COVID-19: sequelae and long-term consequences

The COVID-19 pandemic caused by the SARS-CoV-2 virus has resulted in a broad spectrum of symptoms, ranging from mild to severe respiratory distress, shock, and death. While most people recover from the acute infection within a few weeks, there is mounting evidence for the persistence of symptoms for many weeks or longer, beyond the expected time to recovery, referred to as post-acute sequelae of SARS-CoV-2 infection (PASC). PASC has emerged as a significant cause of morbidity, with an estimated 50% of patients experiencing the persistence of a broad array of pulmonary and extrapulmonary symptoms. This chapter describes the current understanding of the molecular basis of SARS-CoV-2 persistence, the multi-organ system dysfunction due to PASC, immune dysregulation observed in PASC, genetic predisposition to developing PASC, the social and economic impact of PASC, and the effects of vaccination and therapies to mitigate PASC. The lack of understanding of PASC should not discredit the presence of a person’s suffering, and treatment demands a multidisciplinary approach to maximize patients’ quality of life and function.