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Review
. 2021 Sep-Oct;6(9):796-811.
doi: 10.1016/j.jacbts.2021.07.002. Epub 2021 Sep 15.

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A State-of-the-Art Review

David H Jiang  1 , Darius J Roy  2 , Brett J Gu  3 , Leslie C Hassett  4 , Rozalina G McCoy  1   5
Affiliations
Review

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A State-of-the-Art Review

David H Jiang et al. JACC Basic Transl Sci. 2021 Sep-Oct.

Abstract

The vast majority of patients (>99%) with severe acute respiratory syndrome coronavirus 2 survive immediate infection but remain at risk for persistent and/or delayed multisystem. This review of published reports through May 31, 2021, found that manifestations of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) affect between 33% and 98% of coronavirus disease 2019 survivors and comprise a wide range of symptoms and complications in the pulmonary, cardiovascular, neurologic, psychiatric, gastrointestinal, renal, endocrine, and musculoskeletal systems in both adult and pediatric populations. Additional complications are likely to emerge and be identified over time. Although data on PASC risk factors and vulnerable populations are scarce, evidence points to a disproportionate impact on racial/ethnic minorities, older patients, patients with preexisting conditions, and rural residents. Concerted efforts by researchers, health systems, public health agencies, payers, and governments are urgently needed to better understand and mitigate the long-term effects of PASC on individual and population health.

Keywords: ACE2, angiotensin-converting enzyme 2; AKI, acute kidney injury; COVID-19, coronavirus disease-2019; PASC, postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection; PIMS, pediatric inflammatory multisystem syndrome; POTS, postural tachycardia syndrome; RRT, renal replacement therapy; SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2; coronavirus disease 2019; disparities; long COVID; postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection; vulnerable population.

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Conflict of interest statement

This effort was funded by the National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases (grant K23DK114497 [Dr McCoy]) and the Mayo Clinic Research Pipeline K2R Program Award (Dr McCoy). Study contents are the sole responsibility of the authors and do not necessarily represent the official views of National Institutes of Health. Dr McCoy has received support from the National Institute of Diabetes and Digestive and Kidney Diseases (grants R03DK127010 and P30DK11024) and AARP (Quality Measure Innovation Grant) in the past 36 months. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Multi-System Manifestation of PASC Postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) is an emerging multisystemic condition that manifests subsequent to an acute infection of severe acute respiratory syndrome-coronavirus-2. Conditions and symptoms characterized in the published reports and developing or persisting beyond 28 days of the initial coronavirus disease-2019 are summarized in this figure by body systems. POTS = postural tachycardia syndrome.
Figure 1
Figure 1
Patients at Highest Risk for PASC Whereas data on risk factors for postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) are scarce, early published reports suggests several clinical and sociodemographic risk factors. COVID-19 = coronavirus disease-2019.
See this image and copyright information in PMC

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