Caring for patients with post–COVID-19 conditions

Specific sequelae of COVID-19

Specific sequelae of COVID-19

The majority of patients seen in general practice with post–COVID-19 conditions will have had mild or asymptomatic COVID-19 infections. Post-acute COVID-19 symptoms might still occur after mild infection. When assessing any patient, it is important to have an awareness of the known significant sequelae.

 

Box 1. Significant COVID-19-specific sequelae2,3,9,12–14

Pulmonary:
  • Persisting interstitial lung disease
  • Impaired lung function
  • Pneumonia/lung cavitation
  • Dyspnoea
  • Complications of intubation/ventilation, including chronic cough, hoarse voice
Endocrine:
  • Deterioration of diabetic control
  • Osteoporosis due to prolonged immobilisation
  • Diabetic ketoacidosis without known diabetes mellitus
Cardiovascular:
  • Myocardial infarction
  • Myocarditis
  • Pericarditis
  • Arrhythmia
  • Heart failure
  • Venous thromboembolism (VTE)
Mental health:
  • Worsening of cognitive decline
  • Depression
  • Anxiety
  • Post-traumatic stress disorder following severe illness
  • Insomnia/sleep disturbances
Neurological:
  • Stroke
  • Cognitive impairment
  • Encephalopathy
  • Epilepsy
  • Myelitis
  • Critical care neuropathy/myopathy
  • Chronic malaise
  • Loss of taste and smell
  • Paraesthesia
  • Cognitive blunting (brain fog)
Post-intensive care syndrome:
  • Dyspnoea
  • Anxiety
  • Depression
  • Prolonged pain
  • Reduced physical function
Haematological:
  • Hypercoagulable state
  • Anaemia
  • VTE
Musculoskeletal:
  • Diffuse myalgia
  • Joint pain
Rheumatological:
  • Post-viral syndrome similar to chronic fatigue syndrome
Paediatric:
  • Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2
Dermatological:
  • Hair loss
  • Skin rash
 
General:
  • Cardiac/respiratory/musculoskeletal deconditioning
  • Reduced nutritional status and weight loss
  • Low-grade fevers
  • Renal impairment/acute kidney injury
  • Gastrointestinal disturbances
  • Liver dysfunction
  • Pressure sores
  • Reduced quality of life
 
  1. World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. Geneva: WHO, 2021 int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_ case_definition-2021.1 [Accessed 24 November 2021].
  2. Greenhalgh T, Knight M, A’Court M, Buxton M, Husain L. Management of post- acute covid-19 in primary care. BMJ 2020;370:m3026. [Accessed 24 November 2021].
  3. Nalbandian A, Sehgal K, Gupta K, et al. Post-acute COVID-19 syndrome. Nat Med 2021;27(4):601–15. [Accessed 24 November 2021].
  4. National Institute for Health and Care Excellence. COVID-19 rapid guideline: Managing the long-term effects of COVID-19. UK: NICE, 2021 [Accessed 6 December 2021].
  5. Pavli A, Theodoridou M, Maltezou H. Post-COVID syndrome: Incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res 2021;52(6): 575–81. [Accessed 6 December 2021].
  6. Office for National Statistics. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 April 2021. UK: Office for National Statistics, 2021 omsfollowingcoronaviruscovid19infectionintheuk/1april2021#measuring-the-data [Accessed 24 November 2021].
  7. Liu B, Jayasundara D, Pye V, et al. Whole of population-based cohort study of recovery time from COVID-19 in New South Wales Australia. Lancet Reg Health West Pac 2021;12:100193. [Accessed 24 November 2021].
  8. Antonelli M, Penfold R, Merino J, Sudre C. Risk factors and disease profile of post- vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: A prospective, community-based, nested, case-control study. Lancet Infect Dis 2021;S1473-3099(21)00460-6. [Accessed 24 November 2021].
  9. 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(16):949–59. [Accessed 24 November 2021].
  10. Venkatesan P. NICE guideline on long COVID. Lancet Respir Med 2021;9(2):129. [Accessed 24 November 2021].
  11. Australian Institute of Health and Welfare. The first year of COVID-19 in Australia: Direct and indirect health effects. Canberra: Australian Government, 2021 phe-287.pdf [Accessed 23 November 2021].
  12. National COVID-19 Clinical Evidence Taskforce. Care of people with post-COVID-19 (version 4.0). Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022   [Accessed 5 May 2022].
  13. British Society of Rehabilitation Medicine. Rehabilitation in the wake of COVID-19 – A phoenix from the ashes. UK: BSRM, 2020 downloads/covid-19bsrmissue1-published-27-4-2020.pdf  [Accessed 23 November 2021].
  14. Selvaraj V, Dapaah-Afriyie K. Lung cavitation due to COVID 19 pneumonia. BMJ Case  Rep 2020;13(7):e237245. [Accessed 23 November 2021].
  15. Carfi A, Bernabei R, Landi R, Gemelli Against COVID-19 Post-Acute Study Group. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324(6):603–05. [Accessed 23 November 2021].
  16. Spruit MA, Holland AE, Singh SJ, et al. COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated international task force. Eur Respir J 2020;56(6):2002197. [Accessed 23 November 2021].
  17. Rroku A, Kottwitz J, Heidecker B. Update on myocarditis – what we know so far and where we may be heading. Eur Heart J Acute Cardiovasc Care 2020 (ahead of print). [Accessed 23 November 2021].
  18. Firth J, Marx W, Dash S, et al. The effects of dietary improvement on symptoms of depression and anxiety: A meta-analysis of randomized controlled trials. Psychosom Med  2019;81(3):265–80. [Accessed 23 November 2021].
  19. National COVID-19 Clinical Evidence Taskforce. Management of adults with mild-COVID-19 (version 42). Melbourne: National COVID-19 Clinical  Evidence Taskforce, 2022  [Accessed 5 May 2022].
  20. National COVID-19 Clinical Evidence Taskforce. Australian guidelines for clinical care of people with COVID-19 (version 56.1) – Venous thromboembolism (VTE) prophylaxis. Melbourne: National COVID-19 Clinical evidence Taskforce, 2022 [Accessed 5 May 2022].
  21. American Society of Haematology. COVID-19 and VTE/anticoagulation: Frequently asked questions (version 12). Washington: American Society of Haematology, 2021 [Accessed 6 December 2021].
  22. Herrera JE, Niehaus WN, Whiteson J, et al. Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM R 2021;13(9):1027–43. [Accessed 6 December 2021].
  23. Thurber K, Barrett E, Agostino J, et al. Risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander adults: The construct of ‘vulnerable populations’ obscures the root causes of health inequities. Aust N Z J Public Health 2021;4(6):658–63. [Accessed 6 December 2021].
  24. Yashashana A, Pollard-Wharton N, Zwi A, Biles B. Indigenous Australians at increased risk of COVID-19 due to existing health and socioeconomic inequities. Lancet Reg Health West Pac 2020;1:100007. [Accessed 6 December 2021].
  25. Zimmermann P, Pittet L, Curtis N. How common is long COVID in children and adolescents? Pediatr Infect Dis J 2021;40(12):e482–87. [Accessed 6 December 2021].
  26. Murdoch Children’s Research Institute. Frequently asked COVID-19 questions. Melbourne: MCRI, 2021 [Accessed 24 November 2021].
  27. Australian Technical Advisory Group on Immunisation. Clinical guidance  for COVID-19 vaccine providers. Canberra; ATAGI, 2022  [Accessed 5 May 2022].
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