TY - JOUR T1 - Recovering from a pandemic: pulmonary fibrosis after SARS-CoV-2 infection JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW DO - 10.1183/16000617.0194-2021 VL - 30 IS - 162 SP - 210194 AU - Ruben J. Mylvaganam AU - Joseph I. Bailey AU - Jacob I. Sznajder AU - Marc A. Sala A2 - , Y1 - 2021/12/31 UR - http://err.ersjournals.com/content/30/162/210194.abstract N2 - Acute manifestations of SARS-CoV-2 infection continue to impact the lives of many across the world. Post-acute sequelae of coronavirus disease 2019 (COVID-19) may affect 10–30% of survivors of COVID-19, and post-acute sequelae of COVID-19 (PASC)-pulmonary fibrosis is a long-term outcome associated with major morbidity. Data from prior coronavirus outbreaks (severe acute respiratory syndrome and Middle East respiratory syndrome) suggest that pulmonary fibrosis will contribute to long-term respiratory morbidity, suggesting that PASC-pulmonary fibrosis should be thoroughly screened for through pulmonary function testing and cross-sectional imaging. As data accumulates on the unique pathobiologic mechanisms underlying critical COVID-19, a focus on corollaries to the subacute and chronic profibrotic phenotype must be sought as well. Key aspects of acute COVID-19 pathobiology that may account for increased rates of pulmonary fibrosis include monocyte/macrophage–T-cell circuits, profibrotic RNA transcriptomics, protracted elevated levels of inflammatory cytokines, and duration of illness and ventilation. Mechanistic understanding of PASC-pulmonary fibrosis will be central in determining therapeutic options and will ultimately play a role in transplant considerations. Well-designed cohort studies and prospective clinical registries are needed. Clinicians, researchers and healthcare systems must actively address this complication of PASC to minimise disability, maximise quality of life and confront a post-COVID-19 global health crisis.A complication of COVID-19, PASC-pulmonary fibrosis, has the potential to become a global respiratory health crisis. Dedicated surveillance, mechanistic understanding and clinical and research efforts are needed to confront this emerging sequela of COVID-19. https://bit.ly/3GEyB04 ER -