Post-acute Effects of COVID-19 and Its Complication in the Human Organ System

Globally, the COVID-19 disease has caused death and illness in an unparalleled manner worldwide due to the Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). Acute and long-term effects of this disease can cause affect multiple organ systems of the host. Early scientific and clinical evidence suggest dyspnea, fatigue, cognitive disturbances, chest pain, arthralgia and even a decline in quality of life can be caused as residual effects of SARS-CoV-2 infection. Yes, we are going to explore the post-effect of COVID-19 infection.
It’s become preeminent to determine the understanding of the issues surrounding the population of patients who are recovering or recovered from COVID-19 infection. Several clinical assessments recognized the COVID-19 as a multi-organ disease with a wide-ranging of instances. However, the post-acute timeline of COVID-19 is changing. The persistence of symptoms or development of sequelae lasts for 3 or 4 weeks from
the acute symptoms of COVID-19.
Post-acute COVID-19 is defined as ceaseless symptoms or long-term complications that can develop from 3-4 weeks and last up to 12 weeks to 6 months. The common symptoms observed in post-COVID infection are outlined as muscular weakness, joint pain, dyspnea, cough, continual oxygen requirement, disturbances in regular sleep, anxiety/depression, brain fog, headaches, palpitations, chest pain, thromboembolism, chronic kidney disease, hair loss and fatigue decline in quality of life.
Current studies have identified organ-specific sequelae of post- COVID-19 infection to address the management considerations for comprehensive care of patients.

Cardiovascular:
· Symptoms: dyspnea, palpitations, chest pain
· Long-term sequelae may include myocardial fibrosis or scarring, tachycardia, arrhythmias, and autonomic dysfunction, and increased cardio-metabolic demand.
· Patients who have already developed cardiovascular complications at the time of COVOD-19 infection need to be monitored with serial clinical, electrocardiogram, and echocardiogram follow-up.

Pulmonary:
· Symptoms: Dyspnea, hypoxia, and fall off in exercise capacity are commonly tenacious symptoms and signs
· Restrictive pulmonary physiology, decreased ground-glass opacities, diffusion capacity and fibrotic changes need to be observed at follow-up time of COVID-19 patients/survivors.
· Progression and recovery-based assessment of pulmonary disease and function are the obvious tasks.

Renal:
· In acute COVID-19 infection, most of the patients suffer from AKI resolution. However, in 6 months follow-up, reduced eGFR has been reported too.
· COVAN has been found as a predominant pattern of renal injury in individuals of African descent.
· Early and close follow-up in the AKI survivor clinic may be beneficial for the patients who have survived from COVID-19 with impaired renal function.

Neuropsychiatric:
· Cognitive impairment or brain fog, dysautonomia, myalgia, headache, and fatigue are the common continual abnormalities observed in COVID-19 survivors.
· In a study, it is observed that 30% to 40% of the COVID-19 survivors suffered from depression, anxiety, PTSD and sleep disturbances
· Immune dysregulation, microvascular thrombosis, inflammation are the iatrogenic effects (due to the medication) and psychosocial impacts of infection

Endocrine:
· Endocrine sequelae of COVID-19 infection may be worsening for the patients who have earlier complications like sub-acute thyroiditis, diabetes mellitus, and bone demineralization.

Hematologic:
· In retrospective studies of post-acute COVID-19, thromboembolic is observed as below 5%.
· In COVID-19 infection, the time duration of the hyperinflammatory state became undetectable.
· Low-molecular-weight (LMW) heparin and direct oral medicines that are used to prevent blood clotting may be responsible for extended thromboprophylaxis in COVID patients with risk factors for continually elevated d-dimer levels, immobility, and other comorbidities like cancer.

Gastrointestinal and hepatobiliary:
· In SARS-COV-2 infected patients even after the negative report, protracted viral fecal shedding can also occur.
· SARS-COV-2 can alter the intestinal microbiome, including enriching the beneficial organism and reducing beneficial gains.

Dermatologic:
· Approx. 20% of the COVID survivor suffered from hair loss problem
On the global scenario of this pandemic, it is plausible that the healthcare essentials for patients with sequelae of COVID infection will remain to increase for a certain future. The growth in these challenges will require restructuring of prior outpatient infrastructure, development and deployment of high throughput and scalable healthcare system, and its integration across the disciplines to improve the physical and mental
health of the COVID survivors for a long-term basis.