Importance Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region. Objective To estimate organ system–specific frequency and evolution of PASC. Evidence Review PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched from December 2019 through March 2021. A total of 2100 studies were identified from databases and through cited references. Studies providing data on PASC in children and adults were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was frequency of PASC diagnosed by (1) laboratory investigation, (2) radiologic pathology, and (3) clinical signs and symptoms. PASC were classified by organ system, ie, neurologic; cardiovascular; respiratory; digestive; dermatologic; and ear, nose, and throat as well as mental health, constitutional symptoms, and functional mobility. Findings From a total of 2100 studies identified, 57 studies with 250 351 survivors of COVID-19 met inclusion criteria. The mean (SD) age of survivors was 54.4 (8.9) years, 140 196 (56%) were male, and 197 777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). The median (IQR) proportion of COVID-19 survivors experiencing at least 1 PASC was 54.0% (45.0%-69.0%; 13 studies) at 1 month (short-term), 55.0% (34.8%-65.5%; 38 studies) at 2 to 5 months (intermediate-term), and 54.0% (31.0%-67.0%; 9 studies) at 6 or more months (long-term). Most prevalent pulmonary sequelae, neurologic disorders, mental health disorders, functional mobility impairments, and general and constitutional symptoms were chest imaging abnormality (median [IQR], 62.2% [45.8%-76.5%]), difficulty concentrating (median [IQR], 23.8% [20.4%-25.9%]), generalized anxiety disorder (median [IQR], 29.6% [14.0%-44.0%]), general functional impairments (median [IQR], 44.0% [23.4%-62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%-54.5%]), respectively. Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders. Conclusions and Relevance In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries.

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Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review.

The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves

The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves.

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has resulted in millions of deaths and a major strain on health systems worldwide. Medical treatments for COVID-19 (anticoagulants, corticosteroids, anti-inflammatory drugs, oxygenation therapy and ventilation) and vaccination have improved patient outcomes. The majority of patients will recover spontaneously or after acute-phase management, but clinicians are now faced with long-term complications of COVID-19 including a large variety of symptoms, defined as “post-acute COVID-19 syndrome”. Most studies have focused on patients hospitalised for severe COVID-19, but acute COVID-19 syndrome is not restricted to these patients and exists in outpatients. Given the diversity of symptoms and the high prevalence of persistent symptoms, the management of these patients requires a multidisciplinary team approach, which will result in the consumption of large amounts of health resources in the coming months. In this review, we discuss the presentation, prevalence, pathophysiology and evolution of respiratory complications and other organ-related injuries associated with post-acute COVID-19 syndrome. Given the millions of patients infected with SARS-CoV-2 worldwide and the need for multidisciplinary management of the chronic complications, post-acute COVID-19 syndrome will be a major issue for various healthcare providers in the coming months. https://bit.ly/3lBJuXu

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Post-acute COVID-19 syndrome

The public health consequences of the epidemic of Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) infections may well go beyond the current burden on hospital services and the indirect effects of social distancing and lockdowns. Patients, particularly older ones with co-morbidities, do experience persistent dyspnea, fatigue, body aches and brain fog during months after hospital discharge [ 1 ] . Post-acute sequelae of SARS-CoV-2 infection or PASC, more commonly called long Corona Virus Infection Disease-19 or long COVID attract considerable media attention, patient advocacy group-initiated research and recently a $1.15 billion funding by the United States National Institute of Health (NIH) [1]. Cellular damage, inflammatory cytokine production, and pro-coagulant state induced by SARS-CoV-2 infection provide a pathophysiological rationale for long-lasting symptomatology [2]. Given the magnitude of the COVID-19 pandemic, with currently over 150 million reported cases, long COVID may emerge as a huge worldwide medical problem [ 1, 2 ] .

https://erj.ersjournals.com/content/erj/58/2/2101763.full.pdf

Phenotyping long COVID.

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Posttraumatic Stress Disorder in Patients After Severe COVID-19 Infection.

Major depressive disorder (MDD) and other affective disorders may surreptitiously arise in children and adolescents during their school period and impair their social and educational functioning. Besides the social and personal burden, which are increased during the SARS-CoV-2 pandemic, the onset of depression may compromise the future of the growing person with chronicity and recurrence. In this context, educators’ training is essential to detect early the onset of a depressive disorder, to spare later consequences through the timely establishment of adequate treatment. The educational staff should receive adequate training to be able to work closely with healthcare providers and parents, thus directing the young person with an affective disorder to the right psychological and pharmacological treatment provider, i.e., a specialized psychologist or psychiatrist. The first approach should be to establish a trustful relationship with the adolescent and his/her classmates, to reduce social and self-stigma and inform about mental illness. If symptoms do not subside and the suffering child or adolescent fails to reintegrate within his/her school environment, cognitive–behavioral interventions are recommended that are individual, group, or computer-based. When needed, these should be implemented with individualized pharmacotherapy.

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Prevention of Depression in Children, Adolescents, and Young Adults: The Role of Teachers and Parents

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Improving the Assessment of COVID-19-Associated Posttraumatic Stress Disorder-Reply.

SUMMARY. Introduction. The elderly population is more frequently subjected to depressive mood compared to the general population and show peculiarities affecting responsiveness; furthermore, aged people need also special care. Duloxetine is a relatively new antidepressant that proved to be effective in adult depression, but has received little attention in elderly populations heretofore. Aim.To review the evidence of duloxetine in late-life major depressive disorder (MDD). Method.A systematic review of studies focusing on the use of duloxetine in MDD in the elderly has been carried out through the principal specialized databases, including PubMed, PsycLIT, and Embase. Results. Only a handful of papers were specifically dedicated to this issue. Duloxetine was found to be effective and safe in old-age MDD, to be better than placebo on many clinical measures in all studies, and to better differentiate from placebo with respect to selective serotonin reuptake inhibitors. Compared to placebo, its side-effect profile is slightly unfavorable and its drop-out rate is slightly higher. Furthermore, when pain is present in old-age MDD, duloxetine is able to reduce it. Conclusions.The efficacy and safety of duloxetine in old-age depression are similar to those encountered in adult MDD. There is a relative lack of comparative studies other than with placebo. The special needs of elderly patients with MDD must be addressed with close patient contact to avoid the perils of inappropriate dosing.

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Duloxetine in the treatment of elderly people with major depressive disorder L'uso della duloxetina nel trattamento degli anziani con disturbo depressivo maggiore

Georgios D. Kotzalidis

Papers

Posttraumatic Stress Disorder in Patients After Severe COVID-19 Infection.

Prevention of Depression in Children, Adolescents, and Young Adults: The Role of Teachers and Parents

Improving the Assessment of COVID-19-Associated Posttraumatic Stress Disorder-Reply.

Duloxetine in the treatment of elderly people with major depressive disorder L'uso della duloxetina nel trattamento degli anziani con disturbo depressivo maggiore