Friday, August 14, 2020

PAHO Epi Alert: Complications & Sequelae Of COVID-19


#15, 414

Very early on in our COVID-19 outbreak it was apparent that this emerging coronavirus did not carry the same level of lethality as MERS-CoV, SARS-CoV, or H5N1/H7N9 avian flu in humans. The Case Fatality Rate (CFR) - at least among healthy adults - was relatively low, albeit higher than seasonal flu. 

More concerning were the high communicability and attack rates, and the lengthy hospitalization stays and slow recoveries being reported. By the end of February it was apparent we were facing a high-morbidity/low-mortality pandemic. 

One that might kill 1% of those infected, but that could often require weeks or even months for many to recover from. Twenty-five weeks ago, in Pandemics Are More Than Just About The CFR, I warned about the danger of focusing too heavily on the number of deaths, while ignoring the other negative impacts of a high-morbidity contagion. 

Sadly, until recently the media has focused primarily on the grim daily death toll, while glossing over long recoveries and often - long-term health problems and/or disability - associated with SARS-CoV-2 infection. 

Some of the adverse outcomes reported among COVID-19 survivors include:

JAMA: Two Studies Linking SARS-CoV-2 Infection To Cardiac Injury

Over the past few months, we've seen cardiologists and neurologists weigh in on the potential for seeing huge increases in COVID-19 related heart failure and neurological diseases, some that may not become fully apparent for years. 

Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575

Emily A. Troyer, Jordan N. Kohn, and Suzi Hong

And just over a month ago,  Dr. Anthony Fauci expressed concerns that many COVID patients are suffering from a post-viral syndrome - similar to ME/CFS - which has disabled and traumatized well over a million Americans over the past 3 decades (see NIH About CFS/ME). 

We are literally just scratching at the surface of the damage this pandemic virus has caused, and may cause going forward.  

And as we go into what is likely to be a chaotic and dangerous fall,  The Psychological Impact On 1st Responders & Frontline HCWs can't be brushed aside either.  After the limited 2015 MERS-CoV outbreak ins South Korea (see Study: Burnout & PTSD Among Nurses Working During A Large MERS-CoV Outbreak - Korea, 2015) half of all nurses reported PTSD symptoms.

Regardless of the death toll, we'll be living with the physical and psychological wounds of COVID-19 for years to come. 

All of which brings us to a 16-page PAHO (Pan American Health Organization) Epidemiological Alert on Complications and sequelae of COVID-19  released on August 12th.  Due to its length, I've only reproduced the introduction.  Follow the link to download and read it in its entirety. 

More than 7 months following the first report of novel coronavirus disease (COVID-19), knowledge of the complications and sequelae of this disease has increased substantially.

Through this alert, the Pan American Health Organization / World Health Organization (PAHO/WHO) urges Member States to keep health professionals informed as new information continues to become available in order to strengthen the timely detection and proper management of COVID-19 cases, complications, and sequelae.


Between 10 July and 10 August 2020, an additional 4,433,115 cases of COVID-19, including 114,480 additional deaths, were reported in the Region of the Americas, for a cumulative total of 10,697,800 confirmed cases of COVID-19 including 390,849 deaths. This represents a relative increase of 64% in cases and 37% in deaths compared to the number of new cases and deaths reported during the previous 4-week period (12 June to 9 July). The highest proportion of new cases were reported in the United States of America (44%) and Brazil (30%), while the highest proportion of new deaths were reported in Brazil (29%), the United States of America (26%), and Mexico (17%).

More than 7 months following the notification of the first COVID-19 cases (Joint Report of the WHO and the Government of China in February 2020) (1), there have been advances in the knowledge of the disease, including but not limited to the source of infection; the pathogenesis and virulence of the virus; transmissibility; risk factors; effectiveness of prevention measures; surveillance; diagnosis; clinical management; and complications and sequelae, amongst others. However, there remain several gaps pertaining to these factors that still require contribution from the entire scientific community.

The intense transmission of COVID-19 in most of the countries and territories of the Americas, along with evidence generated from the scientific community, has increased our knowledge of several of these factors including those related to complications and sequelae from COVID-19.

Knowledge of these factors is necessary to improve and adjust the prevention and control strategies of the pandemic.

The following is a summary of the available evidence regarding complications and sequelae of COVID-19.
         (Continue . . . )

The morbidity and sequelae associated with COVID-19 not only presents a serious challenge to our already stressed health care delivery system, it can negatively affect economic recovery, supply chains, and the overall functioning of society. 

Longer term, we'll have to figure out how to care for those left permanently damaged or disabled by this pandemic. 

While COVID-19 remains a relatively low-mortality pandemic, its overall impact on individuals, and society, are far from benign.