Abstract:
COVID-19 patients may face a long and winding road to recovery. Outcomes of critically ill patients have been well described, including in China, Italy and the USA, and particularly in the comorbid elderly. However, short-, medium- and long-term health consequences are being realised not only in those that were hospitalised, but also in outpatients with milder or asymptomatic illness. At the end of July, the Centers for Disease Control and Prevention (CDC) in the USA reported that 35% of 292 COVID-19 patients, young and old, with mild disease, had not returned to their usual state of health, 2–3 weeks post testing positive for the virus. Common residual symptoms included cough (43%), fatigue (35%), or shortness of breath (29%). Noteworthy, was that prolonged convalescence occurred in 20% of young adults who had no chronic comorbidities, potentially leading to loss of function at work, studies, or other activities. In Germany, enduring cardiac involvement in 100 recently recovered COVID-19 patients (median age 49 years) has also been described. Cardiovascular MRI performed during the early convalescent stage at a median time interval since COVID-19 diagnosis of 71 days, revealed signs consistent with persistent myocardial inflammation in 60% of patients, which, importantly, was independent of the severity of the original presentation and pre-existing comorbidities. Prolonged coma in COVID-19 patients following ventilation is a new perplexing concern, while post-infectious neurological complications, including Guillain- Barré syndrome and other diseases of the central and peripheral nervous system, may also rarely manifest after COVID-19. The latter are likely the result of immune activation.
