Potential complications and sequelae of SARS-CoV-2 infection

ABSTRACT

COVID-19 disease caused by the SARS-CoV-2 virus affects almost all the organ systems of the body leading to multisystemic morbidities and typical complications hitherto unheard of in seasonal "flu" or SARS-CoV-1 epidemic. Acute life-threatening complications range from unabated pneumonia and respiratory failure to "cytokine release syndrome" or "cytokine storm," cardiovascular and cerebrovascular morbidities leading to multiorgan failure, followed by death. The prepathogenesis, pathogenesis, and the clinico-demographic characteristics of SARS-CoV-2 infection have shown a wide variation across different populations, geographical regions, race, and ethnicities. While there are some commonalities, there continues to be a lack of consensus on several aspects of this infection such as its natural history, infectivity, transmission, and its mutagenic strains. Further, newer aspects of the disease have continued to emerge with passing time since its first appearance in December 2019 in Wuhan, China. The initial case descriptions varied from asymptomatic to mild illness requiring minimal monitoring and support to severe COVID-19 disease requiring admission to intensive care facilities and a higher morbidity and mortality. Only subsequently it was recognized that even after the clinical recovery from illness, the infection may persist for a longer time, with continuing damage to some organ systems and sequelae that compromise the quality of life. These have been called the long-term complications or "chronic COVID" infection, and they may be noted even months after recovery from the acute form of disease. While thus far the global efforts have been rightfully directed at combating the acute illness in the pandemic and maximizing recovery, it is possible that we may soon be faced with the challenge of a "secondary pandemic" with a significant burden of chronic COVID and sequelae. This will be a strain on the palliative care, rehabilitative care, and domiciliary care network essentially supported by the primary health-care providers or first-contact physicians worldwide. This approach is in alignment with an emphasis that the WHO placed on the third clinical outcome indicator "functioning" in addition to the two indicators "cure" and "death." The present review discusses the pathophysiology, clinical aspects, and implications of long-term effects of SARS-CoV-2 infection. It is expected to help in sensitizing the health-care workers and policymakers for preparing adequately and timely for dealing with these effects.