Follow-up studies in COVID-19 recovered patients - is it mandatory?

Abstract

The novel Coronavirus disease 2019 (COVID-19) is an illness caused due to Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The World Health Organization (WHO) has declared this outbreak a global health emergency and as on April 24, 2020, it has spread to 213 countries, with 25,91,015 confirmed cases and 742,855 cases have been recovered from COVID-19. In this dreadful situation our team has already published an article in the Science of the Total Environment, which elaborates the various aspects of the SARS-CoV-2 infection. In this situation, it is imperative to understand the possible outcome of COVID-19 recovered patients and determine if they have any other detrimental illnesses by longitudinal analysis to safeguard their life in future. It is necessary to follow-up these recovered patients and performs comprehensive assessments for detection and appropriate management towards their psychological, physical, and social realm. This urges us to suggest that it is highly important to provide counselling, moral support as well as a few recommended guidelines to the recovered patients and society to restore to normalcy. Epidemiological, clinical and immunological studies from COVID-19 recovered patients are particularly important to understand the disease and to prepare better for potential outbreaks in the future. Longitudinal studies on a larger cohort would help us to understand the in-depth prognosis as well as the pathogenesis of COVID-19. Also, follow-up studies will help us provide more information for the development of vaccines and drugs for these kinds of pandemics in the future. Hence, we recommend more studies are required to unravel the possible mechanism of COVID-19 infection and the after-effects of it to understand the characteristics of the virus and to develop the necessary precautionary measures to prevent it.

Keywords: COVID-19; Epidemiological study; Follow-up studies; Health assessment; Recovered patients; SARS-CoV-2.

Graphical abstract

Fig. 1

Effect of SARS-CoV-2 infection on organs in different parts of the body. (Clockwise) Virus enters through the olfactory bulb causing an inflammatory response leading to a cytokine storm. This may cause anosmia and encephalitis. Upon entry into the eyes, the virus can spread through tear and mediate spreading via nasolacrimal system to other organs of the body and may cause conjunctivitis in the eyes. Entry of virus into the heart through the blood, can cause the formation of a necrotic lipid. When the lipid ruptures it can cause blood clots leading to myocardial infraction. In the kidney, the virus enters the proximal tubules and podocytes via the ACE2 receptors. After entry, it causes deposition of extracellular matrix causing fibrosis, diuresis and proliferation of kidney cells leading to acute kidney injury. In the liver, the virus activates kupffer cells mediating an inflammatory response. This causes activation of the hepatic skellate cells and hepatocytes resulting in pyroptosis and fibrosis derived injury. In the lungs, the virus causes damage to the walls of the alveolar cells, this results in the formation of debris. The debris accumulated in the walls of the alveolar cells causing thickening and results in lung distress and damage. This causes shortness of breath the commonly displayed symptom in COVID-19 (This figure was created by Biorender).