2 Intensive care unit admission was seen in 5.0%, mechanical ventilation used in 2.3%, and 1.4% died. Acute COVID-19 has been recognized to disproportionately affect communities of color27,213,214,215,216. Am. Nat. 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Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. The 6MWT showed that IST patients had a significantly diminished exercise capacity, with a median walking distance of 39283m, which is only 60% of the estimated reference distance after adjusting for age, sex, and body mass index. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. Pre-existing diabetes may first become apparent during the acute phase of COVID-19 and can generally be treated long term with agents other than insulin, even if initially associated with DKA. Lancet Gastroenterol. The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries. Microbiol. Rev. 324, 15671568 (2020). Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis. In both disorders, HR can increase greatly in response to minimal activity. Nakra, N. A., Blumberg, D. A., Herrera-Guerra, A. While the first two are discussed in more detail in the organ-specific sections below, post-intensive care syndrome is now well recognized and includes new or worsening abnormalities in physical, cognitive and psychiatric domains after critical illness32,33,34,35,36. Karuppan, M. K. M. et al. Thrombolysis 50, 7281 (2020). Her work, with her close collaborator, Dr. Drew Weissman of the University of . Unlike the consumptive coagulopathy characteristic of disseminated intravascular coagulation, COVID-19-associated coagulopathy is consistent with a hyperinflammatory and hypercoagulable state88,89. Invest. 22, 22052215 (2020). In a prospective cohort study from Wuhan, China, long-term consequences of acute COVID-19 were evaluated by comprehensive in-person evaluation of 1,733 patients at 6months from symptom onset (hereby referred to as the post-acute COVID-19 Chinese study)5. Notably, clinically significant PTSD symptoms were reported in approximately 30% of patients with COVID-19 requiring hospitalization, and may present early during acute infection or months later143,144. There are several therapies being used to treat the virus infection known as COVID-19, including the medications Chloroquine, Hydroxychloroquine and Azithromycin. Do, T. P. et al. Incidence of venous thromboembolism in patients discharged after COVID-19 hospitalisation. Sosnowski, K., Lin, F., Mitchell, M. L. & White, H. Early rehabilitation in the intensive care unit: an integrative literature review. J. Persistent symptoms in patients after acute COVID-19. This may be associated with reduced cardiac reserve, corticosteroid use and dysregulation of the reninangiotensinaldosterone system (RAAS). Recognition and initial management of fulminant myocarditis: a scientific statement from the American Heart Association. BMC Cardiovasc. Res. Nat. is chair of the scientific advisory board for Applied Therapeutics, which licenses Columbia University technology unrelated to COVID-19 or COVID-19-related therapies. 132). Williamson, E. J. et al. Virol. receives research support from ALung Technologies and is on the medical advisory boards for Baxter, Abiomed, Xenios and Hemovent. Semin. 89, 594600 (2020). The place of early rehabilitation in intensive care unit for COVID-19. Thorax 56, 549556 (2001). 28(1), 6781. Poincar plot of 24-hour ECG monitoring showing the beat-to-beat variability from an uninfected subject and histogram of the frequencydomain parameters. Moores, L. K. et al. I had a 24hr halter that showed SVT. 82(964), 140144. Thank you for visiting nature.com. Nat. 21, 163 (2020). Schupper, A. J., Yaeger, K. A. More importantly, it reported the estimated overall probability of diagnosis of a new psychiatric illness within 90d after COVID-19 diagnosis to be 5.8% (anxiety disorder=4.7%; mood disorder=2%; insomnia=1.9%; dementia (among those 65years old)=1.6%) among a subset of 44,759 patients with no known previous psychiatric illness. For the purpose of this review, we defined post-acute COVID-19 as persistent symptoms and/or delayed or long-term complications of SARS-CoV-2 infection beyond 4weeks from the onset of symptoms (Fig. J. Med. Other post-acute manifestations of COVID-19 include migraine-like headaches135,136 (often refractory to traditional analgesics137) and late-onset headaches ascribed to high cytokine levels. Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain. Res. Swai, J., Hu, Z., Zhao, X., Rugambwa, T. & Ming, G. Heart rate and heart rate variability comparison between postural orthostatic tachycardia syndrome versus healthy participants; A systematic review and meta-analysis. https://doi.org/10.1161/JAHA.113.000700 (2014). Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Prioritization of follow-up care may be considered for those at high risk for post-acute COVID-19, including those who had severe illness during acute COVID-19 and/or required care in an ICU, those most susceptible to complications (for example, the elderly, those with multiple organ comorbidities, those post-transplant and those with an active cancer history) and those with the highest burden of persistent symptoms. Morbini, P. et al. This 2:1:1 comparative design allowed us to establish study reference values for the assessment of HRV and to characterize presumable damage to the sympathetic versus parasympathetic input to the heart rate in the setting of PCS. In adults, a heart rate greater than 100 beats per minute when resting is considered tachycardia. Over the couple of days she developed severe hypertension and recurrent tachycardia. You are using a browser version with limited support for CSS. The small size of the control group is also a limitation, and the real incidence of the disease should be ascertained in larger population studies. COVID-19-mediated postural orthostatic tachycardia syndrome (POTS) is an evolving troublesome disorder that predominantly affects young females. Nature 586, 170 (2020). The study utilized survey questionnaires, physical examination, 6-min walk tests (6MWT) and blood tests and, in selected cases, pulmonary function tests (PFTs), high-resolution computed tomography of the chest and ultrasonography to evaluate post-acute COVID-19 end organ injury. Dysautonomia is often misdiagnosed, in large part because it is not one diagnosis but a group of medical conditions with a variety of symptoms that mimic those of other health issues. All analyses treated the three groups independently, whereas the matching process for every two cases was individual. Romero-Snchez, C. M. et al. 4, 62306239 (2020). Isolated Tachycardia Presenting After Pfizer-BioNTech COVID-19 Vaccination Cureus. Clin. Other studies, including in-person prospective follow-up studies of 110 survivors in the United Kingdom at 812weeks after hospital admission22 and 277 survivors in Spain at 1014weeks after disease onset23, as well as survey studies of 100 COVID-19 survivors in the United Kingdom at 48weeks post-discharge24, 183 individuals in the United States at 35d post-discharge25 and 120 patients discharged from hospital in France, at 100d following admission26, reported similar findings. Ong, K.-C. et al. 6, 233246 (2019). A review of potential options for therapeutic intervention. Manne, B. K. et al. Standardized reference values extracted from healthy populations are frequently not available. Only 3% of patients noted a skin rash at 6months follow-up in the post-acute COVID-19 Chinese study5. 267, 34763478 (2020). Am. All patients had normal 2-D echocardiography results, and no remnant respiratory disease was identified in any patient. Clin. Slider with three articles shown per slide. Gastroenterology 159, 944955.e8 (2020). SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. The need for supplemental oxygen due to persistent hypoxemia, or new requirement for continuous positive airway pressure or other breathing support while sleeping, was reported in 6.6 and 6.9% of patients, respectively, at 60d follow-up in the post-acute COVID-19 US study20. J. Nwazue, V. C. et al. Retrospective data on post-acute thromboembolic events, although limited by small sample size, variability in outcome ascertainment and inadequate systematic follow-up, suggest the rate of venous thromboembolism (VTE) in the post-acute COVID-19 setting to be <5%. In our study, most of the patients could not be evaluated for silent hypoxemia because arterial blood gases were not performed during the acute phase. & Sun, Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Respir. 83, 901908 (2013). Lindner, D. et al. In adults, a heart rate greater than 100 beats per minute when a person is at rest is considered tachycardia. The common symptoms observed in post-acute COVID-19 are summarized. https://doi.org/10.1001/jamaoto.2020.2366 (2020). Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4weeks from the onset of symptoms. Acute pulmonary embolism in patients with COVID-19 at CT angiography and relationship to d-dimer levels. 11, 37 (2011). A number of mechanisms have been proposed to explain the occurrence of ANS dysfunction after a viral infection: denervation of the ANS, virus-dependent tissue damage due to persistent infection, and immune-mediated injury, among others. Microbiota-driven tonic interferon signals in lung stromal cells protect from influenza virus infection. Rep. https://doi.org/10.1007/s11033-021-06358-1 (2021). 1). COVID-19 has the potential to alter the gut microbiome, including enrichment of opportunistic infectious organisms and depletion of beneficial commensals196,197. Arthritis Rheumatol. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems networkUnited States, MarchJune 2020. 20, 697706 (2020). https://doi.org/10.1016/j.cmi.2020.08.028 (2020). Dis. Puchner, B. et al. Med. CAS Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry. Kudose, S. et al. POTS was also linked, to a lesser degree, to Covid vaccination with an mRNA vaccine, according to the new study. Rep. 5, 11491160 (2020). 743, 135567 (2021). Thrombotic microangiopathy in a patient with COVID-19. Platelet gene expression and function in COVID-19 patients. Most of these patients experience mild symptoms that do not warrant hospital admission. 323, 24662467 (2020). & McIntyre, R. S. The involvement of TNF- in cognitive dysfunction associated with major depressive disorder: an opportunity for domain specific treatments. Post-acute COVID-19 is defined as persistent symptoms and/or delayed or long-term complications beyond 4weeks from the onset of symptoms. chills . Neutrophil extracellular traps in COVID-19. Blockade of IL-6 trans signaling attenuates pulmonary fibrosis. https://doi.org/10.1001/jamacardio.2020.1286 (2020). Care 28, 216225 (2015). Crit. Rare areas of myofibroblast proliferation, mural fibrosis and microcystic honeycombing have also been noted. 73(10), 11891206. Salvio, G. et al. Commun. Reply to the letter COVID-19-associated encephalopathy and cytokine-mediated neuroinflammation. & Lakshminrusimha, S. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management. Finally, interference of angiotensin II synthesis by COVID-19 can be postulated as the last possible patho-physiological mechanism leading to dysautonomia. While relatively common, affecting more than 70 million people worldwide, it can sometimes take years to get a diagnosis. Clin. Madjid et al. Nat. Arca, K. N. & Starling, A. J.Treatment-refractory headache in the setting of COVID-19 pneumonia: migraine or meningoencephalitis? Google Scholar. Yu, C. M. et al. The vast . Things that may lead to tachycardia include: Fever Heavy alcohol use or alcohol withdrawal High levels of caffeine High or low blood pressure Muccioli, L. et al. Anxiety disorders, an acknowledged cause of sinus tachycardia, were not systematically evaluated in our patient population. "I apologize on. J. Neurol. The virus that causes COVID-19 is designated "severe acute . 5(7), 831840. J. Thromb. Coll. Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. Acad. 40, 3139 (2019). Immunol. J. However, this is not the first time that IST has been described after coronavirus infection. Chin. 27, 258263 (2021). Lim, W. et al. J. 324, 22512252 (2020). Reichard, R. R. et al. Lett. https://doi.org/10.1007/s12018-020-09274-3 (2020). Ther. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. COVID-19 and SARS-Cov-2 infection: Pathophysiology and clinical effects on the nervous system. He referred the patient to CV who reviewed the patient with JSO, diagnosed postural orthostatic tachycardia syndrome and advised commencement of ivabradine. The severity of illness during acute COVID-19 (measured, for example, by admission to an intensive care unit (ICU) and/or requirement for non-invasive and/or invasive mechanical ventilation) has been significantly associated with the presence or persistence of symptoms (such as dyspnea, fatigue/muscular weakness and PTSD), reduction in health-related quality of life scores, pulmonary function abnormalities and radiographic abnormalities in the post-acute COVID-19 setting5,22,24. Post-discharge thrombosis and hemorrhage in patients with COVID-19. Pozo-Rosich, P. Headache & COVID-19: a short-term challenge with long-term insights. We found that IST is prevalent among PCS patients (affecting 20% in our series), and this disorder was more common in young women without previous comorbidities and with mild SARS-CoV-2 infection. 1. 'I apologize on behalf of my profession for refusing to listen to patients with vax injuries' - Dr. Michael Huang, physician who treated 4,000 COVID patients says he's seen hundreds of COVID-19 vaccine injuries, cancer, pregnancy loss, etc.. Dr. Melissa Halvorson Smith MD. headache. Postgrad. 83, 11181129 (2020). Bradley, K. C. et al. Google Scholar. Mateu-Salat, M., Urgell, E. & Chico, A.SARS-COV-2 as a trigger for autoimmune disease: report of two cases of Graves disease after COVID-19. Nat. J. Thromb. Internet Explorer). Crit. MIS-C is also known to disproportionately affect children and adolescents of African, Afro-Caribbean or Hispanic ethnicity206,208. PubMed Article While the burden of dialysis-dependent AKI at the time of discharge is low, the extent of the recovery of renal function remains to be seen. It is a type of heart rhythm abnormality called an arrhythmia. Rehabil. With adequate longer-term follow-up data, those patients who require RRT for severe AKI experience high mortality, with a survival probability of 0.46 at 60d and rates of renal recovery reportedly at 84% among survivors170. However, our study was unable to demonstrate SNS participation in IST, and further investigations are needed to elucidate and characterize this patho-physiological aspect. Ultrastructural evidence of direct viral damage to the olfactory complex in patients testing positive for SARS-CoV-2. Rep. https://doi.org/10.1038/s41598-021-93546-5 (2021). However, autopsy series have shown that SARS-CoV-2 may cause changes in brain parenchyma and vessels, possibly by effects on bloodbrain and bloodcerebrospinal fluid barriers, which drive inflammation in neurons, supportive cells and brain vasculature155,156. The role of antiplatelet agents such as aspirin as an alternative (or in conjunction with anticoagulation agents) for thromboprophylaxis in COVID-19 has not yet been defined and is currently being investigated as a prolonged primary thromboprophylaxis strategy in those managed as outpatients (ACTIV4 (NCT04498273)). Lancet 397, 220232 (2021). Metab. fatigue. The timing of the emergence of MIS-C (which was lagging approximately 1month behind peak COVID-19 incidence in epicenters in Spring 2020211) and the finding that most patients are negative for acute infection but are antibody positive suggest that MIS-C may result from an aberrant acquired immune response rather than acute viral infection208. Answers ( 1) Dr. Viji Balakrishnan. Neurological complications of MIS-C, such as headache, altered mental status, encephalopathy, cranial nerve palsies, stroke, seizure, reduced reflexes, and muscle weakness, appear to be more frequent than in Kawasaki disease209,210. Santoriello, D. et al. Heart Rhythm 17, 14631471 (2020). Ann, Neurol. Med. For this reason, we performed the same tests in two gender- and age-controlled groups, one with matched disease stage and severity and one without previous infection. The reasons for the absolute predominance of this pathological phenomenon in young females, the concomitant high prevalence of environmental allergies, and the lack of correspondence with the severity of the index SARS-CoV-2 acute infection remain uncertain. Postmortem kidney pathology findings in patients with COVID-19. Paediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19 (PIMS)Guidance for Clinicians (Royal College of Paediatrics and Child Health, 2020); https://www.rcpch.ac.uk/resources/paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims-guidance. Postgrad. Thromb. Post-acute COVID-19 syndrome. A., Omer, S. B. Fatigue, dyspnea and psychological distress, such as post-traumatic stress disorder (PTSD), anxiety, depression and concentration and sleep abnormalities, were noted in approximately 30% or more study participants at the time of follow-up. Rajpal, S. et al. Lancet Haematol. 29, 200287 (2020). Rev. Similarly, no DVT was seen in 390 participants (selected using a stratified sampling procedure to include those with a higher severity of acute COVID-19) who had ultrasonography of lower extremities in the post-acute COVID-19 Chinese study5. Decreased estimated glomerular filtration rate (eGFR; defined as <90mlmin1 per 1.73m2) was reported in 35% of patients at 6months in the post-acute COVID-19 Chinese study, and 13% developed new-onset reduction of eGFR after documented normal renal function during acute COVID-19 (ref. Kartik Sehgal or Elaine Y. Wan. HRV parameters in the three studied groups: IST, fully recovered and uninfected subjects. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Kidney biopsy findings in patients with COVID-19. 193, 37553768 (2014). Human coronaviruses: viral and cellular factors involved in neuroinvasiveness and neuropathogenesis. Instead, abrupt cessation of RAAS inhibitors may be potentially harmful128. J. Dr.Kerryn Phelps is the former President of the Australian Medical Association (AMA). Med. Care Med. 27, 763767 (2020). COVID-19 and multisystem inflammatory syndrome in children and adolescents. Chopra, V., Flanders, S. A. Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. Inoue, S. et al. Immune complement and coagulation dysfunction in adverse outcomes of SARS-CoV-2 infection. Exp. 12, eabe4282 (2020). Lancet Infect. PubMed Central Open 3, e2025197 (2020). JAMA Cardiol. DiMeglio, L. A., Evans-Molina, C. & Oram, R. A. Current recommendations include immunomodulatory therapy with intravenous immunoglobulin, adjunctive glucocorticoids and low-dose aspirin until coronary arteries are confirmed normal at least 4weeks after diagnosis206. Sci. Assoc. PLoS ONE 15, e0244131 (2020). Bikdeli, B. et al. 383, 120128 (2020). Fibrillation. Oto Rhino Laryngol. JAMA Psychiatry https://doi.org/10.1001/jamapsychiatry.2020.2795 (2020). J. Clin. Immun. An observational cohort study from 38 hospitals in Michigan, United States evaluated the outcomes of 1,250 patients discharged alive at 60d by utilizing medical record abstraction and telephone surveys (hereby referred to as the post-acute COVID-19 US study)20. Inappropriate Sinus Tachycardia Follow Posted 6 years ago, 9 users are following. JAMA Otolaryngol. Cardiol. 74, 860863 (2020). https://doi.org/10.1016/j.ijcard.2003.02.002 (2004). & Alhammadi, A. H. Virus-induced secondary bacterial infection: a concise review. Lung transplantation in pulmonary fibrosis secondary to influenza A pneumonia. J. Bikdeli, B. et al. Freeman, E. E. et al. It is not yet known how long the increased severity of pre-existing diabetes or predisposition to DKA persists after infection, and this will be addressed by the international CoviDiab registry183. https://doi.org/10.1093/ofid/ofv103 (2015). Some studies have shown that COVID-19 has significant cardiovascular involvement, but no previous research has focused on IST after SARS-CoV-2 infection. Novak, P. Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Google Scholar. American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version 1. J. Med. Dani, M. et al. Med. Therapeutic anticoagulation with enoxaparin or warfarin and low-dose aspirin is recommended in those with a coronary artery zscore10, documented thrombosis or an ejection fraction<35%. 369, 13061316 (2013). Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Ani Nalbandian,Aakriti Gupta,Mahesh V. Madhavan,Gregg F. Rosner,Nir Uriel,Allan Schwartz&Elaine Y. Wan, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA, Department of Medicine, Brigham and Womens Hospital, Boston, Massachusetts, USA, Harvard Medical School, Boston, Massachusetts, USA, Kartik Sehgal,Behnood Bikdeli,Toni K. Choueiri&Jean M. Connors, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA, Aakriti Gupta,Mahesh V. Madhavan&Behnood Bikdeli, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Claire McGroder,Matthew Baldwin,Daniel Brodie&Christine Kim Garcia, Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Jacob S. Stevens,Sumit Mohan&Donald W. Landry, Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Joshua R. Cook,John C. Ausiello,Domenico Accili&John P. Bilezikian, Department of Neurology, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Department of Psychiatry, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York, New York, USA, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA, Division of Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA, Cardiovascular Division, Brigham and Womens Hospital, Boston, Massachusetts, USA, Division of Infectious Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Clinical Pharmacy, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Division of Rheumatology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Institute of Human Nutrition and Division of Preventive Medicine and Nutrition, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, Division of Hematology, Brigham and Womens Hospital, Boston, Massachusetts, USA, You can also search for this author in PLoS ONE 15, e0243882 (2020). All authores reviewed the mansucript. Although some surveys have shown ACE2 and transmembrane serine protease (TMPRSS2; the protease involved in SARS-CoV-2 cell entry) expression in cells189, the primary deficit in insulin production is probably mediated by factors such as inflammation or the infection stress response, along with peripheral insulin resistance188. Hosey, M. M. & Needham, D. M. Survivorship after COVID-19 ICU stay. Dis. Neurophysiol. Model COVID-19 rehabilitation units such as those in Italy are already routinely assessing acute COVID-19 survivors for swallowing function, nutritional status and measures of functional independence219. It is also imperative that clinicians provide information in accessible formats, including clinical studies available for participation and additional resources such as patient advocacy and support groups. Eur. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): rationale and feasibility of a shared pragmatic protocol. YouTube https://www.youtube.com/watch?v=UMmT48IC0us&feature=emb_logo (2020). Soc. Background Patients with diabetes are more likely to suffer COVID-19 complications. In patients with ventricular dysfunction, guideline-directed medical therapy should be initiated and optimized as tolerated129. Moreover, it is clear that care for patients with COVID-19 does not conclude at the time of hospital discharge, and interdisciplinary cooperation is needed for comprehensive care of these patients in the outpatient setting. Background: Since the advent of global COVID-19 vaccination, several studies reported cases of encephalitis with its various subtypes following COVID-19 vaccinations.