RN, BS, MA, MSN
The term “sequelae” derives from the Latin word “sequela,” meaning to follow or “that which follows.” In a medical context, sequelae refer to the pathological or long-term complications resulting from a previous disease, injury, or trauma.
We can also define sequela as the aftermath or secondary results that follow a disease, injury, or other health condition. Sequela may manifest as pathological conditions or complications resulting from an illness or treatment.
Understanding sequelae in clinical practice is imperative for healthcare professionals, who play a crucial role in patient care and management. We will delve into an overview of sequelae, incorporating their relevance in current disease processes, such as COVID-19. For instance, in the case of a stroke, sequelae may include a constellation of cognitive impairments, motor deficits, speech difficulties, and emotional disturbances.
Many nurses have encountered the sequelae of various diseases, making the understanding of the concept relevant in ensuring that patients receive comprehensive and targeted care and the proper allocation of resources.
Unlike complications, which emerge during an illness, sequelae may manifest long after the treatment of the original condition. The manifestation can be physiological or psychological, chronic, or temporary, and might necessitate additional care, treatment, or lifelong management.
COVID-19, caused by the SARS-CoV-2 virus, presents a wide array of sequelae, affecting multiple organ systems. The severity of the sequelae of COVID-19 can vary depending on the individual’s age, health status, and severity of the initial infection. Some individuals may experience no sequelae at all, while others may experience long-term or even permanent health problems.
The long tail of the COVID-19 pandemic and the evolving variants (SARS CoV-2 Sublineage BA.2.86) have underscored the profound and relevant impact of sequelae. A significant portion of COVID-19 survivors are experiencing ‘Long COVID,’ also referred to as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) is a term coined to describe the myriad of persistent symptoms that continue for weeks or even months after recovery from the acute phase.
From our current and brief medical viewpoint, long COVID’s sequelae is multifaceted, complex, and impressive. Sequela can include respiratory issues including persistent cough, breathlessness, and lung damage.
Cardiovascular effects can include heart palpitations, chest pain, and long-term heart damage. Neurological and psychological problems can include brain fog, headaches, anxiety, and depression. Vascular events and hematological sequelae can include anemia, thrombocytopenia, and disseminated intravascular coagulation (DIC) due to hypercoagulable state.
Musculoskeletal complications include chronic fatigue muscle aches, and joint pain. Psychiatric symptoms can include anxiety, depression, and post-traumatic stress. Renal dysfunction and acute kidney injury can occur during the acute phase which may lead to chronic kidney disease. Gastrointestinal issues can include persistent gastrointestinal symptoms like diarrhea, nausea, or loss of appetite. ENT symptoms can include loss of taste and smell for weeks or months.
Metabolic sequelae can include diabetes mellitus, obesity, and dyslipidemia. In the pediatric population, Pediatric Multi-System Inflammatory Syndrome (MIS-C) is a serious condition in children linked to COVID-19, involving inflammation in various body parts.
The management of COVID-19 sequelae requires a multidisciplinary approach and may necessitate ongoing medical care, physical rehabilitation, mental health support, and patient education. There are no definitive treatments for long COVID, and the medical literature has yet to identify a definitive, one-size-fits-all treatment for “long COVID.” Current treatment includes managing and addressing the individual symptoms.
The concept of sequelae above connotes negative or harmful outcomes following a disease or injury. However, there are instances where an illness may result in secondary effects and can be beneficial under specific circumstances.
Some studies have suggested that infections with certain parasitic worms (helminths) might modulate the host’s immune system in such a way as to reduce the incidence or severity of autoimmune diseases like asthma or inflammatory bowel disease.
Exposure to specific infections may increase the host’s immune surveillance, which might, in turn, reduce the likelihood of cancer development in some tissues.
It is theorized that exposure to certain common childhood infections contributes to the development and maturation of the immune system.
The exposure to low doses of a substance or stressor that is harmful at higher doses may induce a beneficial effect. For example, mild stressors like low-level infection could induce a strengthening response in the host.
Acknowledging that fever is a symptom rather than a sequela, it is a response to infection that can aid in immune function. An elevated body temperature can enhance the immune response and make the environment less favorable to certain pathogens.
The BCG (Bacillus Calmette–Guérin) vaccine used for tuberculosis has found use in treating bladder cancer. The introduction of the vaccine into the bladder can cause an immune response that attacks bladder cancer cells.
An infection with cowpox, a mild disease, can confer immunity to smallpox, a serious and often fatal illness. Observation of this phenomenon has led to the development of the smallpox vaccine.
Just as with COVID-19, it is important for healthcare professionals to recognize that the above examples are complex, context-dependent, and may not apply across individuals or populations. In certain populations negative sequelae or risks associated with the same disease or condition outweigh the “beneficial” effects.
As healthcare professionals, we must appreciate the nuanced and multifactorial nature of these effects, recognizing that what may be beneficial in one context might not be so in another and that individual patient care always requires a comprehensive understanding of all potential outcomes and risks.
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