Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.

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Post-acute COVID-19 syndrome.

The clinicopathological basis for morbidity and mortality with SARS-CoV-2 infection is not well understood. This study reports the clinical and autopsy findings of patients who died of COVID-19.

/pdf/pulmonary-arterial-thrombosis-in-covid-19-with-fatal-outcome-30hofrvli3.pdf

Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome : Results From a Prospective, Single-Center, Clinicopathologic Case Series.

The Covid-19 pandemic has introduced an array of organspecific and systemic phenotypessome previously observed in viral infections, including severe acute respiratory syndrome (SARS) and others that appear to be unique to SARScoronavirus (CoV)-2. Rapidly emerging information from clinical observations, autopsy-based findings, extrapolations from in vitro and ex vivo studies and dynamic modeling are informing management guidelines; however, many questions remain unanswered and clinical trials that are required to provide evidence have not been completed in most areas. Among the many questions that require careful thought, reflection and investigation are the mechanism(s) underlying the development of a systemic coagulopathy and acquired thrombophilia characterized in a majority of cases by a proclivity for venous, arterial and microvascular thrombosis. The following review summarizes emerging insights into the pathobiology, mechanism(s), diagnosis, management, foundations for research and either planned or ongoing clinical trials for Covid-19-associated coagulopathy.

/pdf/covid-19-update-covid-19-associated-coagulopathy-4dxguefmi6.pdf

COVID-19 update: Covid-19-associated coagulopathy.

https://escholarship.org/content/qt75d2h7r6/qt75d2h7r6.pdf?t=qmh0x8

Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis.

The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management.

Thirty-two of 106 patients (30% [95% confidence interval: 22%, 40%]) with coronavirus disease 2019 infection were positive for acute pulmonary embolus on pulmonary CT angiograms.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020201561

Coralie Pauzet

Papers

Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer Levels.