Higher nasal epithelial expression of TMPRSS2 has been reported in Black individuals compared with other self-reported races/ethnicities217. M.S.V.E. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. Circulation 120, 725734 (2009). Her story is here ( click here ): "Dr.Hertz, a gastroenterologist who retired in October, got her first and only dose of Pfizer's vaccine on Dec. 23, 2020". Secondary causes of tachycardia, such as anemia, thyroid pathology, pregnancy, infection, or pulmonary embolism, were investigated, and patients with a systemic condition justifying tachycardia were excluded from the study analysis. J. Med. 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. To investigate the prevalence and. 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. Metab. Primer Auton. Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. Bai, C. et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. 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. Desforges, M., Le Coupanec, A., Stodola, J. K., Meessen-Pinard, M. & Talbot, P. J. Standard screening tools should be used to identify patients with anxiety, depression, sleep disturbances, PTSD, dysautonomia and fatigue76,141. Post-Vaccination Inflammatory Syndrome: a new syndrome - OAText Am. At the acute stage, sinus tachycardia may reflect systemic hyper-sympathetic tone. & ENCOVID-BIO Network. Clin. Acta Diabetol. It has been suggested that persistent tachycardia seen in long COVID, labelled "post-COVID-19 tachycardia syndrome," may present as inappropriate sinus tachycardia or POTS . Can. Sinus Tachycardia | Cardiology | Mercy Health Ritchie, K., Chan, D. & Watermeyer, T. The cognitive consequences of the COVID-19 epidemic: collateral damage? Inappropriate Sinus Tachycardia Follow Posted 6 years ago, 9 users are following. Inappropriate sinus tachycardia (IST) occurs due to unknown reasons. Haemost. Crit. Inappropriate sinus tachycardia (IST) is a common observation in patients with post-COVID-19 syndrome (PCS) but has not yet been fully described to date. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: a systematic review. Dr. Melissa Halvorson Smith is a gynecologist from North Dakota and heads the Women's Health Center. Robbins-Juarez, S. Y. et al. Rev. Slider with three articles shown per slide. Article https://doi.org/10.1007/s00405-020-06220-3 (2020). Chopra, V., Flanders, S. A. Neurological issues in children with COVID-19. 194, 145158 (2014). 383, 789790 (2020). PubMed Central The majority of abnormalities observed by computed tomography were ground-glass opacities. Mo, X. et al. 19(1), 320. https://doi.org/10.1186/s12872-019-01298-y (2019). Cardiol. Aiello, A. et al. 98, 219227 (2020). N. Engl. Article Serial echocardiographic assessment is recommended at intervals of 12 and 46weeks after presentation212. 99, 677678 (2020). Early reports suggest residual effects of SARS-CoV-2 infection, such as fatigue, dyspnea, chest pain, cognitive disturbances, arthralgia and decline in quality of life3,4,5. Answer: Sinus tachycardia is the term used to describe a faster-than-normal heartbeat a rate of more than 100 beats per minute versus the typical normal of 60 to 70 beats per minute. 100% healthy NP prior, never had Covid. Symptoms of autonomic dysfunction in human immunodeficiency virus. Med. Post-acute COVID-19 syndrome. 2). Shah, W., Hillman, T., Playford, E. D. & Hishmeh, L. Managing the long term effects of COVID-19: summary of NICE, SIGN, and RCGP rapid guideline. Dani, M. et al. Unique to this pandemic is the creation and role of patient advocacy groups in identifying persistent symptoms and influencing research and clinical attention. Illustration of the pathophysiological mechanisms underlying Post-COVID-19 syndrome. Care Med. Respir. Xu, Y. et al. 169, 21422147 (2009). 16,17), as replication-competent SARS-CoV-2 has not been isolated after 3weeks18. & Jomha, F. A. COVID-19 induced superimposed bacterial infection. Syst. COVID-19 Vaccine-Injured Doctors Are Finally Starting to Speak Up And Fibrillation. PDF Suspected COVID-19 mRNA Vaccine-Induced Postural Orthostatic Raghu, G. & Wilson, K. C.COVID-19 interstitial pneumonia: monitoring the clinical course in survivors. Do, T. P. et al. Hello to all. Blood 136, 13171329 (2020). In this same study, there was a 3.7% cumulative incidence of bleeding at 30d post-discharge, mostly related to mechanical falls. Aust. Infect. The overlap of sequelae of post-acute COVID-19 with those of SARS and MERS may be explained by phylogenetic similarities between the responsible pathogenic coronaviruses. Some experts have also proposed evaluation with serial PFTs and 6MWTs for those with persistent dyspnea, as well as high-resolution computed tomography of the chest at 6 and 12months75. The remaining parameters are less specific to a determined sympathetic versus parasympathetic influence on the heart rate and, thus, become less useful in characterizing a specific ANS disturbance. 267, 34763478 (2020). COVID-19-mediated postural orthostatic tachycardia syndrome (POTS) is an evolving troublesome disorder that predominantly affects young females. Vaduganathan, M. et al. However, comparison of Kawasaki disease and MIS-C cohorts demonstrates distinctive epidemiologic and clinical characteristics. However, there are notable differences, such as the higher affinity of SARS-CoV-2 for ACE2 compared with SARS-CoV-1, which is probably due to differences in the receptor-binding domain of the spike protein that mediates contact with ACE2. Bikdeli, B. et al. Blood 135, 20332040 (2020). However, the pharmacological agent of choice, the timing of its administration, and the clinical response will warrant a separate investigation. Holter monitoring may help distinguish inappropriate sinus tachycardia Tachycardia is the medical term for a heart rate over 100 beats a minute. International AIDS conference. Histopathologic and ultrastructural findings in postmortem kidney biopsy material in 12 patients with AKI and COVID-19. What heart and stroke patients should know about COVID-19 vaccines (the most common arrhythmia associated with long COVID) from other arrhythmias. In this study, we based our assessment of ANS imbalance on the time-and-frequency-domain heart rate variability (HRV) parameters obtained during 24-h ECG monitoring. Headache 60, 14221426 (2020). The best COVID-19 vaccine is the first one that is available to you. 324, 22512252 (2020). Med. 323, 18911892 (2020). In rare cases, the COVID-19 vaccine can cause a severe allergic reaction, which is why people should be monitored after the injection. Nephrol. Lim, W. et al. 5, 12651273 (2020). Kati Kariko Helped Shield the World From the Coronavirus Head Neck Surg. Similarly, subacute thyroiditis with clinical thyrotoxicosis has been reported weeks after the resolution of respiratory symptoms184,185. In a study of 26 competitive college athletes with mild or asymptomatic SARS-CoV-2 infection, cardiac MRI revealed features diagnostic of myocarditis in 15% of participants, and previous myocardial injury in 30.8% of participants114. Ann. Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. We present a case of a 15-year-old South Asian male who developed suspected POTS two weeks after receiving the Pfizer-BioNTech COVID-19 vaccine booster, which was successfully managed with low-dose Reply to the letter COVID-19-associated encephalopathy and cytokine-mediated neuroinflammation. N. Engl. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. All analyses treated the three groups independently, whereas the matching process for every two cases was individual. During the study period, 6.7% of patients died, while 15.1% of patients required re-admission. Clin. All patients had normal 2-D echocardiography results, and no remnant respiratory disease was identified in any patient. 20, 13651366 (2020). A post-acute outpatient service established in Italy (hereby referred to as the post-acute COVID-19 Italian study)3 reported persistence of symptoms in 87.4% of 143 patients discharged from hospital who recovered from acute COVID-19 at a mean follow-up of 60d from the onset of the first symptom. Maron, B. J. et al. J. Biomol. Open 3, e2025197 (2020). Gastroenterology 158, 18311833.e3 (2020). Carvalho-Schneider, C. et al. 99, 470474 (2020). CAS Rheumatol. All authores reviewed the mansucript. 324, 13811383 (2020). Lancet Haematol. Neurol. Bikdeli, B. et al. Sharma, P. et al. J.A., V.B. Neurology https://doi.org/10.1212/WNL.0000000000010111 (2020). Your heart's sinus node generates electrical impulses that travel through the heart muscle, causing it to beat. Sci Rep. 2022, 12:298. COVID-19 has the potential to alter the gut microbiome, including enrichment of opportunistic infectious organisms and depletion of beneficial commensals196,197. Golmai, P. et al. 372, n136 (2021). Thank you for visiting nature.com. Haemost. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. A normal sinus rhythm has a heart rate of between 60 and 100 beats/minute. Care Med. Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome: less is more. volume27,pages 601615 (2021)Cite this article. They can vary across different age groups. COVID-19 and Cardiovascular Diseases: A Literature Review From Bozkurt, B., Kovacs, R. & Harrington, B. Gupta, A. et al. Nougier, C. et al. Thorac. Vaccine Injured Doctors Starting to Speak Up - ussanews.com Med. Animals | Free Full-Text | Electrocardiographic and Echocardiographic Patients with postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia may benefit from a low-dose beta blocker for heart rate management and reducing adrenergic activity131. Med. MIS-C, also referred to as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is defined by the presence of the following symptoms in people <21years old (or 19years old per the World Health Organization definition): fever; elevated inflammatory markers; multiple organ dysfunction; current or recent SARS-CoV-2 infection; and exclusion of other plausible diagnoses203,204. Hypofibrinolytic state and high thrombin generation may play a major role in SARS-COV2 associated thrombosis. N. Engl. Children (Basel) 7, 69 (2020). & Thompson, P. D. Arrhythmogenic right ventricular cardiomyopathy. Thromb. Moreno-Prez, O. et al. Soc. Acute kidney injury due to collapsing glomerulopathy following COVID-19 Infection. Persistent symptoms in patients after acute COVID-19. Infectious diseases causing autonomic dysfunction. Nature 584, 430436 (2020). reports a consultant or advisory role for Abbott Vascular, Bristol-Myers Squibb, Portola and Takeda, as well as research support (institutional) from CSL Behring. Needham, D. M. et al. Post-acute COVID-19 syndrome. Authors Charles Tate 1 , Luay Demashkieh 2 , Wael Hakmeh 3 Affiliations 1 Emergency Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, USA. "I apologize on. Unlike the consumptive coagulopathy characteristic of disseminated intravascular coagulation, COVID-19-associated coagulopathy is consistent with a hyperinflammatory and hypercoagulable state88,89. Scientific and Standardization Committee communication: clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. Previous studies have suggested a number of concurrent mechanisms, including direct brain invasion across the ethmoid bone or via the olfactory bulb during acute infection or blood dissemination of the virus and use of the ACE2 receptor for intracellular penetration. Rey, J. R. et al. COVID-19-associated kidney injury: a case series of kidney biopsy findings. Platelet and vascular biomarkers associate with thrombosis and death in coronavirus disease. 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 Guidance on diagnosis and management of cerebral venous sinus Diabetes Obes. https://doi.org/10.1016/j.jac.2012.07.074 (2013). "Professor Shmuel Shapira might be the most senior ranking medical-scientist in the world to openly criticize the COVID vaccines." On May 13, 2022, Dr. Shapira said: "I received 3 vaccinations (Pfizer), I was physically injured in a very significant way as many others were injured". Children and teens ages 6 months-17 years Adults 18 years and older After a second shot or booster Withdrawal of guideline-directed medical therapy was associated with higher mortality in the acute to post-acute phase in a retrospective study of 3,080 patients with COVID-19 (ref. N. Engl. PubMed Central A spectrum of pulmonary manifestations, ranging from dyspnea (with or without chronic oxygen dependence) to difficult ventilator weaning and fibrotic lung damage, has been reported among COVID-19 survivors. 218(3), e20202135. Ameres, M. et al. Although conclusive evidence is not yet available, extended post-hospital discharge (up to 6weeks) and prolonged primary thromboprophylaxis (up to 45d) in those managed as outpatients may have a more favorable riskbenefit ratio in COVID-19 given the noted increase in thrombotic complications during the acute phase, and this is an area of active investigation (NCT04508439, COVID-PREVENT (NCT04416048), ACTIV4 (NCT04498273) and PREVENT-HD (NCT04508023))106,107. Postgrad. PubMed 146, 215217 (2020). 24-h ECG monitoring and HRV parameters. Microbiol. Potential neurological manifestations of COVID-19. 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. Wu, Q. et al. Cardiol. Nalbandian, A., Sehgal, K., Gupta, A. et al. 130, 26202629 (2020). Wrobel, A. G. et al. Neurology 95, e1060e1070 (2020). Recommendations for competitive athletes with cardiovascular complications related to COVID-19 include abstinence from competitive sports or aerobic activity for 36months until resolution of myocardial inflammation by cardiac MRI or troponin normalization124,125. Immunol. Sinus tachycardia: Normal vs. inappropriate, and more - Medical News Today A real-world, large-scale dataset analysis of 62,354 COVID-19 survivors from 54 healthcare organizations in the United States estimated the incidence of first and recurrent psychiatric illness between 14 and 90d of diagnosis to be 18.1%145. 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. Sadly, no research on us! Arch. Tenforde, M. W. et al. Spyropoulos, A. C. et al. 8, 807815 (2020). 20, 11351140 (2020). Dr.Kerryn Phelps is the former President of the Australian Medical Association (AMA). PubMed Central Microbiol. 4, 62306239 (2020). Brain 143, 31043120 (2020). Sinus Tachycardia: Causes, Symptoms, and Treatment - Healthline Nat. Barnes, G. D. et al. 120, 10041024 (2020). Am. is founder, director and chair of the advisory board of Forkhead Therapeutics. Supraventricular tachycardia - Symptoms and causes - Mayo Clinic Huang, Y. et al. Schaller, T. et al. Endocrine manifestations in the post-acute COVID-19 setting may be consequences of direct viral injury, immunological and inflammatory damage, as well as iatrogenic complications. Consecutive patients admitted to the PCS Unit between June and December 2020 with a resting sinus rhythm rate 100bpm were prospectively enrolled in this study and further examined by an orthostatic test, 2D echocardiography, 24-h ECG monitoring (heart rate variability was a surrogate for cardiac autonomic activity), quality-of-life and exercise capacity testing, and blood sampling. CAS Dis. Am. Article 5(7), 831840. Med. Thank you for visiting nature.com. Thorac. Libby, P. & Lscher, T. COVID-19 is, in the end, an endothelial disease. Ther. Moldofsky, H. & Patcai, J. At physical examination, the mean heart rate was 96 3bpm at supine and 112 17bpm at the upright position, with 8 patients fulfilling diagnostic criteria of POTS. Soc. Immunosenescence and its hallmarks: how to oppose aging strategically? Neurology 43(1), 132137. These authors contributed equally: Lourdes Mateu and Roger Villuendas. Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children (MIS-C) (Centers for Disease Control and Prevention, 2020); https://www.cdc.gov/mis-c/hcp/, Multisystem Inflammatory Syndrome in Children and Adolescents with COVID-19 (World Health Organization, 2020); https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. Ongoing studies are evaluating long-term sequelae in these children (NCT04330261). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen responsible for coronavirus disease 2019 (COVID-19), has caused morbidity and mortality at an unprecedented scale globally1. 43, 15271528 (2020). Potential pitfalls and practical guidance. Med. https://doi.org/10.23736/S1973-9087.21.06549-7 (2021). Dyspnea, decreased exercise capacity and hypoxia are commonly persistent symptoms and signs, Reduced diffusion capacity, restrictive pulmonary physiology, and ground-glass opacities and fibrotic changes on imaging have been noted at follow-up of COVID-19 survivors, Assessment of progression or recovery of pulmonary disease and function may include home pulse oximetry, 6MWTs, PFTs, high-resolution computed tomography of the chest and computed tomography pulmonary angiogram as clinically appropriate, Thromboembolic events have been noted to be <5% in post-acute COVID-19 in retrospective studies, The duration of the hyperinflammatory state induced by infection with SARS-CoV-2 is unknown, Direct oral anticoagulants and low-molecular-weight heparin may be considered for extended thromboprophylaxis after riskbenefit discussion in patients with predisposing risk factors for immobility, persistently elevated d-dimer levels (greater than twice the upper limit of normal) and other high-risk comorbidities such as cancer, Persistent symptoms may include palpitations, dyspnea and chest pain, Long-term sequelae may include increased cardiometabolic demand, myocardial fibrosis or scarring (detectable via cardiac MRI), arrhythmias, tachycardia and autonomic dysfunction, Patients with cardiovascular complications during acute infection or those experiencing persistent cardiac symptoms may be monitored with serial clinical, echocardiogram and electrocardiogram follow-up, Persistent abnormalities may include fatigue, myalgia, headache, dysautonomia and cognitive impairment (brain fog), Anxiety, depression, sleep disturbances and PTSD have been reported in 3040% of COVID-19 survivors, similar to survivors of other pathogenic coronaviruses, The pathophysiology of neuropsychiatric complications is mechanistically diverse and entails immune dysregulation, inflammation, microvascular thrombosis, iatrogenic effects of medications and psychosocial impacts of infection, Resolution of AKI during acute COVID-19 occurs in the majority of patients; however, reduced eGFR has been reported at 6months follow-up, COVAN may be the predominant pattern of renal injury in individuals of African descent, COVID-19 survivors with persistent impaired renal function may benefit from early and close follow-up in AKI survivor clinics, Endocrine sequelae may include new or worsening control of existing diabetes mellitus, subacute thyroiditis and bone demineralization, Patients with newly diagnosed diabetes in the absence of traditional risk factors for type 2 diabetes, suspected hypothalamicpituitaryadrenal axis suppression or hyperthyroidism should undergo the appropriate laboratory testing and should be referred to endocrinology, Prolonged viral fecal shedding can occur in COVID-19 even after negative nasopharyngeal swab testing, COVID-19 has the potential to alter the gut microbiome, including enrichment of opportunistic organisms and depletion of beneficial commensals, Hair loss is the predominant symptom and has been reported in approximately 20% of COVID-19 survivors, Diagnostic criteria: <21years old with fever, elevated inflammatory markers, multiple organ dysfunction, current or recent SARS-CoV-2 infection and exclusion of other plausible diagnoses, Typically affects children >7years and disproportionately of African, Afro-Caribbean or Hispanic origin, Cardiovascular (coronary artery aneurysm) and neurologic (headache, encephalopathy, stroke and seizure) complications can occur. Kudose, S. et al. This is another serious side effect that is being increasingly recognized. In our case, there was a temporal association between COVID-19 vaccination and onset of clinical symptoms in the absence of prior similar episodes. Human coronaviruses: viral and cellular factors involved in neuroinvasiveness and neuropathogenesis. Rates of PTSD were similar in BAME and White participants in this study. J. Did COVID-19 Mess Up My Heart? - The Atlantic 'Inappropriate' Sinus Tachycardia - medscape.com Res. Lancet Infect. Finally, our results suggest a major role of the ANS in the pathophysiology of IST. Ong, K.-C. et al. 10, 576551 (2020). Med. Survivors of previous coronavirus infections, including the SARS epidemic of 2003 and the Middle East respiratory syndrome (MERS) outbreak of 2012, have demonstrated a similar constellation of persistent symptoms, reinforcing concern for clinically significant sequelae of COVID-19 (refs.
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