Table 4.

Complications identified with COVID and Long COVID effects in humans

Complication	COVID associated or post-COVID	Reasons	Management	Remarks	References
Happy Hypoxemia	COVID associated	It is caused due to abnormal blood clotting. The micro-thrombosis of pulmonary vasculature occurs on activation of pulmonary endothelium which leads to the development of hypoxemia	•Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a therapy that can replace cardiopulmonary function temporarily and improve the hypoxemia condition	This condition wherein the arterial blood has abnormally low oxygen is an indicator of the COVID infection	[102, 240]
Acute respiratory distress	COVID associated	It is caused by damage to the alveoli. The fluid from blood vessels enters the alveoli through the damaged walls which consequently leads to inflammation inhibiting the normal gaseous exchange in the lungs	•Oxygen therapy •Breathing support like ventilators, and non-invasive ventilation •Drugs like acid-reducing medicines, antibiotics, blood thinners, muscle relaxants, and sedatives	The most prominent complication on the occurrence of the infection	[102, 241]
Cardiovascular complications	COVID associated	It is caused by the binding of the spike protein of the virus with the ACE 2 receptor on the endothelial cells, cardiomyocytes, and pericytes in the heart leading to direct infection by the virus The cytokine storm or enhanced immune response also is an important factor in the development of cardiovascular complications	•It focuses on supportive care and infection control •An early diagnosis is an important approach •Antiviral therapy •AVOId non-steroidal antiviral drugs	Increases mortality and causes cardiovascular injuries, including myocarditis, cardiac rhythm abnormalities, endothelial cell injury, thrombotic events, and myocardial interstitial fibrosis in COVID-19 patients	[102, 107]
Cytokine storm and inflammatory response	COVID associated	It is triggered by the entry of the virus into the host cell which consequently leads to acute respiratory distress and finally death	•Immunosuppression by immune-modulatory drugs like hydroxychloroquine additionally inhibits the replication of the virus	The hyperinflammatory responses in the infected host result in myocardial injury and increased death rates	[107, 242]
Multi-organ complications	COVID associated	It is mainly attributed to the fact that multiple organs (like kidney, heart, and liver in addition to the heart) in the body contain the ACE 2 receptor which binds to the Spike protein of the virus. These organs during the progression of infection fail and consequently lead to the death of the patients	•Effective anti-viral therapy •Supportive interventions •Hospitalization of symptomatic patients with pneumonia-like symptoms •Oxygen/ breathing support •Pharmacotherapy	Multi-organ complications precede multi-organ failure which ultimately causes death	[243]
Autoimmune responses	COVID associated and post-COVID	The virus triggers autoimmunity by cross-reaction with the host cells and disturbs the self-tolerance of host cells	•Initiation of early treatment on early diagnosis •Immuno-modulatory drugs	The COVID-19 infection is similar to autoimmune disorders in terms of pathogenesis, immune response, and mechanisms The COVID-positive patients showed the presence of autoantibodies which are prevalent in autoimmune disorders	[244]
Long-term psychiatric sequelae	Post-COVID	Develops during hospitalization or quarantine period as it affects the psychology of patients	•Regular follow-up check-ups for 30 or 60 days •Diagnosis in 14–90 days posts infection	Patients may develop post-traumatic stress disorder (PTSD), insomnia, anxiety, and depression post-infection	[105]
Neurological complications	Post-COVID	Direct infection of the virus, systemic inflammation, cerebrovascular changes, or a combination of these factors	•Neuropsychological testing of patients to identify symptoms	It is accompanied by a loss of smell and taste. The findings suggest that systemic inflammation plays a crucial role in neurological complications	[105]
Dermatological complications	Post-COVID	Viral infections can cause dermatological complications that could last for 6 months	•The hair loss can be reversed by using medications like minoxidil, finasteride, and topical corticosteroids	Reports on the development of rashes and hair loss in patients months after the infection. The commonly prevalent complication is cutaneous manifestation	[105]
Renal Complications	Post-COVID	Direct damage by a virus, systemic hypoxia, effects of inflammatory cytokines, and abnormal coagulation are the factors that could lead to complications	•Regular follow-ups with a nephrologist	It leads to new-onset renal dysfunction and certain cases could require renal replacement therapy	[105]
Gastrointestinal complications	COVID associated and post-COVID	SARS-CoV-2 is found to have prolonged fecal shedding and these complications imply replication of the virus in the gastrointestinal tract	•In the cases of survivors of the infection, the liver condition may take from weeks to months to normalize. A proper diet should be followed	Diarrhea, nausea, vomiting, abdominal pain, and loss of appetite are some long-term symptoms	[105]
Musculoskeletal complications	COVID associated and post-COVID	It is caused by direct infection by the virus as the skeletal muscle and synovial tissue also contain the ACE2 receptor for adherence to the virus	•Understanding the need for effective rehabilitation is critical in helping patients return to pre-infection mobility and function	The SARS-CoV-2 virus leads to the development of myalgias and arthralgias, unlike inflammatory arthritis. Severe COVID-19 infection causes catabolic muscle wasting because of systemic inflammation, prolonged bed rest, and malnutrition	[105]