Long COVID, or Post-Acute Sequelae of COVID-19 (PASC), is a condition marked by the continuation of COVID-19 symptoms—or the emergence of new ones—after recovery from acute COVID-19 illness. In a systematic review by Vernon M. Chinchilli, PhD, Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, of 57 studies comprising more than 250 000 survivors of COVID-19, most sequelae included mental health, pulmonary, and neurologic disorders, which were prevalent longer than 6 months after SARS-CoV-2 exposure.
Short-term and long-term persistent post acute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region. The study was published on JAMA Open.
In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing healthcare capacity, particularly in low- and middle-income countries.
The global COVID-19 pandemic that began in late 2019 has caused more than 187 million infections and 4 million deaths as of July 10, 2021. Survivors experience long-lasting medical, psychological and economic consequences, further increasing the disability-adjusted life years lost.
Despite current vaccination efforts, the health consequences of COVID-19 remain urgent, with long-term multi-organ system impacts that are yet to be elucidated. With a variety of clinical presentations and degrees of severity in patients there is a dire need to better understand the lasting and emergent effects of COVID-19.
Frequently reported residual effects from SARS-CoV-2 virus include fatigue, dyspnea, chest pain, persistent loss of taste and/or smell, cognitive changes, arthralgias and decreased quality of life. Many of these symptoms may result from widespread neuropathological events occurring in major white matter bundle tracts, cortical gray matter, and subcortical gray matter.
Furthermore, persistent symptoms (>6 weeks) have been reported in 19% of fully vaccinated individuals. However, as the pandemic emerged in 2019, most studies have been limited in the duration of observation, and there has yet to be a consolidation of these trends to portray an overarching evolution of these symptoms from short-term to long-term sequelae following COVID-19 infection.
The researchers sorted studies into groups that focused on (1) postacute symptoms at 1-month after acute COVID-19 (short term), (2) persisting and new clinical manifestations between 2 and 5 months after infection (intermediate term), and (3) clinical manifestations that were present at least 6 months after COVID-19 (long term).
These categorizations were based on literature reports proposing a framework that COVID-19 infection progresses from an acute infection lasting approximately 2 weeks into a postacute hyperinflammatory illness lasting approximately 4 weeks, until ultimately entering late sequelae. As we better understand the disease burden of PASC in COVID-19 survivors, we can develop precise treatment plans to improve clinical care in patients with COVID-19 who are at greatest risk of PASC and establish integrated, evidence-based clinical management for those affected.
The results suggest that rates of PASC are indeed common; 5 of 10 survivors of COVID-19 developed a broad array of pulmonary and extrapulmonary clinical manifestations, including nervous system and neurocognitive disorders, mental health disorders, cardiovascular disorders, gastrointestinal disorders, skin disorders, and signs and symptoms related to poor general well-being, including malaise, fatigue, musculoskeletal pain, and reduced quality of life. Short- and long-term rates of PASC were similar, highlighting the potential for pathological sequelae long after exposure to the SARS-CoV-2 virus.
