Introduction
People are still learning about the COVID-19 virus, initially discovered in Wuhan, in the Hubei province of China, at the beginning of December 2019. The WHO China Office declared the virus to the world on December 31, 2019, and its agent was discovered on January 7, 2021. People are learning more and more each day about the long-term consequences and problems. Upon hospital release, patients may endure persistent symptoms for several months, including cough, exertional dyspnea, exhaustion, and muscle aches.
This is particularly the case for individuals experiencing severe COVID-19. Patients undergoing invasive mechanical ventilation (IMV) therapy after being intubated for acute respiratory distress syndrome (ARDS) may develop chronic respiratory failure and irreversible lung fibrosis. Pulmonary involvement is currently the most well-known and prevalent kind of post-COVID syndrome (PCS).
What Is Post-Covid 19 Syndrome (PCS)?
Acute COVID-19: COVID-19 symptoms and indicators present from the start to four weeks after infection.
COVID-19 Symptoms that Persist: COVID-19 symptoms appear between four and twelve weeks.
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Post-COVID-19: Symptoms and signs that do not correspond with another diagnosis and extend longer than 12 weeks.
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Extended COVID-19: Denotes the correlation between COVID-19 and its aftermath.
However, there are a lot of confusing circumstances that make defining post-COVID-19 challenging because determining a timetable for both acute and chronic symptoms is difficult. Additionally, it is challenging to differentiate between post-COVID-19 and the previously recognized post-ARDS, post-intubation complications (tracheal trauma, edema, etc.), post-ARDS, and post-mechanical ventilation (anxiety, fibrosis, etc.).
It is vital to understand the patient's pre-COVID-19 baseline status to differentiate between the effects of COVID-19 and prior comorbidities. It is critical to determine whether the clinical outcome results from a post-secondary infection (resistant bacteria, fungal infections, etc.) or post-COVID-19 or post-viral infection sequelae (bronchial hypersensitivity, constitutional issues, etc.). Considerations should also be made for issues following the use of corticosteroids (muscle weakness, diabetes mellitus (DM), infections, etc.); post-ischemic (infarction-blockage due to blood clot, functional limitation, etc.); and post-traumatic syndrome (anxiety, panic, etc.).
What Is the Significance of PCS?
The long-term follow-up of patients treated for COVID-19 is justified by the following:
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It ensures that clinically recovered patients' radiological complications are resolved.
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It identifies and manages previously undiagnosed respiratory disease;
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It identifies and treats life-limiting complications like pulmonary fibrosis and pulmonary vascular disease.
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It assesses patients' oxygen requirement and the provision of rehabilitation, palliative care, symptom management, and psychosocial support;
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It monitors, identifies, and treats early, medium, and long-term respiratory complications.
It is advised to perform this thorough assessment following each visit with the patient to identify any issues early on and treat any long-term symptoms.
What Are the Clinical Characteristics of PCS?
The term "post-COVID-19 syndrome" refers to the clinical situation where symptoms and signs have been present for more than 12 weeks, either during or after the COVID-19 infection, and no alternative explanation can be found. Clusters of symptoms and signs that regularly overlap can affect any body system and change and fluctuate over time. While the upper and lower respiratory tracts are the primary entry points for SARS-CoV-2, it can also induce pneumonia (fluid accumulation in air sacs of the lungs), pulmonary fibrosis (scarring of lung tissue), and acute lung damage over time, all of which can impair quality of life.
The likelihood of developing post-COVID-19 syndrome is increased by advanced age, the existence of concomitant chronic conditions, and the severe course of acute COVID-19 sickness. Regardless of comorbidities, it is anticipated that 15 percent to 40 percent of COVID-19 patients not requiring hospitalization experience post-covid symptoms. In contrast, this rate might reach 85 percent in hospitalized patients and patients with significant conditions. Different medical institutions have classified post-COVID syndrome based on initial symptoms, time since onset, length of symptoms, and organ dysfunctions. Still, standardization of the classification is required to give a common path for diagnostic, therapeutic, and research purposes.
Breathlessness and coughing are the most prevalent respiratory symptoms in patients with post-COVID-19 syndrome. It has been found that 70 percent of patients hospitalized and discharged from the intensive care unit experience dyspnea (shortness of breath) and impaired exercise tolerance 2-4 months after discharge, while 10 percent to 40 percent of hospitalized COVID-19 patients experience dyspnea. Post-COVID interstitial lung disease (organized pneumonia, pulmonary fibrosis) and chronic cough are among the often observed clinical disorders.
What Is Chronic Cough and Its Treatment?
Along with symptoms including chronic exhaustion, headaches, and widespread discomfort, coughing is one of the first signs of acute COVID-19 disease and is also commonly seen in post-COVID syndrome. Chronic cough in post-COVID syndrome, in contrast to cough that lasts after a cold or flu, is frequently accompanied by additional multisystemic manifestations that may point to multifactorial pathophysiology or shared mechanisms that underlie these symptoms but are currently unknown. In cases of acute COVID, opioid-derived antitussives are advised; however, caution should be exercised due to their propensity for addiction and potential negative effects on the central nervous system.
Patients with asthma can get steroids orally or by inhalation. It is possible to suggest neuromodulator medications like pregabalin and gabapentin. Since antimuscarinic medications like tiotropium might lessen cough sensitivity in cases of acute viral upper respiratory tract infections, they can be used to manage COVID-19 cough.
How Are PCS Lung Complications Managed?
Since the SARS-CoV-2 epidemic began more than a year ago, people have learned more about the long-term pulmonary consequences of COVID-19 illness. The approach to PCS patients will be further shaped by experience with longer follow-ups. The most frequent and serious issue during the illness is viral pneumonia, and whether widespread COVID-19 pneumonia can cause chronic lung fibrosis in the long run is still unknown.
Prevention and Management of PC-ILD (Post COVID-19 Interstitial Lung Disease):
Based on the available data, the following treatment alternatives can be listed:
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Antivirals: High viral loads are known to be closely associated with the development of lung fibrosis, and reducing viral loads with early antiviral therapies (Favipiravir) has proven to be a successful strategy.
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Anti-inflammatory Medications: Systemic steroids effectively treat severe illness during the acute phase. Research indicates that to prevent lung fibrosis, 20 to 30 mg/day of Prednisolone should be started in the presence of diffuse ground glass opacities and continued until radiological improvement is seen.
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Antifibrotics: Although there is no enough information currently, there is a case to be made for using antifibrotic medications in treating PC-ILD if fibrosis still exists four months after COVID-19 infection. It is recommended to use Nintedanib or pirfenidone for a minimum of one to three months to measure the antifibrotic response accurately.
Management and Prevention of Pulmonary Emboli:
In cases where the condition is severe, long-term prophylaxis may be advised because hypercoagulation may persist long after the acute phase of the illness. This problem still needs to be fully evident, though. Anticoagulation therapy is necessary in patients with severe illness and a concomitant pulmonary embolism.
Conclusion
The fact that COVID-19 disease is more than just an acute infection and is a complex entity with long-term repercussions and post-infection problems, particularly affecting the pulmonary system, highlights the necessity of continuing therapy for this illness even after patients are released from the hospital. In-depth research is required to find biomarkers and risk factors for those who may advance, allowing for early intervention and treatment to reduce long-term impacts. The pathogenesis of this novel disease is still mostly unknown, making treating these individuals challenging. COVID-19 specialized hospitals or centers can assist with optimal treatment and follow-up.
