University of Nevada-Reno, School of Medicine, Reno, NV, USA.
Department of Family Medicine, Southern Illinois University School of Medicine, Decatur, IL, USA.
Mayo Clin Proc. 2022 Mar;97(3):579-599. doi: 10.1016/j.mayocp.2021.12.017. Epub 2022 Jan 12.
Coronavirus disease 2019 (COVID-19) is the third deadly coronavirus infection of the 21st century that has proven to be significantly more lethal than its predecessors, with the number of infected patients and deaths still increasing daily. From December 2019 to July 2021, this virus has infected nearly 200 million people and led to more than 4 million deaths. Our understanding of COVID-19 is constantly progressing, giving better insight into the heterogeneous nature of its acute and long-term effects. Recent literature on the long-term health consequences of COVID-19 discusses the need for a comprehensive understanding of the multisystemic pathophysiology, clinical predictors, and epidemiology to develop and inform an evidence-based, multidisciplinary management approach. A PubMed search was completed using variations on the term post-acute COVID-19. Only peer-reviewed studies in English published by July 17, 2021 were considered for inclusion. All studies discussed in this text are from adult populations unless specified (as with multisystem inflammatory syndrome in children). The preliminary evidence on the pulmonary, cardiovascular, neurological, hematological, multisystem inflammatory, renal, endocrine, gastrointestinal, and integumentary sequelae show that COVID-19 continues after acute infection. Interdisciplinary monitoring with holistic management that considers nutrition, physical therapy, psychological management, meditation, and mindfulness in addition to medication will allow for the early detection of post-acute COVID-19 sequelae symptoms and prevent long-term systemic damage. This review serves as a guideline for effective management based on current evidence, but clinicians should modify recommendations to reflect each patient's unique needs and the most up-to-date evidence. The presence of long-term effects presents another reason for vaccination against COVID-19.
2019 年冠状病毒病(COVID-19)是 21 世纪第三次致命的冠状病毒感染,其致命性明显高于前两次,感染患者和死亡人数仍在逐日增加。从 2019 年 12 月到 2021 年 7 月,这种病毒已感染近 2 亿人,导致 400 多万人死亡。我们对 COVID-19 的认识在不断发展,使我们对其急性和长期影响的异质性有了更好的了解。最近关于 COVID-19 长期健康后果的文献讨论了需要全面了解多系统病理生理学、临床预测因素和流行病学,以制定和提供循证、多学科管理方法的必要性。使用术语“急性后 COVID-19”的变体在 PubMed 上完成了搜索。仅考虑纳入 2021 年 7 月 17 日之前以英语发表的同行评议的研究。除非另有说明(如儿童多系统炎症综合征),本文讨论的所有研究均来自成人人群。关于肺部、心血管、神经、血液、多系统炎症、肾脏、内分泌、胃肠道和皮肤后遗症的初步证据表明,COVID-19 在急性感染后仍在继续。除药物治疗外,采用整体管理进行跨学科监测,考虑营养、物理治疗、心理管理、冥想和正念,可以早期发现急性后 COVID-19 后遗症症状,并防止长期全身损害。本综述基于现有证据为有效管理提供了指导,但临床医生应根据每个患者的独特需求和最新证据修改建议。长期影响的存在为 COVID-19 疫苗接种提供了另一个理由。