The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.
SMJ // Article
Review Article
COVID-19 Legacy
Abstract
Coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome-coronavirus-2 virus that led to a pandemic. Acute manifestations of COVID-19 include fever, cough, dyspnea, respiratory failure, pneumonitis, anosmia, thromboembolic events, cardiogenic shock, renal injury, ischemic strokes, encephalitis, and cutaneous eruptions, especially of hands or feet. Prolonged symptoms, unpredictable recoveries, and chronic sequelae (long COVID) sometimes emerge even for some people who survive the initial illness. Sequelae such as fatigue occasionally persist even for those with only mild to moderate cases. There is much to learn about postacute COVID-19 dyspnea, anosmia, psychosis, thyroiditis, cardiac arrhythmia, and/or multisystem inflammatory response syndrome in children. Determining prognoses is imprecise. Examining patient databases about those who have survived COVID-19 is warranted. Multidisciplinary teams are assessing such disease databases to better understand longer-term complications and guide treatment.Posted in: Infectious Disease154
Full Article
Having trouble viewing the article content below? Click here to open it directly.
Images
References
1. Johns Hopkins Coronavirus Resource Center. Home page. https:// coronavirus.jhu.edu. Accessed March 11, 2021.
2. Centers for Disease Control and Prevention. COVID-19 data tracker. https:// www.cdc.gov/covid-data-tracker. Accessed March 11, 2021.
3. Ojo A, Balogun S, Williams O, et al. Pulmonary fibrosis in COVID-19 survivors: predictive factors and risk reduction strategies. Pulm Med 2020;5:1–10.
4. Centers for Disease Control and Prevention. Risk for COVID-19infection, hospitalization, and death by race/ethnicity https://www.cdc.gov/ coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalizationdeath-by-race-ethnicity.html. Accessed March 11, 2021.
5. Rubin-Miller L, Alban C, Artiga S, et al. COVID-19 racial disparities in testing, infection, hospitalization, and death: analysis of Epic patient data. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-racialdisparities-testing-infection-hospitalization-death-analysis-epic-patientdata. Published September 16, 2020. Accessed March 11, 2021.
6. Lopez L, Hart L, Katz M. Racial and ethnic health disparities related to COVID-19. JAMA 2021;325:719–720.
7. Greenhalgh T, Knight M, A’Court C, et al. Management of post-acute covid-19 in primary care. Br Med J 2020;370:1–8.
8. Centers for Disease Control and Prevention. Post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html. Accessed March 11, 2021.
9. Baig AM. Chronic COVID syndrome: need for an appropriate medical terminology for long-COVID and COVID long-haulers. J Med Virol 2021; 93:2555–2556.
10. Baig AM. Deleterious outcomes in long-hauler COVID-19: the effects of SARS-CoV-2 on the CNS in chronic COVID syndrome. ACS Chem Neurosci 2020;11:4017–4020.
11. Aucott J, Rebman A. Long-haul COVID: heed the lessons from other infection-triggered illnesses. Lancet 2021;397:967–968.
12. National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. https://www.nice.org.uk/ guidance/NG188. Accessed March 11, 2021.
13. Barker-Davies R, O’Sullivan O, Senaratne K, et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med 2020;54:949–959.
14. Carruthers B, van de Sande M, De Meirleir K, et al. Myalgic encephalomyelitis: international consensus criteria: review. J Intern Med 2011;270:327–338.
15. Pan A, Liu L, Wang C, et al. Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. JAMA 2020;323:1915–1923.
16. Pascarella G, Strumia A, Piliego C, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med 2020;288:192–206.
17. Lai C, Shih T, Ko W, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents 2020;55:1–9.
18. Cheng J, Huang C, Zhang G, et al. Epidemiological characteristics of novel coronavirus pneumonia in Henan. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43:327–331.
19. Shimabukuro-Vornhagen A, Gödel P, Subklewe M, et al. Cytokine release syndrome. J Immunother Cancer 2018;6:56–70.
20. Chousterman B, Swirski F, Weber G. Cytokine storm and sepsis disease pathogenesis. Semin Immunopathol 2017;39:517–528. .
21. Landi F, Gremese E, Bernabei R, et al. Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin Exp Res 2020;32:1613–1620.
22. Bonow R, O’Gara P, Yancy C. Cardiology and COVID-19. JAMA 2020; 324:1131–1132.
23. Madjid M, Safavi-Naeini P, Solomon S, et al. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol 2020;5:831–840.
24. Bikdeli B, Madhavan M, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol 2020;75:2950–2973.
25. Inciardi R, Lupi L, Zaccone G, et al. Cardiac involvement in a patient With coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:819–824.
26. Puntmann V, Carerj M, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:1265–1273.
27. Giustino G, Croft L, Oates C, et al. Takotsubo cardiomyopathy in COVID-19. J Am Coll Cardiol 2020;76:628–629.
28. Dweck M, Bularga A, Hahn R, et al. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imag 2020;21:949–958.
29. Park J, Moon J, Sohn K, et al. Two fatal cases of stress-induced cardiomyopathy in COVID-19 patients. J Cardiovasc Imag 2020;28:300–303.
30. Lai P, Lancet E, Weiden M, et al. Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City. JAMA Cardiol 2020;5:1154–1163.
31. Shinkai K, Bruckner A. Dermatology and COVID-19. JAMA 2020;324: 1133–1134.
32. Sernicola A, Alaibac M. How to deal with post-viral cutaneous eruptions in the era of coronavirus infection. Front Med 2020;7:224.
33. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol 2020;34:212–213.
34. Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 2020;183:71–77.
35. Droesch C, Do M, DeSancho M, et al. Livedoid and purpuric skin eruptions associated with coagulopathy in severe COVID-19. JAMA Dermatol 2020; 156:1–3.
36. Zhang Y, Cao W, Xiao M, et al. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi 2020;41:302–307.
37. Yao X, Li T, He Z, et al. A pathological report of three COVID-19 cases by minimal invasive autopsies. Zhonghua Bing Li Xue Za Zhi 2020;49: 411–417.
38. Roca-Ginés J, Torres-Navarro I, Sánchez-Arráez J, et al. Assessment of acute acral lesions in a case series of children and adolescents during the COVID-19 pandemic. JAMA Dermatol 2020;156:992–998.
39. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–1720.
40. Deng Y, Liu W, Liu K, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study. Chin Med J (Engl) 2020;133:1261–1267.
41. Kliger A, Silberzweig J. Mitigating risk of COVID-19 in dialysis facilities. Clin J Am Soc Nephrol 2020;15:707–709.
 
42. Winkelmayer W, Khairallah P, Charytan D. Nephrology and COVID-19. JAMA 2020;324:1137–1138.
43. Santoriello D, Khairallah P, Bomback A, et al. Postmortem kidney pathology findings in patients with COVID-19. J Am Soc Nephrol 2020; 31:2158–2167.
44. Su H, Yang M, Wan C, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int 2020;98:219–227.
45. Chan L, Chaudhary K, Saha A, et al. AKI in hospitalized patients with COVID-19. J Am Soc Nephrol 2021;32:151–160.
46. Loupy A, Aubert O, Reese P, et al. Organ procurement and transplantation during the COVID-19 pandemic. Lancet 2020;395:e95–e96.
47. Boyarsky B, Werbel W, Durand C, et al. Early national and center-level changes to kidney transplantation in the United States during the COVID-19 epidemic. Am J Transplant 2020;20:3131–3139.
48. Imam S, Lao W, Reddy P, et al. Is SARS-CoV-2 (COVID-19) postviral olfactory dysfunction (PVOD) different from other PVOD? World J Otorhinolaryngol Head Neck Surg 2020;6:S26–S32.
49. Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a casecontrolled study. BioMed Cent Neurol 2011;11:1–7.
50. Hives L, Bradley A, Richards J, et al. Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome/myalgic encephalomyelitis? A diagnostic accuracy study. BMJ Open 2017;7:e017521.
51. Kida S, Pantazis A, Weller R. CSF drains directly from the subarachnoid space into nasal lymphatics in the rat. Anatomy, histology and immunological significance. Neuropathol Appl Neurobiol 1993;19:480–488.
52. Perrin R, Riste L, Hann M, et al. Into the looking glass: post-viral syndrome post COVID-19. Med Hypotheses 2020;144:110055.
53. Politi L, Salsano E, Grimaldi M. Magnetic resonance imaging alteration of the brain in a patient with coronavirus disease 2019 (COVID-19) and anosmia. JAMA Neurol 2020;77:1028–1029.
54. Zubair A, McAlpine L, Gardin T, et al. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: a review. JAMA Neurol 2020;77:1018–1027.
55. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683–690.
56. Josephson S, Kamel H. Neurology and COVID-19. JAMA 2020;324: 1139–1140.
57. Merkler A, Parikh N, Mir S, et al. Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza. JAMA Neurol 2020;77:1–7.
58. Spence J, Greitas G, Pettigrew L, et al. Mechanisms of stroke in COVID-19. Cerebrovasc Dis 2020;49:451–458.
59. Carod-Artal F. Neurological complications of coronavirus and COVID-19. Rev Neurol 2020;70:311–322.
60. Poyiadji N, Shahin G, Noujaim D, et al. Covid-19 associated acute hemorrhagic necrotizing encephalopathy. CT and MRI features. Radiology 2020;296: E119–E120.
61. Solomon I, Normandin E, Bhattacharyya S, et al. Neuropathological features of Covid-19. N Engl J Med 2020;383:989–992.
62. Gupta S, Hayek S, Wang W, et al. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA Intern Med 2020;180:1436–1446.
63. Kuderer N, Choueiri T, Shah D, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet 2020;395:1907–1918.
64. Disis ML. Oncology and COVID-19. JAMA 2020;324:1141–1142.
65. Lee L, Cazier J, Angelis V, et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet 2020;395:1919–1926.
66. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727–733.
67. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–513.
68. Raptis C, Hammer M, Short R, et al. Chest CT and coronavirus disease (COVID-19): a critical review of the literature to date. Am J Roentgenol 2020;215:839–842.
69. Thompson B, Chambers R, Liu K. Acute respiratory distress syndrome. N Engl J Med 2017;377:562–572.
70. Ackermann M, Verleden S, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med 2020;383:120–128.
71. Sun P, Qie S, Liu Z, et al. Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: a single arm meta-analysis. J Med Virol 2020;92:612–617.
72. Wong K, Antonio G, Hui D, et al. Severe acute respiratory syndrome: thin-section computed tomography features, temporal changes, and clinicoradiologic correlation during the convalescent period. J Comput Assist Tomogr 2004;28:790–795.
73. Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol 2020;138:575–578.
74. Bressler NM. Ophthalmology and COVID-19. JAMA 2020;324:1143–1144.
75. Zeng W, Wang X, Li J, et al. Association of daily wear of eyeglasses with susceptibility to coronavirus disease 2019 infection. JAMA Ophthalmol 2020;138:1196–1199.
76. Maragakis L. Eye protection and the risk of coronavirus disease 2019: does wearing eye protection mitigate risk in public, non–health care settings? JAMA Ophthalmol 2020;138:1199–1200.
77. Druss B. Addressing the COVID-19 pandemic in populations with serious mental illness. JAMA Psychiatry 2020;77:891–892.
78. Rogers J, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry 2020;7:611–627.
79. Noone R, Cabassa J, Gardner L, et al. Letter to the editor: new onset psychosis and mania following COVID-19 infection. J Psychiatr Res 2020;130:177–179.
80. Ladani A, Loganathan M, Danve A. Managing rheumatic diseases during COVID-19. Clin Rheumatol 2020;39:3245–3254.
81. Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: a systematic review. EClinicalMedicine 2020;26:100527.
82. Ehrenfeld M, Tincani A, Andreoli L, et al. Covid-19 and autoimmunity. Autoimmun Rev 2020;19:102597.
83. Gagiannis D, Steinestel J, Hackenbroch C, et al. COVID-19-induced acute respiratory failure: an exacerbation of organ-specific autoimmunity? medRxiv 2020. DOI: 10.1101/2020.04.27.20077180.
84. Zulfiqar A, Lorenzo-Villalba N, Hassler P, et al. Immune thrombocytopenic purpura in a patient with Covid-19. N Engl J Med 2020;382:e43.
85. Tsao H, Chason H, Fearon D. Immune thrombocytopenia (ITP) in a pediatric patient positive for SARS-CoV-2. Pediatrics 2020;146:e20201419.
86. Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 2020;382:e38.
87. Harzallah I, Debliquis A, Drénou B. Lupus anticoagulant is frequent in patients with Covid-19. J Thromb Haemost 2020;18:2064–2065.
88. Bowles L, Platton S, Yartey N, et al. Lupus anticoagulant and abnormal coagulation tests in patients with Covid-19. N Engl J Med 2020;383: 288–290.
89. Massachusetts General Hospital, and ZOE. COVID Symptom Study. Continue the fight against COVID. https://covid.joinzoe.com/us. Accessed February 7, 2021.
90. Lan L, Xu D, Ye G, et al. Positive RT-PCR test results in patients recovered from COVID-19. JAMA 2020;323:1502–1503.
91. Carfì A, Bernabei R, Landi F, et al. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324:603–605.
92. Coraci D, Fusco A, Frizziero A, et al. Global approaches for global challenges: the possible support of rehabilitation in the management of COVID-19. J Med Virol 2020;92:1739–1740.
93. Lazzeri M, Lanza A, Bellini R, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis 2020;90:163–168.
94. Boldrini P, Kiekens C, Bargellesi S, et al. First impact on services and their preparation. "Instant paper from the field" on rehabilitation answers to the Covid-19 emergency. Eur J Phys Rehabil Med 2020;56:319–322.
95. Stam H, Stucki G, Bickenbach J. Covid-19 and post intensive care syndrome: a call for action. J Rehabil Med 2020;52:1–4.
96. Zhang P, Li J, Liu H, et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Res 2020;8:8.
97. Marshall M. The lasting misery of coronavirus long-haulers. Nature 2020; 585:339–341.
98. Hu Y, Li W, Gao T, et al. The severe acute respiratory syndrome coronavirus nucleocapsid inhibits type I interferon production by interfering with TRIM25-mediated RIG-I ubiquitination. J Virol 2017;91:e02143–16.
99. Mitrani R, Dabas N, Goldberger J. COVID-19 cardiac injury: implications for long-term surveillance and outcomes in survivors. Heart Rhythm 2020; 17:1984–1990.
100. Lindner D, Fitzek A, Bräuninger H, et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol 2020;5:1281–1285.
101. Del Rio C, Collins L, Malani P. Long-term health consequences of COVID19. JAMA 2020;324:1723–1724.
102. Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020;324:259–269.
103. Brancatella A, Ricci D, Viola N, et al. Subacute thyroiditis after Sars-COV-2 infection. J Clin Endocrinol Metab 2020;105:2367–2370.
104. Brancatella A, Ricci D, Cappellani D, et al. Is subacute thyroiditis an underestimated manifestation of SARS-CoV-2 infection? Insights from a case series. J Clin Endocrinol Metab 2020;105:dgaa537.
105. Bruchfeld A. The COVID-19 pandemic: consequences of nephrology. Nat Rev Nephrol 2021;17:81–82.
106. Das K, Lee E, Singh R, et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging 2017; 27:342–349.
107. Wang J, Wang B, Yang J, et al. Advances in the research of mechanism of pulmonary fibrosis induced by corona virus disease 2019 and the corresponding therapeutic measures. Chin J Burns 2020;36:691–697.
108. Zhao Y, Shang Y, Song W, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine 2020;25:100463.
109. Huang Y, Tan C, Wu J, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res 2020;21:163.
110. Ngai J, Ko F, Ng S, et al. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology 2010;15:543–50.
111. Hui D, Joynt G, Wong K, et al. Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax 2005;60:401–409.
112. Boston.com. After a COVID-19 infection, mental and neurological effects can smolder. https://www.boston.com/news/coronavirus/2020/08/13/longafter-the-fire-of-a-covid-19-infection-mental-and-neurological-effects-canstill-smolder. Accessed March 11, 2021.
113. Troyer E, Kohn J, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun 2020;87:34–39.
114. Ray C, Weir W, Phillips S, et al. Development of a measure of symptoms in chronic fatigue syndrome: the profile of fatigue-related symptoms(pfrs). Psychol Health 1992;7:27–43.
115. Wilson C. Concern coronavirus may trigger post-viral fatigue syndromes. New Sci 2020;246:10–11.
116. Montoya J, Holmes T, Anderson J, et al. Cytokine signature associated with disease severity in chronic fatigue syndrome patients. Proc Natl Acad Sci USA 2017;114:7150–7158.
117. Öngür D, Perlis R, Goff D. Psychiatry and COVID-19. JAMA 2020;324: 1149–1150.
118. Galea S, Merchant RM, Lurie N. The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention. JAMA Intern Med 2020;180:817.
119. Feldstein L, Rose E, Horwitz S, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020;383:334–346.
120. Chiotos K, Bassiri H, Behrens E, et al. Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: a case series. J Pediatr Infect Dis Soc 2020;9:393–398.
121. Demeco A, Marotta N, Barletta M, et al. Rehabilitation of patients post-COVID-19 infection: a literature review. J Int Med Res 2020;48: 300060520948382.
122. Center for Post-COVID Care, Mount Sinai Hospital, Mount Sinai Health System. Home page. https://www.mountsinai.org/about/covid19/centerpost-COVID-care. Accessed March 11, 2021.
123. Fosbøl E, Butt J, Østergaard L, et al. Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality. JAMA 2020;324:168–177.
124. Liu K, Zhang W, Yang Y, et al. Respiratory rehabilitation in elderly patients with COVID-19: a randomized controlled study. Complement Ther Clin Pract 2020;39:101166.
125. National Institutes for Health. NIH launches new initiative to study "long COVID." https://www.nih.gov/about-nih/who-we-are/nih-director/statements/ nih-launches-new-initiative-study-long-covid. Accessed March 11, 2021.
