Professional Documents
Culture Documents
2021 Covid Syndrome Theoretical and Management
2021 Covid Syndrome Theoretical and Management
ABSTRACT
As COVID-19 continues to spread, with the chronic inflammation (eg, fatigue), sequelae
United States surpassing 29 million cases, of organ damage (eg, pulmonary fibrosis,
health care workers are beginning to see chronic kidney disease), and hospitalization
patients who have been infected with SARS- and social isolation (eg, muscle wasting, mal-
CoV-2 return seeking treatment for its longer- nutrition). Health care providers are instru-
term physical and mental effects. The term mental in developing a comprehensive plan
long-haulers is used to identify patients who for identifying and managing post–COVID-19
have not fully recovered from the illness after complications. This article addresses the
weeks or months. Although the acute symp- possible etiology of postviral syndromes and
toms of COVID-19 have been widely described, describes reported symptoms and suggested
the longer-term effects are less well known management of post-COVID syndrome.
because of the relatively short history of the Key words: long-haulers, post-COVID syn-
pandemic. Symptoms may be due to persistent drome, symptom management
e1
SCORDO ET AL W W W .AACN ACCON LIN E .ORG
e2
P U BL I SH E D ONL INE MAY 4 , 2021 P OST- COVID - 19 SYND ROM E
disorders noted with COVID-19.12 Abnormal- Five cutaneous patterns have been noted in
ities of this lymphatic system may lead to an patients with COVID-19: maculopapular, urti-
accumulation of proinflammatory cytokines that carial, pseudochilblain, vesicular, and livedoid
eventually affect the autonomic nervous sys- (see Table).24 Characterizing these skin changes
tem with resultant cognitive dysfunction and may help to identify mechanisms involved.
severe fatigue, which are also noted in ME/CFS For instance, livedoid changes are associated
patients.12,14 Although more research is needed, with occlusion of cutaneous vessels that may
understanding ME/CFS may facilitate under- portend systemic thrombosis.18
standing of post–COVID-19 syndrome. Neuropsychiatric manifestations of COVID-
19 are abundant, with evidence of impact on
e3
SCORDO ET AL W W W .AACN ACCON LIN E .ORG
Urticarial
Red, raised welts (eg, hives) Lasts for a shorter period of time
Truncal or widespread; some Frequently appears concurrently
palmar with other symptoms
Associated with more severe
disease
Usually involves itching
Pseudochilblain
Painful, swollen red bumps with Tends to occur in younger
some vesicles or pustules patients
Typically appears on fingers and Occurs later in disease
toes; may be asymmetrical Associated with less severe
disease
Vesicular
Blister, monomorphic lesions Tends to occur in middle-aged
Appears on trunk, limbs patients
Associated with medium
severity of disease
May appear before other
symptoms
Frequently involves itching
Livedoid
Necrotic Uncommon
Truncal or on fingers/toes Usually occurs in elderly
patients
Associated with severe disease
Suggestive of coagulopathies
or vascular changes
a
Data were derived from Casas et al.24 Sources of images: Microsoft Bing images (pseudochilblain, vesicular), National Institutes of Health (urti-
caria), authors’ files (maculopapular, livedoid). Vesicular image republished under the Creative Commons Attribution-Share Alike 3.0 (http://cre-
ativecommons.org/licenses/by-sa/3.0/deed.en). Urticaria image republished under the Creative Commons Attribution Share Alike 2.0 (https://
creativecommons.org/licenses/by/2.0/).
e4
P U BL I SH E D ONL INE MAY 4 , 2021 P OST- COVID - 19 SYND ROM E
e5
SCORDO ET AL W W W .AACN ACCON LIN E .ORG
intended to improve gait and balance.33 Patients As always, patients with persistent symp-
should start slowly and be monitored for wors- toms should be referred to an appropriate
ening symptoms such as breathlessness and specialist (eg, cardiologist, pulmonologist,
muscle aches. In addition to exercise training, psychologist, infectious diseases specialist,
patients with significant respiratory symptoms neurologist, nephrologist). For example,
may also benefit from pulmonary rehabilita- advanced neuroimaging may be needed to
tion programs. Many programs offer various fully investigate cognitive impairment, unre-
virtual models, including video-linked classes, solved depression should be addressed by a
printed materials, and telephone support. mental health practitioner, and persistent
abnormal chest radiography and oximeter
e6
P U BL I SH E D ONL INE MAY 4 , 2021 P OST- COVID - 19 SYND ROM E
6. Wirth K, Scheibenbogen C. A unifying hypothesis of the 22. Davido B, Seang S, Tubiana R, de Truchis P. Post COVID-19
pathophysiology of myalgic encephalomyelitis/chronic chronic symptoms: a postinfectious entity? Clin
fatigue syndrome (ME/CFS): recognitions from the find- Microbiol Infect. 2020;26(11):1448-1449. doi:10.1016/j.
ing of autoantibodies against ß2-adrenergic receptors. cmi.2020.07.028
Autoimmun Rev. 2020;19(6):102527. doi:10.1016/j. 23. Townsend L, Dyer AH, Jones K, et al. Persistent fatigue
autrev. 2020.102527 following SARS-Cov-2 infection is common and indepen-
7. Scheibenbogen C, Loebel M, Freitag H, et al. Immunoad- dent of severity of initial infection. PLoS One. 2020;15
sorption to remove ß2 adrenergic receptor antibodies in (11):e024078. doi:10.1101/2020.07.29.20164293
chronic fatigue syndrome CFS/ME. PLoS One. 2018;13(3): 24. Casas CG, Català A, Hernández GC, et al. Classification
e0193672. doi:10.1371/journal.pone.0193672 of the cutaneous manifestations of COVID-19: a rapid
8. McCance K, Huether S. Pathophysiology: The Biologic prospective nationwide consensus study in Spain with
Basis for Disease in Adults and Children. 8th ed. Else- 375 cases. Br J Dermatol. 2020;183(1):71-77. doi:10.
vier; 2019. 1111/bjd.19163
9. He L, Ding Y, Che X, et al. Expression of the monoclonal 25. Iadecola C, Anrather J, Kamel H. Effects of COVID-19
e7
SCORDO ET AL W W W .AACN ACCON LIN E .ORG
CE Evaluation Instructions
This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the
following objectives:
1. Describe the theoretical pathophysiology of long-term symptoms following infection with
SARS-CoV-2.
2. Relate post–COVID-19 symptoms to pathophysiologic mechanisms.
3. Identify at least 2 strategies for managing patients with post–COVID-19 symptoms.
To complete evaluation for CE contact hour(s) for article #ACC3222, visit www.aacnacconline.org and click
the “CE Articles” button. No CE evaluation fee for AACN members. This expires on June 1, 2023.
The American Association of Critical-Care Nurses is accredited as a provider of nursing continuing professional development
by the American Nurses Credentialing Center’s Commission on Accreditation, ANCC Provider Number 0012. AACN has
been approved as a provider of continuing education in nursing by the California Board of Registered Nursing (CA BRN),
CA Provider Number CEP1036, for 1.0 contact hour.
e8