Abstract
Since the outbreak of the coronavirus (COVID-19) pandemic, most attention has focused on containing transmission and addressing the surge of critically ill patients in acute care settings. As we enter the second phase of the pandemic, emphasis must evolve to post-acute care of COVID-19 survivors. Persisting cardiorespiratory symptoms have been reported at several months after the onset of the infection. Information is lacking on the pathophysiology of exercise intolerance after COVID-19. Previous outbreaks of coronaviruses have been associated with persistent dyspnea, muscle weakness, fatigue and reduced quality of life. The extent of Covid-19 sequelae remains to be evaluated, but persisting cardiorespiratory symptoms in COVID-19 survivors can be described as two distinct entities. The first type of post-Covid symptoms are directly related to organ injury in the acute phase, or the complications of treatment. The second type of persisting symptoms can affect patients even with mild initial disease presentation without evidence of organ damage. The mechanisms are still poorly qualified to date. There is a lack of correlation between initial symptom severity and residual symptoms at exertion. We report exercise hyperventilation as a major limiting factor in COVID-19 survivors. The origin of this hyperventilation may be related to an abnormality of ventilatory control, by either hyperactivity of activator systems (automatic and cortical ventilatory control, peripheral afferents, and sensory cortex) or failure of inhibitory systems (endorphins) in the aftermath of pulmonary infection. Hyperventilation-induced hypocapnia can cause a multitude of extremely disabling symptoms such as dyspnea, tachycardia, chest pain, fatigue, dizziness and syncope at exertion.
Highlights
The infection with severe respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic on March 11, 2020
Since the outbreak of the pandemic, most attention has focused on containing transmission and managing the wave of critically ill patients in acute care settings
We aimed to review the available evidence on persisting exercise intolerance experienced by COVID-19 survivors
Summary
The infection with severe respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic on March 11, 2020. We report exercise hyperventilation as a major limiting factor that can cause a multitude of extremely disabling symptoms such as dyspnea, tachycardia, chest pain, fatigue, dizziness, and syncope at exertion To our knowledge, this is the first report of a possible explanation for prolonged exercise intolerance in long-lasting COVID-19. Diffuse alveolar damage was showed by several post-mortem studies (Carsana et al, 2020; Schaller et al, 2020), leading to hypotheses of residual pulmonary function impairment at long term These hypotheses are supported by the available evidence on previous coronavirus outbreaks. Multisystem involvement is the key pathophysiological feature of SARS-CoV-2 infection and can help explain the TABLE 1 | prospective studies on residual symptoms, pulmonary function impairment and exercise intolerance following SARS-CoV, MERS-CoV and SARS-CoV-2 viral infections
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