COVID-19 Legacy

Amit P. Ladani, MD; Muruga Loganathan, MD; Murali K. Kolikonda, MD; Steven Lippmann, MD


South Med J. 2021;114(12):751-759. 

In This Article

Abstract and Introduction


Coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome-coronavirus-2 virus that led to a pandemic. Acute manifestations of COVID-19 include fever, cough, dyspnea, respiratory failure, pneumonitis, anosmia, thromboembolic events, cardiogenic shock, renal injury, ischemic strokes, encephalitis, and cutaneous eruptions, especially of hands or feet. Prolonged symptoms, unpredictable recoveries, and chronic sequelae (long COVID) sometimes emerge even for some people who survive the initial illness. Sequelae such as fatigue occasionally persist even for those with only mild to moderate cases. There is much to learn about postacute COVID-19 dyspnea, anosmia, psychosis, thyroiditis, cardiac arrhythmia, and/or multisystem inflammatory response syndrome in children. Determining prognoses is imprecise. Examining patient databases about those who have survived COVID-19 is warranted. Multidisciplinary teams are assessing such disease databases to better understand longer-term complications and guide treatment.


The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) originated in China in December 2019, causing the coronavirus disease 2019 (COVID-19) pandemic, which brought the world to a standstill. Although a novel coronavirus, it has similarity with coronaviruses SARS-CoV-1 and Middle East respiratory syndrome (MERS).

As of March 10, 2021, a coronavirus resource center reported >117 million infections worldwide, with >2.6 million deaths.[1] By the same date, almost 29 million Americans had been infected by COVID-19 and >517,000 had died.[2] Approximately 80% of SARS-CoV-2 infections are mild, 14% are more severe, and 6% of affected people become critically ill.[3] The COVID-19 pandemic in the United States has caused more harm to ethnic and racial minorities—Black, Hispanic, Asian, and Native Americans—as compared with Whites.[4] Minority populations have a much higher rates of infection, hospitalization, and death.[5] Lower socioeconomic status leads to a higher number of chronic medical comorbidities, poor access to health care, and a tendency to seek care later in the disease course.[6]

Acute COVID-19 symptom duration is 1 month; post-COVID or COVID-19 sequelae are symptoms persisting beyond 1 month. Although there is no consensus about the postacute COVID-19 (long COVID) definition, it is described as symptoms extending beyond 3 weeks from initial onset of symptoms and chronic COVID-19 is described as extending beyond 12 weeks.[7] The long-term effects of COVID-19 are defined differently around the world: long COVID, postacute sequelae of SARS-CoV-2, chronic COVID-19 syndrome, and long-haulers.[8–11] The Centers for Disease Control and Prevention lists it as "long COVID." The National Institutes of Health calls it "postacute sequelae of SARS-CoV-2." The National Institute for Health and Care Excellence of the United Kingdom differentiates it into "acute COVID-19" (<1 month), "ongoing symptomatic COVID-19" (1–3 months), and "post-COVID-19 syndrome" (>3 months).[12]

Previous outbreaks of other coronavirus such as SARS-CoV-1 during 2002–2003 and MERS-CoV in 2012 resulted in physical pathology, decreased quality of life, emotional distress, and/or death in some who survived acute illness.[13] Physical, psychological, and cognitive impairment is documented in many COVID-19 survivors who required critical care during their acute illness.[13] Post-COVID-19 syndrome is usually defined as a state of chronic fatigue and neuroimmune exhaustion.[14] Acute COVID-19 manifestations are described below, followed by COVID-19 sequelae (combines postacute and chronic COVID-19).