3. Since December 2019, coronavirus
disease 2019 (COVID‑19), caused by severe
acute respiratory syndrome coronavirus 2
(SARS‑CoV‑2) infection, has rapidly swept the
world. As of February 9, 2021, there were more
than 107 million confirmed cases and nearly 2.3
million deaths worldwide.
5. • When the COVID-19 pandemic began, initial
descriptions of the symptomology focused on the
clinical presentations of patients in the acute,
inpatient setting.
• More recently, data have emerged that some
patients continue to experience symptoms related
to COVID-19 after the acute phase of infection.
• There is currently no clearly delineated
consensus definition for the condition:
terminology has included “long COVID,” “post-
COVID syndrome” and “post-acute COVID-19
syndrome.”
15. Liang X, et al, CNS Neurosci Ther. 2020 Aug;26(8):876-8
Post traumatic stress disorder
16. - It appears that SARS-CoV-2 can likely do long-term
damage in different parts of the body through:-
1. Direct effects of viral infection and tissue damage
2. Collateral damage from excessive inflammation
3. Post-viral autoimmunity
4. The consequences of thrombotic complications
21. - Effects on lung fucntion
- Post covid lung fibrosis
- Thromboembolism
Post covid effects on lungs:
22. Torres-Castro R, et al. Pulmonol. 2020. https://doi.org/10.1016/j.pulmoe.2020.10.013
23.
24.
25. Risk factors:
1. Advanced age
2. Increased disease severity
3. Comorbidities such as hypertension, diabetes, and coronary
artery disease
4. Lab findings: lymphopenia, leukocytosis, and elevated LDH
5. Prolonged ICU stay / mechanical ventilation. risk of ventilator-
induced lung injury (VILI).
6. Smoking
7. Alcohol Abuse: WHO and the National Institute on Alcohol Abuse
and Alcoholism (NIAAA) have issued communications warning
people to avoid excessive drinking
27. In the current SARS‑CoV‑2 pandemic, the molecular basis of
progression to pulmonary fibrosis and PC‑ILD is still unclear but is
believed to be multifactorial
PATHOGENIC MECHANISMS
29. A 58-year-old male patient was
diagnosed with COVID-19
on 27 January 2020. He received
lung transplantation on 29
February 2020, 7 days after the
veno-venous (VV) ECMO
establishment. The patient
recovered quickly having no sign
of viral infection relapse.
Explanted lung showed Extensive fibrosis,
inflammatory cells infiltration and haemorrhage
in the lungs
Chen X et all, Eur J Clin Invest. 2021;51:e13443
30. Huang W, et al. Journal of Infection (2020), Reference: YJINF 4859
a) A 33-year-old male with critical pneumonia who undergone both ARDS and mechanical ventilation,
discharged at March 5, 2020 with subtle linear opacities on follow-up CT.
b) A 69-year-old male with critical pneumonia, undergone both ARDS and mechanical ventilation and
discharged at March 1, 2020 with fibrotic pulmonary remodeling on follow-up CT
32. - Currently, no fully proven options are available for the
treatment of post inflammatory COVID 19 pulmonary fibrosis.
- Though risk-benefit ratio should be assessed
prior to use, prolonged low dose corticosteroid may prevent
remodeling of lung in survivors.
- Various treatment strategies are under evaluation.
Gentile F, et al. Eur J Prev Cardiol. 2020;27(13):1442-6.
Treatment
37. Our findings suggest that some patients with severe
COVID-19 develop fibrotic lung disease for which lung
transplantation is their only option for survival.
Bharat et al., Sci. Transl. Med. 12, eabe4282 (2020)
43. - For nonhospitalized patients with COVID-19,
anticoagulants and antiplatelet therapy should not be
initiated for the prevention of venous thromboembolism
(VTE) or arterial thrombosis unless the patient has other
indications for the therapy.
Non-Hospitalized Patients
44. - Hospitalized adults with COVID-19 should receive
prophylactic dose anticoagulation. Anticoagulant or
antiplatelet therapy should not be used to prevent
arterial thrombosis outside of the usual standard of
care for patients without COVID-19.
Hospitalized Patients
- Hospitalized patients with COVID-19 should not
routinely be discharged from the hospital while on
VTE prophylaxis.
52. Extended VTE prophylaxis after hospital discharge can
be considered in patients who are at low risk for
bleeding and high risk for VTE.
Modified IMPROVE VTE risk score ≥ 4
or
Modified IMPROVE VTE risk score ≥ 2 and D-dimer
level > 2 times the upper limit of normal
Plus
IMPROVE BLEED risk score < 7
57. Remember:
1. Post covid syndrome can occur in patient without
symptoms during acute stage.
2. Fatigue is the most common symptoms.
3. PTSD is common especially after ICU admission.
4. Regular follow up is mandatory for patient liable to
post covid lung fibrosis.
5. Consider extended VTE prophylaxis after hospital
discharge, in patients who are at low risk for
bleeding and high risk for VTE.
