Based on our experience of following-up COVID-19 patients discharged from the hospital, fatigue appears as a prominent feature, even at 12 weeks post-discharge. Patients assert that they were unable to return to their baseline activity level. They find trivial daily activities fatigue-inducing. This is a major complaint that has been acknowledged by the literature. 4 Another prominent feature of long COVID experienced by our patients is shortness of breath. This was more significant among patients with severe COVID-19 who were admitted to ICU and required either non-invasive or mechanical ventilation. Further investigation revealed mild anemia in some patients, evidence of pulmonary embolism in some, and changes suggestive of pulmonary fibrosis in computer tomography of the chest among others. Cardiac causes such as heart failure with preserved ejection fraction or impaired ventricular function were found in a small number of patients. However, there was no cause identifiable in the majority of patients.

Post-acute COVID-19 syndrome management remains a clinical challenge as there are no evidencebased international guidelines to follow at the time of writing. Pulmonary embolism is managed in the usual way with anticoagulation for at least three months. There is no consensus on the benefit, or duration, of prolonged prophylaxis, with low molecular weight heparin, post-discharge. Management of post-COVID-19 pulmonary fibrosis is also unclear. Clinical, radiological, and biochemical markers are required to help clinicians anticipate which patients with COVID-19-related ARDS are susceptible to developing pulmonary fibrosis following the resolution of COVID-19. 13 We have used systemic steroids in some patients with good results. The role of the antifibrotic drugs, pirfenidone and nintedanib, is awaiting clinical trial evidence. A unified definition of long COVID and characterization of its manifestation are important for early detection. In addition, more research should be directed to identify risk factors and exact mechanisms leading to the development of long COVID syndrome. Such knowledge may enhance further research aimed at the prevention of such a complication.