COVID-19 Infection: An Overview of Pathophysiology, Management, and Complications
Abstract
COVID-19 has been the most common infection worldwide for the last two years, with many clinical manifestations, complications, comorbidities, and high mortality. Cardiac and pulmonary complications contribute the most towards morbidity mortality and pose great difficulty in the management. In addition, the disease has badly damaged the global economy and lifestyle. Recently, there have been many updates in the preventative and pharmacological options available for COVID-19 disease, including vaccines and biological drugs.
This review article focuses on the pros and cons of the main aspects of the disease, its complications, and management, options currently used to manage. This article is a general review, and the management guidelines are different in different parts of the World. Hence, the reader should consult local health guidelines to manage their patients.
How to Cite This Article
Javaid MM, Mahmood U, Hussain A, Itrat S, Avais J. COVID-19 Infection: An Overview of Pathophysiology, Management, and Complications. J Pak Soc Intern Med. 2022;3(1):7–19. doi:10.70302/jpsim.v3i1.2203
Conflict of Interest
All authors declare no competing interests.
Funding
No specific funding was received for this research.
Funder information follows the Crossref Funder Registry standard.
References
- Zang R, Castro MF, McCune BT, Zeng Q, Rothlauf PW, Sonnek NM, Liu Z, Brulois KF, Wang X, Greenberg HB, Diamond MS. TMPRSS2 and TMPRSS4 promote SARS-CoV-2 infection of human small intestinal enterocytes. Sci Immunol. 2020;5(47):eabc3582.
- Thevarajan I. Breadth of concomitant immune responses before patient recovery: a case report of non-severe COVID-19. Nat Med. 2020; 26(4), 453-5.
- Huang C, Huang L, Wang Y, Li X, Ren L, Gu X et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220–32..
- Brigger D, Horn MP, Pennington LF, Powell AE, Siegrist D, Weber B, Engler O, Piezzi V, Damonti L, Iseli P, Hauser C. Accuracy of serological testing for SARS‐CoV‐2 antibodies: First results of a large mixed‐method evaluation study. Allergy. 2021;76(3):853-65.
- Berry JD, Hay K, Rini JM, Yu M, Wang L, Plummer FA, Corbett CR, Andonov A. Neutralizing epitopes of the SARS-CoV S-protein cluster independent of repertoire, antigen structure or mAb technology. In MAbs. 2010; 2(1):53-66).
- Barnes CO, West Jr AP, Huey-Tubman KE, Hoffmann MA, Sharaf NG, Hoffman PR, Koranda N, Gristick HB, Gaebler C, Muecksch F, Lorenzi JC. Structures of human antibodies bound to SARS-CoV-2 spike reveal common epitopes and recurrent features of antibodies. Cell. 2020;182(4):828-42.
- Brouwer PJ, Caniels TG, van der Straten K, Snitselaar JL, Aldon Y, Bangaru S, Torres JL, Okba NM, Claireaux M, Kerster G, Bentlage AE. Potent neutralizing antibodies from COVID-19 patients define multiple targets of vulnerability. Science. 2020 Aug 7;369(6504):643-50.
- Grant OC, Montgomery D, Ito K, Woods RJ. Analysis of the SARS-CoV-2 spike protein glycan shield reveals implications for immune recognition. Scientific Reports. 2020;10(1):1.
- WHO coronavirus disease (COVID-19) dashboard [website]. Geneva: World Health
- Buitrago-Garcia D, Egli-Gany D, Counotte MJ, Hossmann S, Imeri H, Ipekci AM, et al. Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: A living systematic review and meta-analysis. PLoS Medicine 2020;17(9): e1003346
- Byambasuren O, Cardona M, Bell K: Estimating the extent of true asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis. Available at SSRN 3586675
- Mizumoto K, Kagaya K, Zarebski A, Chowell G: Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eu Communicable Dis Bull 2020;25(10):10-12.
- The novel coronavirus pneumonia emergency response epidemiology team: Vital Surveillances: the epidemiological characteristics of an outbreak of 2019 Novel Coronavirus diseases (COVID-19)-China 2020. China CDC weekly. 2020;2(8) 113-22.
- Spinato G., Fabbris C., Polesel J., Cazzador D., Borsetto D., Hopkins C., et al. Alterations in Smell or Taste in Mildly Symptomatic Outpatients With SARS-CoV-2 Infection. JAMA. 2020; 26;323(20):2089-90.
- Favas TT, Dev P, RN C. Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurological Sciences 2020; ;41(12):3437-70.
- Abdullahi A, Candan SA, Abba MA: Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis. Front Neurol. 2020;11(6):687-20.
- Kantonen J, Mahzabin S, Mäyränpää MI. Neuropathologic features of four autopsies COVID-19 patients. Letter to the editor. Brain Pathology 2020; 30(6):1012-6.
- Koutroumanidis M, Gratwicke J, Sharma S. Alpha coma EEG pattern in patients with severe COVID-19 related encephalopathy. Clin Neurophysiol. 2020;1388(2457):30480-6
- Mao L, Jin H, Wang M, Hu Y, Chen S, He Q. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77(6):683-90.
- Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med 2020; 382(23):2268-70.
- Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: a retrospective study. BMJ 2020;368(1): 1091.
- World Health Organization: Mask used in the context of COVID-19. Interim guidance. 2020.
- World Health Organization: Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages. Interim guidance. 2020.
- Rawson TM, Moore LSP, Zhu N., Ranganathan N., Skolimowska K., Gilchrist M., et al. Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020; 71(9):2459-68.
- Goossens H, Fenech M, Vander Stichele R, Elseviers M, Group EP: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579-87.
- Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5(6):229.
- World Health Organization: AWARE classification of antibiotics. 2019.
- WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, et al. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA 2020; 324(6):1330.
- Marconi VC, Ramanan AV, de Bono S, et al. Efficacy and safety of baricitinib for treating hospitalized adults with COVID-19 (COV-BARRIER): a randomized, double-blind, parallel-group, placebo-controlled phase 3 trial. Lancet Respir Med 2021; 9(8):1407.
- Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC et al. Remdesivir for the Treatment of COVID-19 – Preliminary Report. New Eng J Med. 2020; 383(19):1813-36.
- Chen P, Nirula A, Heller B. SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19. N Engl J Med. 2021; 384(3):229.
- Weinreich DM, Sivapalasingam S, Norton T. REGEN-COV Antibody Combination and Outcomes in Outpatients with Covid-19. N Engl J Med 2021; 385(4):e81.
- Fact sheet for healthcare providers emergency use authorization (EUA) of sotrovimab. [updated 2020, cited 2022] Available from website: [https://www.fda.gov/media/149534/download].
- Gillenwater S, Rahaghi F, Hadeh A. Remdesivir for the treatment of Covid-19-preliminary report. N Engl J Med. 2020 Sep 3;383(10):992.
- Gupta A, Gonzalez-Rojas Y, Juarez E. Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab. N Engl J Med. 2021; 385(4):1941.
- Thomas P., Baldwin C., Bissett B., Boden I., Gosselink R., Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020; 66(2):73-82..
- Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017;43(3):304-377
- Lee MK, Choi J, Park B, Kim B, Lee SJ, Kim SH, et al.: High flow nasal cannula oxygen therapy in acute-moderate hypercapnic respiratory failure. Clin Respir J 2018;12(6):2046-2056
- Luo Y, Ou R, Ling Y, Qin T. The therapeutic effect of high flow nasal cannula oxygen therapy for the first imported case of the Middle East respiratory syndrome to China. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015;27(10):841-4
- Arabi YM, Arifi AA, Balkhy HH, Najm H, Aldawood AS, Ghabashi A, et al.: Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection. Ann Intern Med. 2014;160(6):389-97
- Oran DP, Topol EJ. The Proportion of SARS-CoV-2 Infections That Are Asymptomatic: A Systematic Review. Ann Intern Med. 2021;174(5):655.
- Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239.
- Williamson EJ, Walker AJ, Bhaskaran K et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430.
- Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, Tie Y, Fullerton KE. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(24):759.
- Tang N, Bai H, Chen X. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020 May;18(5):1094-9.
- Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191(4):145.
- Flower L, Laundy N, Khosravi M, et al. Haemophagocytic lymphohistiocytosis secondary to COVID-19: a case series. Lancet Rheumatol. 2021;3(11):e744-7.
- Aziz M, Fatima R, Assaly R. Elevated interleukin-6 and severe COVID-19: a meta-analysis. J Med Virol. 2020;92(11):2283-5.
- Centre for Evidence-Based Medicine; Kernohan A, Calderon M. What are the risk factors and effectiveness of prophylaxis for venous thromboembolism in COVID-19 patients? [updated July 2020, cited 2022] Available from website:[ https://covid19-evidence.paho.org/handle/20.500.12663/2093].
- Cui LY, Cheng WW, Mou ZW. Risk factors for pulmonary embolism in patients with COVID-19: a systemic review and meta-analysis. Int J Infect Dis. 2021;111(2):154-63.
- Cuker A, Tseng EK, Nieuwlaat R. American Society of Hematology 2021 guidelines on anticoagulation for thromboprophylaxis in patients with COVID-19. Blood Adv. 2021;5(3):872.
- Ponomariova OV, Petelskyi PV, Kasianenko AS, Horbatiuk TA, Nosko MM, Banakhevych NV, Kliusov AN, Kondratenko AV, Kapinos AV. Neutropenia and management of cancer patients during the COVID-19 pandemic. Pract Oncol. 2021;4(2):11-3.
- Raina R, Mahajan ZA, Vasistha P. Incidence and outcomes of acute kidney injury in COVID-19: a systematic review. Blood Purif. 2021:1-14.
- Chan KW, Yu KY, Lee PW. Global REnal Involvement of CORonavirus Disease 2019 (RECORD): a systematic review and meta-analysis of incidence, risk factors, and clinical outcomes. Front Med. 2021;8(5):678200.
- Akilesh S, Nast CC, Yamashita M, Henriksen K et al. Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria. Am J Kidney Dis. 2021; 77(1):82.
- Uppal NN, Kello N, Shah HH, Khanin Y, De Oleo IR, Epstein E, Sharma P, Larsen CP, Bijol V, Jhaveri KD. De Novo ANCA-Associated Vasculitis With Glomerulonephritis in COVID-19. Kidney Int Rep. 2020;5(11):2079.
- Sun JK, Liu Y, Zou L, Zhang WH, Li JJ, Wang Y, Kan XH, Chen JD, Shi QK, Yuan ST. Acute gastrointestinal injury in critically ill patients with COVID-19 in Wuhan, China. World J Gastroenterol. 2020;26(39):6087.
- Kaafarani HMA, El Moheb M, Hwabejire JO et al. Gastrointestinal Complications in Critically Ill Patients With COVID-19. Ann Surg. 2020;272(2):e61.
- Thuluva SK, Zhu H, Tan MML, Gupta S, Yeong KY, Cheong Wah ST, Lin L, Yap ES. A 29-Year-Old Male Construction Worker from India Presented with Left-Sided Abdominal Pain Due to Isolated Superior Mesenteric Vein Thrombosis Associated with SARS-CoV-2 Infection. Am J Case Rep. 2020;21(9):e926785.
- Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, Gu Z, Gao L, Shi H, Mai L, Liu Y, Lin X, Lai R, Yan Z, Li X, Shan H. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut. 2020;69(6):997.
- Pun BT, Badenes R, Heras La. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Med. 2021;9(3):239.
- Lin E, Lantos JE, Strauss SB. Brain Imaging of Patients with COVID-19: Findings at an Academic Institution during the Height of the Outbreak in New York City. AJNR Am J Neuroradiol. 2020;41(11):2001.
- Paterson RW, Brown RL, Benjamin L. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020;143(10):3104.
- Pezzini A, Padovani A. Lifting the mask on neurological manifestations of COVID-19. Nat Rev Neurol. 2020;16(11):636.
- Sabatino J, De Rosa S, Di Salvo G. Impact of cardiovascular risk profile on COVID-19 outcome: a meta-analysis. PLoS One. 2020;15(8):e0237131.
- Pellicori P, Doolub G, Wong CM. COVID-19, and its cardiovascular effects: a systematic review of prevalence studies. Cochrane Database Syst Rev. 2021;(3): CD013879.
- Huang C, Wang Y, Li X, Ren L, Zhao J et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497.
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061.
- Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV, Group WC. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; doi: 10.1016/S1473-3099(21)00703-9. doi:10.1016/S1473-3099(21)00703-9
- Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: a systematic review and meta-analysis. Eur J Intern Med. 2021;92:55-70.
Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.