Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Nat Med. 2021 Apr;27(4):601-615. doi: 10.1038/s41591-021-01283-z. Epub 2021 Mar 22.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.
严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 是导致 2019 年冠状病毒病 (COVID-19) 大流行的病原体,大流行导致了全球医疗保健危机和卫生资源紧张。随着 COVID-19 康复患者人数的增加,了解围绕他们的医疗保健问题至关重要。COVID-19 现在被认为是一种多器官疾病,具有广泛的表现。与在其他烈性冠状病毒流行的幸存者中描述的急性后病毒综合征类似,越来越多的报告表明急性 COVID-19 后存在持续和长期的影响。许多自称是长途旅行者的患者权益组织帮助认识到了急性 COVID-19 后的问题,这是一种以症状持续存在和/或从症状出现后 4 周以上出现延迟或长期并发症为特征的综合征。在这里,我们全面回顾了关于急性 COVID-19 后的文献,其病理生理学及其特定器官的后遗症。最后,我们讨论了 COVID-19 幸存者多学科护理的相关注意事项,并提出了通过专门的 COVID-19 诊所识别那些有急性 COVID-19 后风险的患者并对其进行协调管理的框架。