The Post-COVID Condition (Long COVID)

Abstract

Carfi et al. reported 2 months follow-up   after recovering from COVID-19. Many patients have been found to have signs of abnormality that persist. Persistant symptoms in many body systems and some patients have been found to have new abnormalities. Several subsequent studies have reported abnormal signs after recovering from COVID-19. in a similar way. Unusual signs that persist after recovering from COVID-19 It is possible that it may be caused by a reinfection of the coronavirus. 2019 New mutations, or caused by previously pathogenic viruses that are in a reactivated state, or may be caused by a new pathogenic mechanism.

Persistent abnormal symptoms or syndromes or new abnormal manifestations For more than 4 weeks in people who have recovered from COVID-19 and not due to coronavirus infection. 2019  is a recurrent mutation, and it is not caused by a virus that is triggered to reappear. There are different triggers such as Long COVID, Post–COVID 19 Condition, Acute Post-COVID Condition.  Post–acute COVID syndrome   Post-acute Sequelae of COVID-19 (PASC), Long-Haul  COVID and Chronic COVID-19, etc.

The U.S. Center for Disease Control (CDC) calls for symptoms or signs that persist or recur for more than four weeks. After recovering from COVID-19, the "   Post-Covid Condition" causes and mechanisms of pathogenesis are still unknown, but it is believed to be caused by many factors (Multifactorial factors) as shown in Chart 1.

1. Coronavirus 2019 (SARS-CoV-2) causes many organs in the body to function improperly. As a result, abnormal symptoms occur.
2. Immune system This leads to a condition called "Systemic Inflammatory Response Syndrome (SIRS)", the body adjusts and rebalances against inflammatory processes called "Compensatory Anti-inflammatory Response Syndrome (CARS)". Immune activation and immunosuppression Immunosuppression or between "SIRS" and "CARS" results in injury to the tissues of organs in the body by the body's own immune system.
3. From the effects of severe illness Post-critical illness has been found that patients with severe illness often suffer from injury and damage to the small vascular system. Microvascular Injury causes imbalance of water and minerals. This causes the functioning of many organs in the body to be abnormal.

The U.S. CDC classifies post-COVID status. Post-Covid Condition according to the mechanism of disease formation into 3 groups as follows:

1. I. Long Covid or Persistent Post-Covid Syndrome (PPCS) is a symptom or group of abnormal signs that persist or recur for more than 4 In people who have recovered from COVID-19 The main symptoms of Long COVID include low-grade fevers, headache, dizziness, dyspnea, cough, chest tightness, fatigue, tiredness, abdominal pain, diarrhea, loss of appetite, earache, ringing in ears, palpitations, and lack of concentration. Brain fogginess, insomnia Mood swings, numbness, muscle pain and joint pain, persistent loss of smell or taste, rash on the body. In females, menstrual cycles may come irregularly.
2. Multiorgan effects of COVID-19 are symptoms related to abnormal functioning of multiple organs in the body of patients who have been infected with coronavirus. It is caused by inflammatory substances secreted by white blood cells. However,  large amounts of cytokines are secreted continuously until a condition called "Cytokine storm" causes damage to the tissues of many organs by their own immune system. It is found in cardiovascular, pulmonary, renal, neuropsychiatric, and skin tissues. Acute Respiratory Distress Syndrome (ARDS), Hypercoagulable state  , and Maladaptation of the Angiotensin-Converting Enzyme 2 (ACE2) pathway cause hypoperfusion to end organs to supply oxygen (Hypoperfusion to end organs).  Multiorgan failure, which can eventually lead to death.

In pediatric patients, Multisystem Inflammatory Syndrome associated with COVID-19  , also known as "MIS-C", is a symptom of Kawasaki Syndrome, which is multiorgan effects, high fever, and rash. conjunctivitis Enlarged lymph nodes At the time of contracting COVID-19 or immediately after recovering from COVID-19. How long the disease will run is still unknown.

III. Effects of  COVID-19 Treatment/Hospitalization Effects of prolonged hospitalization in patients with COVID-19  This  is especially true for patients in intensive care units. Experiencing severe acute stress from intubation or cardiopulmonary resuscitation     Accumulated stress affects the mind, leading to mental disorders that follow "Post-Intensive Stress Disorder (PTSD").  Limb weakness, fatigue, slowing thinking and speech, and economic impacts. The symptoms and compound consequences of these accumulated stresses improve over time. In addition to COVID-19 patients themselves. Many of the patients' close contacts were also psychologically affected. From being isolated during long periods of isolation or hospitalization, or death.