A Proposed Framework and Timeline of the Spectrum of Disease Due to SARS-CoV-2 InfectionIllness Beyond Acute Infection and Public Health Implications

Type Journal Article Author S. Deblina Datta Author Amish Talwar Author James T. Lee URL https://jamanetwork.com/journals/jama/fullarticle/2773338 Publication JAMA Network Date 18/11/2020 DOI 10.1001/jama.2020.22717 Abstract Although much of the response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has focused on acute coronavirus disease 2019 (COVID-19) illness, accumulating evidence demonstrates morbidity beyond acute SARS-CoV-2 infection.1-4 At least 2 other periods of illness appear to be temporally associated with SARS-CoV-2 infection: a rare postacute hyperinflammatory illness and late inflammatory and virological sequelae. These 3 illness periods not only define the temporal course of SARS-CoV-2 infection at the population level but also capture distinct phases of host-viral interaction. A theoretical framework describing illness periods of SARS-CoV-2 infection (including clinical presentations and timing of onset), their pathophysiological underpinnings, and associated key laboratory findings may contribute to a more inclusive and ordered understanding of the natural history of SARS-CoV-2 infection and enhance research efforts. Within the proposed framework, a patient may experience any combination of these illnesses or may have asymptomatic infection without illness (Figure).