key: cord-0948667-2t2dwg4p authors: Suvvari, Tarun K.; Kutikuppala, L. V. Simhachalam; Tsagkaris, Christos; Corriero, Anna C.; Kandi, Venkataramana title: Post‐COVID‐19 complications: Multisystemic approach date: 2021-07-28 journal: J Med Virol DOI: 10.1002/jmv.27222 sha: faeb553123b2ad86702e7ce5a2657e93192708be doc_id: 948667 cord_uid: 2t2dwg4p nan To The Editor, Coronavirus disease 2019 (COVID-19) is a communicable disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Following a reported incubation period of 1-14 days, the disease commonly presents through symptoms of fever, cough, fatigue, breathing difficulties, and loss of taste and smell. 1 The majority of COVID-19 patients are, however, either asymptomatic or only have mild symptoms; while a few may develop acute respiratory distress syndrome (ARDS), which can be life-threatening or fatal. 1 Although many COVID-19 patients eventually recover, some do not cease experiencing symptoms long after their COVID-19 polymerase chain reaction test turns negative; this is commonly referred to as "post-COVID-19 syndrome" or "long COVID." As per guidelines by the National Institute for Health and Care Excellence (NICE), Post COVID-19 syndrome is defined as, "signs and symptoms that develop during or after an infection consistent with COVID-19, continuing for more than 12 weeks (3 months), and not explained by an alternative diagnosis." 2 NICE has also recommended research on the following topics regarding the post-COVID-19 syndrome: Guillain−Barré syndrome, encephalitis, polyneuropathy, depressive syndrome, delirium, and psychosis were also frequently reported as neuropsychiatric manifestations, and tinnitus, possibly associated with vestibular neuritis, has also been reported significantly. Thrombotic complications like deep-vein thrombosis and pulmonary embolism have also been described as possible consequences, along with acute kidney injury and renal failure. [3] [4] [5] A detailed description outlining the reported and published complications [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] has been given in (Table 1) . Having understood the possible long-term consequences of COVID-19, it is recommended to study a number of patients through long prospective cohort studies with common methodology and standards. This practice has been previously employed in observing the consequences of outbreaks of other major infectious diseases such as SARS in 2003 and Ebola in 2004. If we look at the literature regarding SARS, it was found that 52% of the survivors suffered longterm respiratory impairment and reduced exercise endurance; considering that similar manifestations have been reported in patients recovering from COVID, it would bode well to investigate the epidemiology, clinical features and burden of possible post-COVID symptoms now more than ever, as the acute phase of the COVID pandemic appears to be approaching its end. The assessment of not only respiratory insufficiency, but also of symptoms such as anxiety and depression, joint and chest pain, headache, and dementia should be taken into consideration, considering their debilitating effect and their increased prevalence in the general population. 22 In a study by Ferraro et al., 23 Understanding the unusual viral outbreak: coronavirus disease 2019 COVID-19 rapid guideline: managing the long-term effects of COVID-19 Long-term effects Gemelli against COVID-19 post-acute care study group. Persistent symptoms in patients after acute COVID-19 Assessment and characterisation of post-COVID-19 manifestations Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging Patients recovered from COVID-19 show ongoing subclinical myocarditis as revealed by cardiac magnetic resonance imaging Pulmonary longterm consequences of COVID-19 infections after hospital discharge Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery Long-COVID': a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19 Arul JNPost COVID-19 sequelae: venous thromboembolism complicated by lower GI bleed Persistent psychotic symptoms following COVID-19 infection Surviving COVID-19 in Bergamo province: a post-acute outpatient re-evaluation Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study Post COVID 19 multisystem inflammatory syndrome in an older adult Assessment of acute kidney injury and longitudinal kidney function after hospital discharge among patients with and without COVID-19 Six-month neurological and psychiatric outcomes in 236,379 survivors of COVID-19 Gastrointestinal sequelae 90 days after discharge for COVID-19 Post-COVID-19 cholangiopathy: a novel entity Post-COVID-19 cholangiopathy-a new indication for liver transplantation: a case report The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status COVID-19 related fatigue: which role for rehabilitation in post-COVID-19 patients? A case series Rehabilitation of patients post-COVID-19 infection: a literature review UK guidelines for managing longterm effects of COVID-19