October 14, 2021

More than half of COVID survivors experience post-acute sequelae of SARS-CoV-2 infection 6 months after recovery: Study

More than half of coronavirus disease 2019 (COVID-19) survivors experienced post-acute sequelae of COVID-19 (PASC) 6 months after recovery, according to a study published in JAMA Network Open.

“The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders,” wrote Destin Groff, Penn State College of Medicine and Milton S Hershey Medical Center, Hershey, Pennsylvania, and colleagues. ”These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries.” 

The researchers conducted a systematic review of 57 studies comprising 250,351 survivors of COVID-19 (December 2019 to March 2021). Among the survivors, 197,777 (79%) were hospitalised during acute COVID-19. Patients’ median age was 54 years, and the majority (56%) of the patients were male. 

The median proportion of COVID-19 survivors experiencing at least 1 PASC was 54% (45%-69%; 13 studies) at 1 month (short-term), 55.0% (34.8%-65.5%; 38 studies) at 2 to 5 months (intermediate-term), and 54.0% (31.0%-67.0%; 9 studies) at 6 or more months (long-term).

The most prevalent pulmonary sequelae was chest imaging abnormality (median [interquartile range (IQR)], 62.2% [45.8%-76.5%]), while the most common neurologic disorder and mental health disorder were difficulty concentrating (median [IQR], 23.8% [20.4%-25.9%]) and generalised anxiety disorder (median [IQR], 29.6% [14.0%-44.0%]), respectively.

General functional impairments (median [IQR], 44.0% [23.4%-62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%-54.5%]) were also reported. Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders.

“In this systematic review, we evaluated the temporal progression of clinical abnormalities experienced by patients who recovered from an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), starting with a mean of 30 days post–acute illness and beyond,” the authors noted. 

“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 SARS-CoV-2,” they added. 

“The mechanisms underpinning the post-acute and chronic manifestations of COVID-19 are not entirely understood. Nevertheless, these mechanisms can be grouped into the direct effect of the viral infection and the indirect effect on mental health due to posttraumatic stress, social isolation, and economic factors, such as loss of employment,” the authors remarked, citing “direct viral effects can be explained by several hypotheses, including persistent viremia due to immune fatigue and paresis, relapse or reinfection, hyperinflammatory immune response, cytokine- and hypoxia-induced injury, and autoimmunity as well as neurotropism using a transsynaptic spread mechanism, resulting in hypoxic- or hemorrhagic-driven neuronal apoptosis.”

“Moving forward, clinicians may consider having a low threshold for PASC and must work toward a holistic clinical framework to deal with direct and indirect effects of SARS-CoV-2 sequelae,” the authors added. “Our results indicate that clinical management of PASC will require a whole-patient perspective, including management tools like virtual rehabilitation platforms and chronic care for post-acute COVID-19 symptoms in conjunction with the management of preexisting or new comorbidities.”

SOURCE: JAMA Network Open