The emergence of COVID-19 in December 2019 marked a significant turning point in global health. Initially identified as a novel respiratory illness in Wuhan, China, by January 7, 2020, the causative agent was identified as SARS-CoV-2, leading to the subsequent classification of the disease as COVID-19. The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, triggering a worldwide effort to develop vaccines and antiviral treatments. By early 2021, effective COVID-19 vaccines were being rolled out, providing hope for controlling the spread of the virus.

Despite significant progress, the pandemic’s impact lingered beyond the cessation of the global health emergency. On May 5, 2023, WHO declared an end to the emergency status as the mortality rate of COVID-19 approached that of other endemic respiratory viruses like influenza, even in countries with prolonged lockdowns. However, for some individuals previously infected with the virus, post-acute sequelae of COVID-19 persisted, raising concerns about long-term health consequences.

While the public’s awareness of post-viral sequelae heightened during the COVID-19 pandemic, infectious disease experts have long recognized the phenomenon. Following the 1918 influenza pandemic, post-influenza syndromes, including “encephalitis lethargica,” characterized by marked lethargy and neurological symptoms, were described. Similar post-viral syndromes have been observed after infections with DNA viruses such as Epstein-Barr virus, cytomegalovirus, herpes simplex virus, and RNA viruses like measles.

Chronic immune activation and inflammation play a central role in the pathophysiology of post-viral sequelae. This mechanism has been well-documented in infections like HIV. In the case of COVID-19, hospitalization for severe illness significantly increases the risk of long-term health complications compared to mild cases.

The burden of post-COVID-19 health outcomes following hospitalization has prompted comparisons with severe influenza outcomes, highlighting the need for a deeper understanding of post-viral sequelae. By examining historical cases and contemporary research on COVID-19, we can glean valuable insights into the nature of post-viral sequelae and their implications for public health and clinical management.1

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References

  1. Gandhi, M. (2023). Post-viral sequelae of COVID-19 and influenza. The Lancet Infectious Diseases. https://doi.org/10.1016/s1473-3099(23)00762-4

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