key: cord-0726735-zuhg2c02 authors: Santana, Lucas Alves da Mota; Lima dos Santos, Marcos Antônio; de Albuquerque, Hélio Igor Melo; de Oliveira, Eduardo Morato; Miguita Luiz, Lucyene; Takeshita, Wilton Mitsunari; Souza, Liane Maciel de Almeida title: Postacute coronavirus disease 2019 (COVID-19) syndrome in maxillofacial surgeons after initial infection: A Brazilian experience date: 2021-09-06 journal: Infection control and hospital epidemiology DOI: 10.1017/ice.2021.401 sha: 989fe61f2fce4e2b65119e58825604bd641f4969 doc_id: 726735 cord_uid: zuhg2c02 nan Postacute COVID-19 syndrome, or long COVID, is defined as persistence of symptoms or appearance of sequelae beyond 3 or 4 weeks from the onset of disease. 2 In general, the most commonly reported symptoms are fatigue, sleep difficulties, and anxiety and/or depression. 2, 5 The pathophysiologic mechanisms of syndrome are unclear, although damage provoked by host inflammatory response and immunological deficits may predispose a COVID-19 patient to a greater chance of sequelae. 6 To our knowledge, this is the first study to report a case series of sequelae of COVID-19 in maxillofacial surgeons presenting postacute COVID-19 syndrome followed for 12 months. Commonly, studies have reported the prevalence of postacute COVID-19 syndrome in patients followed for 6 months; fatigue and dyspnea affected a larger number of these patients. 2, 5 Also, the presence of comorbidities have been reported as determining factors of increased severity of disease, 3,6 which was not observed in our study. Researchers have focused on the analysis of the sequelae of COVID-19 in hospitalized patients once they are expected to have longer convalescence. 5 The professionals evaluated in our study did not need hospitalization; thus, regardless of the severity of the disease, the sequelae may be significant and can impact quality of life. Interestingly, Augustin et al (2021) 5 demonstrated that longterm symptoms of postacute COVID-19 syndrome are not exclusive to more severely ill patients or those with a long period of hospitalization, despite the expectation of longer convalescence for hospitalized patients. In their study, 930 (97.1%) of 958 COVID-19 patients who were not hospitalized developed symptoms as shortness of breath, fatigue, joint pain, anosmia, and/or ageusia. Other important alterations found in the literature are thromboembolic disorders, renal failure, pulmonary fibrosis, Hashimoto thyroiditis, gastrointestinal and hepatobiliary sequelae, psoriasis, and Guillain-Barré syndrome. 2, 7 The association between COVID-19 and development of these pathologies is still poorly understood, but some hypotheses have been postulated. Regarding anosmia, it is thought that SARS-CoV-2 may damage the olfactory neuroepithelium by linkage to the ACE2 receptor and that fatigue could result from endothelial dysfunction in brain capillaries as consequence of the inflammatory process. 8 In conclusion, our results reinforce the need for long follow-up of healthcare workers affected by novel coronavirus, mainly, those working on the front lines and in environments with a high flow of infected patients, including individuals not hospitalized. In addition, most of these symptoms may be underdiagnosed and directly affect quality of life; thus, a multidisciplinary approach is needed, as well as monitoring of symptoms after the initial period of illness. The natural history, pathobiology, and clinical manifestations of SARS-CoV-2 infections Postacute COVID-19 syndrome Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments COVID-19 contamination among maxillofacial surgeons and impact in Brazilian public center Post-COVID syndrome in nonhospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur Factors associated with COVID-19-related death using Open SAFELY COVID-19-associated Guillain-Barré syndrome: the early pandemic experience SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor Assessing brain capillaries in coronavirus disease 2019 Acknowledgments.Financial support. No financial support was provided relevant to this article.Conflicts of interest. All authors report no conflicts of interest relevant to this article.