Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.
Crit Rev Clin Lab Sci. 2021 Aug;58(5):297-310. doi: 10.1080/10408363.2020.1860895. Epub 2020 Dec 21.
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite pulmonary impairments being the most prevalent, extra-pulmonary manifestations of COVID-19 are abundant. Confirmed COVID-19 cases have now surpassed 57.8 million worldwide as of 22 November 2020. With estimated case fatality rates (number of deaths from COVID-19 divided by number of confirmed COVID-19 cases) varying between 1 and 7%, there will be a large population of recovered COVID-19 patients that may acquire a multitude of long-term health consequences. While the multi-organ manifestations of COVID-19 are now well-documented, the potential long-term implications of these manifestations remain to be uncovered. In this review, we turn to previous similar coronaviruses (i.e. SARS-CoV-1 and Middle East respiratory syndrome coronavirus [MERS-CoV]) in combination with known health implications of SARS-CoV-2 infection to predict potential long-term effects of COVID-19, including pulmonary, cardiovascular, hematologic, renal, central nervous system, gastrointestinal, and psychosocial manifestations, in addition to the well-known post-intensive care syndrome. It is necessary to monitor COVID-19 patients after discharge to understand the breadth and severity of long-term effects. This can be accomplished by repurposing or initiating large cohort studies to not only focus on the long-term consequences of SARS-CoV-2 infection, but also on acquired immune function as well as ethno-racial group and household income disparities in COVID-19 cases and hospitalizations. The future for COVID-19 survivors remains uncertain, and if this virus circulates among us for years to come, long-term effects may accumulate exponentially.
2019 年冠状病毒病(COVID-19)由严重急性呼吸系统综合征冠状病毒 2 型(SARS-CoV-2)引起。尽管肺损伤最为常见,但 COVID-19 的肺外表现也很丰富。截至 2020 年 11 月 22 日,全球已确诊 COVID-19 病例超过 5780 万例。估计 COVID-19 的病死率(COVID-19 死亡人数除以 COVID-19 确诊病例数)在 1%至 7%之间,因此将有大量 COVID-19 康复患者可能会出现多种长期健康后果。虽然 COVID-19 的多器官表现现在已经有了充分的记录,但这些表现的潜在长期影响仍有待揭示。在这篇综述中,我们参考了以前的类似冠状病毒(即 SARS-CoV-1 和中东呼吸综合征冠状病毒[MERS-CoV]),以及 SARS-CoV-2 感染的已知健康影响,来预测 COVID-19 的潜在长期影响,包括肺、心血管、血液、肾脏、中枢神经系统、胃肠道和心理社会表现,以及众所周知的重症监护后综合征。有必要对出院后的 COVID-19 患者进行监测,以了解长期影响的广度和严重程度。这可以通过重新利用或启动大型队列研究来实现,不仅要关注 SARS-CoV-2 感染的长期后果,还要关注获得性免疫功能以及 COVID-19 病例和住院的种族和家庭收入差异。COVID-19 幸存者的未来仍不确定,如果这种病毒在未来几年继续在我们中间传播,长期影响可能会呈指数级增长。