it can affect multiple organ systems.

Post - acute COVID-19 timeline.

Based on recent studies, is further divided into two categories : (1) sub-acute or persistent subacute or persistent COVID-19 COVID-19 symptoms symptoms , including acute COVID-19 after 4--12 weeks symptoms and abnormalities ; ( 2) chronic or chronic or COVID-19 COVID-19 syndrome after the syndrome , including acute COVID-19 attack 12 weeks after the occurrence of symptoms and persistent abnormal or can not be attributed to other diagnosis .

Summary of changes in various organ systems of COVID-19 post-acute syndrome Summary of changes in various organ systems of COVID-19 post-acute syndrome

lung

Pulmonary lung

• Difficulty breathing , decreased exercise capacity and hypoxia are common and persistent symptoms and signs

• During the follow-up of COVID-19 survivors, it was found that the spreading ability was weakened , the lung physiology was restricted, and the ground glass shadow and fibrosis were affected.

• progression of lung disease and functional recovery assessment may include family or pulse oximeter, 6 MWTS , PFTs , high resolution chest CT , pulmonary vascular vascular CT angiography.

Blood system blood system

• A retrospective study found that acute COVID-19 there after thrombotic embolic event rate of <5%

• A retrospective study found that acute COVID-19 there after thrombosis incidence of thromboembolic events thrombotic <5%

• The duration of the hyperinflammatory state caused by SARS-CoV-2 infection is unknown

• After discussing the risk - benefit of patients who are susceptible to immobility, d- dimer levels that continue to rise ( more than twice the upper limit of normal ), and other high-risk comorbidities ( such as cancer ) , direct oral anticoagulants may be considered And low molecular weight heparin is used for thrombosis prevention .

medsci.

• Persistent symptoms may include palpitations, difficulty breathing, chest pain

• Long-term sequelae may include increased cardiovascular metabolic demands, myocardial fibrosis or scars ( can be detected by cardiac MRI ) , medsci.

• Long-term sequelae may include increased cardiovascular metabolic requirements, myocardial fibrosis or scars ( can be detected by cardiac MRI ) , medsci.

•Patients with cardiovascular complications or persistent cardiac symptoms during acute infection can be monitored through clinical follow-up, echocardiography and ECG follow-up

Neuropsychiatric

Neuropsychiatric Neuropsychiatric

• Persistent abnormalities may include fatigue, myalgias, headaches, neurological abnormalities and cognitive impairment

• Similar to other pathogenic coronavirus survivors, in 30-40% of COVID-19 survivors, anxiety, depression, sleep disorders and post-traumatic stress disorder

• pathophysiology of neuropsychiatric complications are diverse , by immune disorders, inflammation, microvascular thrombosis , influence iatrogenic effects of drugs and psychological factors

kidney

Kidney Kidney

• Most COVID-19 patients were cured of acute kidney injury in the acute phase, but an article reported that eGFR was lowered during a 6 -month follow-up .

• COVID-19- related nephropathy ( COVAN ) may be the main mode of kidney injury in African-American patients.

• Survivors of COVID-19 with persistent renal impairment may benefit from early and close clinical follow-up of AKI survivors.

endocrine

Endocrine Endocrinology

• Endocrine sequelae may include deterioration of new or existing diabetes control, subacute thyroiditis and osteoporosis .

• Endocrine sequelae may include deterioration of new or existing diabetes control, subacute thyroiditis and osteoporosis .
Diabetic osteoporosis

• newly diagnosed with diabetes if not 2 traditional risk factors for diabetes, suspected hypothalamic - pituitary - adrenal axis suppression or hyperthyroidism should receive appropriate laboratory tests, and should be referred to the Department of Endocrinology.

Gastrointestinal, liver and gallbladder

Gastrointestinal, liver and gallbladder gastrointestinal, liver and gallbladder

• Even after a nasopharyngeal swab test is negative, prolonged viral fecal shedding may occur in COVID-19 .

• COVID-19 may change the gut microbiota, including the abundance of opportunistic microorganisms and the depletion of beneficial symbionts.

dermatology

Dermatology Dermatology

•Hair loss is the main symptom, and it is reported that about 20% of COVID-19 survivors have hair loss.

Children's Multiple System Inflammatory Syndrome ( MIS-C )

Children's Multiple System Inflammatory Syndrome ( Children's Multiple System Inflammatory Syndrome (Children MIS-C MIS-C ) )

•Diagnostic criteria: age <21 years, fever, elevated inflammatory markers, multiple organ dysfunction, current or recent infection with SARS-CoV-2 , other reasonable diagnoses are excluded.

• Usually affects children over 7 years of age and disproportionately affects African, Afro-Caribbean or Hispanic ancestry.
• Cardiovascular ( coronary artery aneurysm ) and neurological ( headache, encephalopathy, stroke, and medsci.
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• Usually affects children over the age of 7 and disproportionately affects African, Afro-Caribbean, or Hispanic ancestry.
• cardiovascular ( coronary artery aneurysms ) and neurological ( headache, encephalopathy, stroke and medsci.
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do?w=%E7%99%AB%E7%97%AB"> seizures ) complications may occur.

The sequelae of multiple organs beyond the acute phase of COVID-19 infection have received more and more attention with the increase of data and clinical experience in this time frame.
The necessary active future research includes identifying and characterizing the main clinical, serological, imaging and epidemiological characteristics of COVID-19 in the acute, subacute and chronic phases of the disease, which will help us better understand this new disease Natural history and pathophysiology.
Active and future clinical research, including prospective cohorts and clinical trials, as well as frequent reviews of emerging evidence by working groups and task forces, are essential for building a strong knowledge base and providing information for clinical practice in this field important.
Currently, medical professionals who care for survivors of acute COVID-19 play a key role in identifying, carefully recording, investigating, and managing emerging or new symptoms, as well as tracking organ-specific complications that occur during acute illness.
Equally important, clinicians must provide information in an accessible form, including clinical research and other resources for participation, such as patient advocacy and support groups.

Interdisciplinary management of COVID-19 .
Multidisciplinary collaboration is essential to provide comprehensive outpatient care for acute COVID-19 survivors in COVID-19 clinics .
According to the resource situation, priority can be given to the high-risk population of COVID-19 after acute COVID-19 , which is defined as those who suffer from serious illness during acute COVID-19 and / or need care in the intensive care unit, the elderly and the presence of organ comorbidities ( previously People with respiratory disease, obesity, diabetes, high blood pressure, chronic cardiovascular disease, chronic kidney disease, post-organ transplantation or active cancer ) .
HRCT , high-resolution CT ; PE , pulmonary embolism.
Interdisciplinary management of COVID-19 .
Multidisciplinary collaboration is essential to provide comprehensive outpatient care for acute COVID-19 survivors in COVID-19 clinics .
According to the resource situation, priority can be given to the high-risk population of COVID-19 after acute COVID-19 , which is defined as people who suffer from serious illness during acute COVID-19 and / or need care in the intensive care unit, the elderly and the presence of organ comorbidities (People with previous respiratory disease, obesity, diabetes, hypertension, chronic cardiovascular disease, chronic kidney disease, post-organ transplantation or active cancer ) .
HRCT , high-resolution CT ; PE , pulmonary embolism.

In addition, the care of COVID-19 patients obviously does not end when they are discharged from the hospital.
Interdisciplinary cooperation is needed to provide comprehensive care for these patients in an outpatient setting.
Therefore, the healthcare system and hospitals recognize the need to establish specialized COVID-19 clinics where experts from multiple disciplines can provide comprehensive care, which is crucial .
For people at high risk of post - acute COVID-19 , follow-up care can be considered as a priority, including those who are severely ill during acute COVID-19 and / or need to be treated in the ICU , and those who are most prone to complications ( such as the elderly) , Patients with multiple organ complications, post-transplant patients , and those with a history of active cancer ) and those with the highest burden of persistent symptoms.

In addition, COVID-19 COVID 19- patient care is clearly not ended at the time of discharge, it requires cross-disciplinary cooperation, comprehensive care for these patients in an outpatient setting.
Therefore, the healthcare system and hospitals recognize that the need to establish specialized patient care obviously does not end when they are discharged from the hospital, and interdisciplinary cooperation is needed to provide comprehensive care for these patients in an outpatient setting.
Therefore, the healthcare system and hospitals recognize the need to establish specialized COVID-19 COVID-19 clinics, where experts from multiple disciplines can provide comprehensive care, which is crucial for clinics, where experts from multiple disciplines can It is essential to provide comprehensive care .
For people at high risk of post - acute COVID-19 , follow-up care can be considered as a priority, including those who are severely ill during acute COVID-19 and / or need to be treated in the ICU , and those who are most prone to complications ( such as the elderly) , Patients with multiple organ complications, post-transplant patients , and those with a history of active cancer ) and those with the highest burden of persistent symptoms.

Given the global scale of this pandemic, it is clear that the medical needs of patients with sequelae of COVID-19 will continue to increase in the foreseeable future .
To meet this challenge, it will be necessary to use the existing outpatient infrastructure, develop a scalable medical model, and conduct interdisciplinary integration to improve the physical and mental health of COVID-19 survivors in the long-term .

Given the global scale of this pandemic, it is clear that in the foreseeable future, COVID-19 COVID-19 medical needs of patients with sequelae will continue to increase.
To cope with this challenge, it will be necessary to use the existing outpatient infrastructure, develop a scalable medical model, and conduct interdisciplinary integration to improve the medical needs of patients with sequelae in the long-term will continue to increase.
To meet this challenge, the need to use existing clinic infrastructure, the development of scalable medical model, and interdisciplinary integration in order to improve the long-term COVID-19 COVID-19 physical and mental health of survivors.
The physical and mental health of the survivors.

Original source:

Nalbandian, Ani et al.
“Post-acute COVID-19 syndrome.
” Nature medicine , 10.
1038/s41591-021-01283-z.
22 Mar.
2021, doi:10.
1038/s41591-021-01283-z

Nalbandian, Ani et al.
“Post-acute COVID-19 syndrome.
” Nature medicine , 10.
1038/s41591-021-01283-z.
22 Mar.
2021, doi:10.
1038/s41591-021-01283-z Nalbandian, Ani et al .
"Post-acute COVID-19 syndrome.
" Nature medicine

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