An overview of post‐COVID‐19 complications

The emergency of coronavirus disease 2019 (COVID-19) has resulted in an incomparable worldwide pandemic. Thus, the World Health Organization (WHO) has declared COVID-19 as a pandemic in 12 March 2020.1 Amid the acute phase of COVID-19, patients can be presented by several manifestations including cough, fever, nausea, diarrhoea, vomiting, muscles and joints pain, headache, fatigue and anosmia. Moreover, several studies reported that different types of complications occur in multiple body systems during post-viral infection phases.2 Upon searching three databases (PubMed, Google Scholar and WHO COVID-19 data bases), a recent systematic review found 69 articles from 15 countries reported post-COVID-19 complications among survivors.3 Respiratory complications were identified in 36 studies from several countries (China, Egypt, Germany, Italy, the UK, Netherland, Canada, Saudi Arabia, Iran, France, Spain and the United States).3 The commonly reported symptoms were breathlessness, lung function abnormalities, pulmonary fibrosis (interstitial thickening and crazy paving), residual ground-glass opacity, abnormal diffusion, pneumonia and pulmonary embolism. The longest duration of follow-up that reported respiratory sequelae was 4 months post-hospital discharge.4, 5 Although the lungs are the main organs affected by COVID-19, cardiovascular complications and neurological complications are involved in the identified studies.6 Nine studies in China, Italy, Australia, and Germany have reported cardiovascular events of COVID-9.3 The longest duration of follow-up documented among these studies was 3 months post-hospital discharge.7 The cardiovascular complications included an increase in heart rates, increase palpitations, elevation in blood pressure, chest tightness, pericardial chest pain, myocardial infarction, myocardial oedema, pericardial effusion, diastolic dysfunction, pulmonary hypertension and cardiac arrhythmia.6, 8 However, 28 studies in China, Egypt, Germany, the UK, Italy, Ireland, Spain, Korea, the USA and Bangladesh have reported neurological complications among COVID-19 survivors.3 In these studies, COVID-19 survivors were presented with multiple symptoms included post-traumatic stress disorder, depression, anxiety, memory problems (immediate memory and delayed memory), cognitive impairment, insomnia and sleeping disorder.4, 6 Chieffo et al reported neurological sequelae among survivors 4 months post-hospital discharge.9 Post-traumatic stress disorder is the commonly reported symptom in these studies. It is presented commonly post-intensive care unit (ICU) survivors, females, young population and survivors who had a previous history of psychological diseases.4 In addition, 23 studies from 12 countries reported musculoskeletal complications including generalised pain, joint and muscle pain, fatigue and reduction in exercise tolerance as consequences after COVID-19 recovery.3 Fatigue and physical decline were attributed to pulmonary impairment and shortness of breath which are commonly reported among the survivors.4, 5, 10 Furthermore, gastrointestinal tract (GIT) complications including nausea, vomiting, diarrhoea and acute liver injury (non-specific pattern) were among the prolonged complications which lasted in some cases up to 3 months after recovery. Four studies in the UK, Germany and China have reported these GIT complications.10, 11 Raman et al reported urinary complications that involved residual renal failure among COVID-19 survivors who had no kidney injury prior to the infection.10 Some other miscellaneous complications such as mild to moderate headache, fever, weight loss, alopecia, sore throat and loss of smell and taste were reported after recovery. Seventeen studies had reported these symptoms among survivors and they lasted for 3 months post full recovery.6, 11 Until now, literatures cannot conclude the prolonged complications of COVID-19 and the residual organs damage that may persist among the survivors. Therefore, long-term follow-up is recommended for COVID-19 survivors. In summary, lung abnormalities, neurological complications and exercise intolerance are frequently identified complications among COVID-19 survivors. Thus, some of these post-COVID-19 complications may need long-term follow-up and management (Table 1). The authors appreciate the feedback and revisions of Prof. Bernard Sorofman at the University of Iowa College of Pharmacy, USA. The authors declare no conflict of interest.

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