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and there are already specific ICD-10 &#40;U09&#41; and ICD-11 &#40;RA02&#41; codes to identify it<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">With the aim of unifying criteria&#44; the National Institute for Health and Care Excellence proposed the following definitions to describe the various symptomatic phases of SARS-CoV-2 infection<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Acute COVID-19 generally lasts up to 4 weeks from the onset of symptoms&#46; When symptoms last longer than 4 weeks or late or long-term symptoms appear&#44; then the term &#8216;post-acute COVID-19&#8217; is used&#46; The latter term encompasses both patients with long COVID &#40;LC&#41; and post-COVID-19 sequelae&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">LC applies to symptoms that remain 4 or even 12 weeks beyond the acute infection&#44; or that appear later on in the case of subjects with asymptomatic infection&#44; but without the presence of irreversible organ damage&#46; In terms of post-COVID-19 sequelae&#44; patients tend to present a history of severe acute COVID-19 and symptoms resulting from structural damage secondary to complications suffered during the acute phase<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Making this distinction is important since these 2 sub-types of post-acute COVID-19 affect different patient profiles&#46; While sequelae are predominant in older males&#44; typically around 70 years-old and with associated comorbidities&#44; LC tends to present in middle-aged women&#44; around 40 years-old&#44; without significant health issues&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Three clinical phenotypes within LC have been described&#58; permanent &#40;no changes during follow-up&#41;&#44; relapsing&#47;recurring &#40;episodic and fluctuating course&#44; with intervals of symptom exacerbation and remission&#41;&#44; and slowly progressive improvement<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pathophysiology</span><p id="par0050" class="elsevierStylePara elsevierViewall">The fact that some patients with COVID-19 experience symptoms after recovering from acute infection is to be expected&#46; Other infections&#44; such as those caused by the Epstein-Barr virus&#44; <span class="elsevierStyleItalic">Giardia lamblia&#44; Coxiella burnetii&#44; Borrelia burgdorferi</span> &#40;Lyme disease&#41; and the Ross River virus&#44; as well as other coronaviruses such as SARS-CoV and MERS-CoV &#40;causes of severe acute respiratory syndrome &#91;SARS&#93; and Middle East respiratory syndrome &#91;MERS&#93;&#44; respectively&#41;&#44; are also associated with a higher risk of post-infectious sequelae&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">These sequelae include long-term symptoms &#40;months&#44; even years&#41; in the absence of active infection and include debilitating fatigue&#44; musculoskeletal pain&#44; neurocognitive difficulties&#44; and mood disorders<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; These acute&#44; post-infection syndromes show a clear clinical and pathophysiological parallel with long COVID syndrome&#44; particularly with SARS and MERS due to the phylogenetic similarities between the pathogenic coronaviruses responsible&#46; The overlap of the genome sequence identity of SARS-CoV-2 is 79&#37; with SARS-CoV-1 and 50&#37; with MERS-CoV<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The potential mechanisms that contribute to the pathophysiology of LC are not yet clear&#44; as numerous factors have been suggested &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A key element may be the presence of a state of chronic hyperinflammation<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; The virus&#44; in relation to the lungs&#44; activates innate immunity&#44; resulting in an inflammatory cytokine release cascade&#44; including interleukin 6 &#40;IL-6&#41;&#44; IL-1&#44; tumour necrosis factor alpha&#44; and reactive oxygen species&#46; This systemic cytokine elevation becomes involved in the development of pulmonary fibrosis<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and cardiac and neurological lesions secondary to endothelial damage caused by the activation of fibroblasts with collagen and fibronectin deposition&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In addition&#44; damage to the blood&#8211;brain barrier &#40;BBB&#41; has been observed with increased permeability for neurotoxic substances&#46; Likewise&#44; elevated levels of IL-6 can disrupt muscle metabolic homoeostasis<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and exacerbate muscle loss&#44; which is why some authors postulate that skeletal muscle may be impacted both by direct infection by SARS-CoV-2 of the myocytes&#44; cells with elevated expression of the angiotensin-converting enzyme 2 receptor &#40;ACE2&#41;&#44; and indirectly through systemic cytokine release and subsequent muscle homoeostasis disruption&#44; resulting in fatigue and muscle weakness&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Some studies<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> have aimed to detect the presence of T cells and NK lymphocytes in these patients and so it seems long COVID is characterised by alterations in the TCD4&#43; and TCD8&#43; cells&#44; with two clinically important profiles distinguished&#58; one that is more inflammatory &#40;decrease in TCD4&#43; and increase in TCD8&#43;&#41; and another that is more immune &#40;increase in TCD4&#43; and TCD8&#43;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Other suggested mechanisms include the autoimmune&#44; via the existence of autoantibodies that act against modulator proteins which would disrupt immune function<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; Another mechanism that may be involved is the hypercoagulability state associated with SARS-CoV-2 infection &#40;thromboinflammatory state&#41;&#44; responsible for the disproportionately high &#40;20-30&#37;&#41; rates of thrombotic complications observed in patients with COVID-19<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In addition&#44; a hypothesis has been proposed in which SARS-CoV-2 infection may affect the autonomic nervous system&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> resulting in autonomic dysfunction mediated by the virus itself&#46; This dysautonomia manifests as various syndromes of orthostatic intolerance including orthostatic hypotension&#44; vasovagal syncope&#44; and postural orthostatic tachycardia syndrome &#40;POTS&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Another etiopathogenetic hypothesis may be the persistence of the virus in the body due to a weak or absent antibody response<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#44; relapses or reinfections&#44; and other factors related to COVID-19 such as&#58; immobilisation&#44; nutrition disorders&#44; mental disorders such as post-traumatic stress&#44; or alterations in the intestinal microbiota<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Epidemiology and risk factors</span><p id="par0090" class="elsevierStylePara elsevierViewall">Persistent symptoms following SARS-CoV-2 infection occur in both patients who required hospitalisation due to severe COVID-19 presentation and those who presented with mild paucisymptomatic disease&#44; and even in subjects with asymptomatic infection<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Published studies have produced varying results on the prevalence of LC &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In the United Kingdom&#44; around 10&#37; of patients with documented SARS-CoV-2 infection remained symptomatic after 3&#8239;weeks&#44; and a smaller proportion during months following acute infection<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">An observational cohort study conducted in Michigan &#40;United States&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> which used a telephone survey to evaluate 488 patients discharged from hospital due to COVID-19 found that 32&#46;6&#37; of the patients reported persistent symptoms at 3 months&#44; with 18&#46;9&#37; of the subjects with new or worsening symptoms&#59; dyspnoea &#40;23&#37;&#41; was the most prevalent symptom&#46; A total of 38&#46;5&#37; of the patients were not able to return to their activities of daily living and 48&#46;8&#37; reported being emotionally affected by their health&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Other studies have reported even higher rates of prevalence&#46; In Italy<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#44; 87&#46;4&#37; of 143 patients discharged from hospital due to COVID-19 presented persistent symptoms at mean follow-up of 2 months after the onset of symptoms&#44; with the most common symptoms being fatigue &#40;53&#46;1&#37;&#41;&#44; dyspnoea &#40;43&#46;4&#37;&#41;&#44; joint pain &#40;27&#46;3&#37;&#41;&#44; and chest pain &#40;21&#46;7&#37;&#41;&#46; In a study conducted in France<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#44; 66&#37; of patients still had symptoms at 60 days of follow-up&#46; In a prospective cohort study conducted in Wuhan &#40;China&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> which evaluated 1&#44;733 subjects 6 months after onset of COVID-19 symptoms&#44; the majority of the patients &#40;76&#37;&#41; reported at least one symptom&#44; the most common being fatigue&#47;muscle weakness &#40;63&#37;&#41;&#44; sleep difficulties &#40;26&#37;&#41;&#44; and anxiety&#47;depression &#40;23&#37;&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">There are 2 studies in Spain that stand out<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a>&#46; One retrospective multicentre cohort study conducted at 4 centres in Andalusia<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> analysed symptom prevalence in 962 patients who required hospitalisation during the acute phase&#58; up to 63&#46;9&#37; presented symptoms after 6 months of follow-up&#44; predominantly respiratory symptoms &#40;42&#37;&#41;&#44; followed by systemic &#40;36&#46;1&#37;&#41;&#44; neurological &#40;20&#46;8&#37;&#41;&#44; and psychological &#40;12&#46;2&#37;&#41;&#46; Another national study conducted in the Primary Care service<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> via an online survey with 2&#44;120 individual participants with a history of COVID-19 concluded that 5&#37; of patients presented at least one symptom after an average of 185 days post-acute infection&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">One of the main lines of investigation is the development of tools to be able to predict the likelihood of developing LC&#46; The risk factors related to LC have not been described in the majority of previous studies&#46; It has been suggested that experiencing more than 5 symptoms in the first 7 days increases the risk of developing persistent symptoms<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Though the presence of anosmia&#44; particularly in adults over the age of 70&#44; has been related to a better prognosis in patients hospitalised due to COVID-19<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#44; it is considered to be the most predictive symptom for LC<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A German study<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#44; which included 958 non-hospitalised patients&#44; found a significant association between the presence of long-term symptoms and a lower baseline level of IgG subclass antibodies&#44; and the presence of anosmia and diarrhoea during acute COVID-19&#46; Persistent symptoms have also been related to female sex&#44; a larger number of symptoms at the start of the clinical picture&#44; and admission to Intensive Care<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In summary&#44; and in the absence of more rigorous studies&#44; it is estimated that around 10&#8211;20&#37; of subjects infected with SARS-CoV-2 will develop LC&#44; although this prevalence varies due to the differences in methodology used and the populations analysed&#44; particularly between studies including hospitalised patients and outpatient patients&#46; What&#8217;s more&#44; in many cases no differentiation is made between true persistence of symptoms and sequelae of severe acute disease<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Symptomatology</span><p id="par0130" class="elsevierStylePara elsevierViewall">The clinical presentation of patients with long COVID is highly heterogeneous&#46; Over 200 associated symptoms affecting different organs and systems have been described<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The most common long-term symptoms are fatigue &#40;52&#37;&#41;&#44; cardiorespiratory symptoms &#40;30&#8211;42&#37;&#41;&#44; and neurological symptoms &#40;40&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#44; including symptoms of dysautonomia<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Symptoms and respiratory sequelae</span><p id="par0135" class="elsevierStylePara elsevierViewall">The lung is the organ that is most affected by SARS-CoV-2 infection&#46; Therefore&#44; persistent respiratory symptoms and exercise limitations are common following severe COVID-19&#46; The most common persistent respiratory symptom is dyspnoea&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> followed by cough and chest pain<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;40</span></a>&#46; The proportion of symptoms that are due to pulmonary sequelae is not well defined&#46; Venous thromboembolism &#40;VTE&#41; and pulmonary fibrosis are the most significant pulmonary sequelae and&#44; unlike other post-acute sequelae&#44; present a clear association with the severity of the infection during its initial phase&#44; and are more common in patients requiring admission to intensive care units and those in need of chronic home oxygen therapy&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The reported prevalence of VTE varies across the different studies &#40;18&#8211;42&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#46; It has been hypothesised that pulmonary artery occlusions could be caused by local pulmonary thrombi within the context of the inflammatory response &#40;thromboinflammation&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#46; However&#44; the long-term risks of chronic pulmonary embolism and consequent pulmonary hypertension are unknown&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Some studies in hospitalised patients report the onset of pulmonary fibrosis in up to 40&#37; during subsequent follow-up<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;44</span></a>&#46; The onset of pulmonary fibrosis is related to the duration and severity of the disease&#44; as well as advanced age<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;44</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">While descriptions of findings via high-resolution computed tomography &#40;HRCT&#41; remain scarce&#44; after the acute phase 3 types of radiological patterns have been observed<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a>&#58; the first in which there is a predominance of ground-glass and organisational areas&#59; a second pattern in which fibrosing changes in the septal thickening are observed&#44; and a third pattern in which a combination of the 2 previous patterns occurs&#46; The first pattern responds to low-dose corticosteroids over an extended period&#44; while the response of the second is little to none&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Neurocognitive symptoms</span><p id="par0155" class="elsevierStylePara elsevierViewall">It was initially thought that SARS-CoV-2 did not cross the BBB&#44; but post-mortem studies have shown that the virus broadly attacks the central nervous system&#46; The entry route for SARS-CoV-2 is the transmembrane enzyme protein ACE2&#44; to which it binds with excellent affinity via the S spike protein&#46; The ACE2 receptor expresses widely in the endothelial cells of the brain<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a>&#44; and this S protein can directly damage the integrity of the BBB&#44; and also induce a strong immune response generated by the cytokine release&#46; In addition&#44; it also seems that the virus affects the peripheral nervous system via the interaction with ACE2 receptors&#44; which could result in neuromuscular complications<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">During ongoing infection&#44; around 36&#37; of cases develop neurological symptoms<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a>&#44; of which headache is the most frequent&#44; both in the acute phase and in LC&#46; These headaches are similar to migraines&#44;48 and often refractory to typical analgesics&#44; which is attributed to elevated levels of circulating cytokines&#46; Cognitive impairment has also been observed&#44; sometimes in a fluctuating manner&#44; with symptoms such as &#8216;brain fog&#8217; that can manifest as difficulty concentrating&#44; memory loss&#44; receptive language or impaired executive functions<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a>&#46; Anosmia and ageusia are also common and lingering&#44; as are sleep disorders&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Cardiac symptoms and autonomic nervous system symptoms</span><p id="par0165" class="elsevierStylePara elsevierViewall">Persistent chest pain has been reported in 20&#8211;30&#37; of patients&#44; though coronary artery disease must always be ruled out&#44; particularly in patients with cardiovascular risk factors&#46; In the event of persistent symptoms&#44; the presence of myocarditis must be suspected&#44; which has been reported via magnetic resonance imaging &#40;MRI&#41; in up to 60&#37; of patients after 2&#8239;months of acute symptoms<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The existence of pericardial effusion&#44; generally low in numbers&#44; can be observed via MRI in 20&#37; of the subjects during the acute phase&#44; however symptomatic pericarditis is less frequent<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a>&#46; Palpitations are also common&#44; though if recurrent these suggest a dysautonomia clinical picture such as inappropriate sinus tachycardia&#44; or POTS if associated with symptoms of orthostatic hypotension&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Digestive symptoms</span><p id="par0175" class="elsevierStylePara elsevierViewall">While some follow-up studies on patients hospitalised due to COVID-19 have not reported gastrointestinal or significant hepatobiliary sequelae<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a>&#44; other authors have pointed out that digestive manifestations are present in over half of those affected by LC&#44; including symptoms such as diarrhoea&#44; meteorism&#44; dyspepsia&#44; abdominal pain&#44; nausea&#44; and vomiting&#46; Some studies have reported the existence of changes to intestinal microbiota following acute infection&#44; which remains in patients with LC<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; In addition&#44; it has been observed that the ileum is a preferred target of SARS-CoV-2&#44; where it is able to remain for months<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a>&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Endocrine disorders</span><p id="par0180" class="elsevierStylePara elsevierViewall">The acute phase of SARS-CoV-2 infection has been associated with stress hyperglycaemia in patients without known diabetes mellitus&#44; as well as worse glycaemic control in those with prior diabetes<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>&#46; Hyperglycaemia and the onset of diabetes mellitus also appear during follow-up of patients with LC<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a>&#46; Similarly&#44; thyroid alterations have also been reported&#44; such as Hashimoto&#8217;s disease<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a>&#44; Graves&#8217; disease<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a>&#44; or subacute thyroiditis<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dermatological symptoms</span><p id="par0185" class="elsevierStylePara elsevierViewall">The most commonly reported sequela is hair loss which&#44; according to a Chinese post-COVID-19 study&#44; affected 20&#37; of patients at 6 months follow-up<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;58</span></a>&#46; This hair loss may be attributed to telogen effluvium resulting from a viral infection or a stress response<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Psychological symptoms</span><p id="par0190" class="elsevierStylePara elsevierViewall">Individuals with COVID-19 may experience a series of psychiatric symptoms that persist or present after the initial infection<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a>&#46; The most frequently reported symptoms are anxiety and depression &#40;30&#8211;40&#37;&#41;&#44; followed by post-traumatic stress disorder&#44; insomnia&#44; and obsessive-compulsive symptomatology&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Follow-up and clinical-therapeutic approach</span><p id="par0195" class="elsevierStylePara elsevierViewall">As we have seen&#44; the symptoms of LC are just as heterogeneous as those observed in the acute phase of the disease and can manifest in an ongoing&#44; fluctuating&#44; or changing manner&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In the absence of a solid and standardised foundation for patients with long COVID&#44; various clinical guidelines have been published with recommendations on long-term follow-up for said patients&#44; both internationally<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and nationally<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;60&#44;61</span></a>&#44; and post-COVID-19 specialized consultation units have been set up in many hospitals&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">These recommendations coincide in that&#44; due to the complexity of this viral infection and the potential involvement of multiple systems and organs&#44; a multidisciplinary assessment involving different medical specialists is needed to allow doctors to optimally monitor patient progress and offer the best possible care and management&#46; Said recommendations suggest the need for an initial evaluation that includes a comprehensive physical examination&#44; lab testing&#44; and imaging tests&#46; In addition&#44; studying patient comorbidities and social and functional staus is also essential&#46; All of this will enable doctors to perform a comprehensive assessment of the patient&#8217;s baseline condition<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The proposed follow-up strategies recommend performing a basic analysis that includes a complete blood count&#44; erythrocyte sedimentation rate&#44; blood sugar&#44; lipid profile&#44; renal&#44; ions&#44; hepatic panel&#44; albumin&#44; lactate dehydrogenase&#44; C-reactive protein&#44; thyroid function tests&#44; iron metabolism&#44; vitamin B<span class="elsevierStyleInf">12</span>&#44; folic acid&#44; vitamin D&#44; calcium&#44; phosphorus&#44; and coagulation tests as well as&#44; in certain circumstances&#44; and depending on the medical history and examination&#44; other specific analytical assessments according to patient symptoms&#46; In certain circumstances &#40;persistent lymphopenia or altered lymphocyte count&#41;&#44; it may be convenient to perform a basic cellular immunity study&#44; including lymphocyte subpopulations &#40;B cells&#44; T cells&#44; TCD4&#43;&#44; TCD8&#43;&#41;&#44; immunoglobulins&#44; and a supplementary study to enable us to rule out other alternative illnesses<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The need to perform imaging studies in the follow-up of patients with COVID-19 remains a topic of controversy&#46; The British Thoracic Society guidelines recommend performing a chest X-ray at 12 weeks in those patients who have experienced significant respiratory illness during the acute phase and&#44; if alterations are observed&#44; performing a chest CT with high-resolution reconstructions and contrast&#44; according to the pulmonary thromboembolism protocol<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">62&#44;63</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Other authors recommend performing a baseline pre-contrast high-resolution chest CT at 6 and 12 months and&#44; if fibrotic alterations persist&#44; to repeat this at 24 and 36 months<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a>&#46; One reasonable instruction would be to perform a chest CT in patients with persistent respiratory symptoms and alterations in their pulmonary function tests &#40;PFT&#41;&#44; or if anomalies persist in chest X-rays 3 months post-discharge or resolution of clinical pneumonia&#44; this being a time when acute lesions should have resolved and would now be considered chronic<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Other supplementary tests that could be conducted depending on symptomatology include electrocardiogram&#44; transthoracic echocardiogram&#44; PFT&#44; stress test&#44; Holter monitor&#44; ambulatory blood pressure monitoring or self-measured blood pressure monitoring&#44; tilt table test for patients with dysautonomia symptomatology&#44; and any other test considered necessary after conducting a thorough medical history and physical examination<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">The guidelines recommend an initial consultation with patients who present persistent symptoms 4 weeks after acute COVID-19&#46; This assessment may be in-person or over the phone depending on the warning signs&#44; need to perform a physical examination&#44; the patient&#8217;s medical history&#44; the severity and impact of the symptoms on their quality of life&#44; or difficulties communicating&#46; Follow-up strategies adhere to stricter protocols in hospitalised patients&#44; with the recommendation being an initial telephone assessment at 4 weeks post-hospital discharge&#44; followed by an in-person appointment at 12 weeks&#46; If at that time the patient is asymptomatic&#44; they will be given the all-clear&#59; otherwise&#44; they will be scheduled for follow-up<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a>&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The use of questionnaires or health measurement scales has been proposed as potentially useful in these patients since they allow doctors to make a comparison with their prior health status&#46; It also enables follow-up of symptom evolution and helps determine the prognosis of the disease and standardise criteria among health professionals<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a>&#46; Diverse scales are currently used to evaluate the most frequent symptoms &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; however there is a need to develop a specific measurement scale that globally reflects how these patients are affected<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">In general&#44; there is a trend towards spontaneous improvement of persistent post-COVID-19 symptoms&#44; however it is difficult to determine the percent of patients who improve&#44; and the time needed to achieve improvement&#44; based on the heterogeneity of the studies published to date&#46; Some prospective studies indicate that COVID-19 vaccination in patients with LC may significantly improve persistent symptoms&#44; however more data are needed to confirm this theory<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Though various national and international clinical trials are currently under way&#44; no specific treatment for LC is currently available&#46; While we wait for results that can guide us towards more effective and specific therapies&#44; in the majority of cases symptomatic treatment is used&#44; both pharmacological &#40;analgesics&#44; anti-inflammatory agents&#44; bronchodilators&#44; cough suppressants&#44; antiemetic agents&#44; antidepressants&#44; anxiolytics&#44; etc&#46;&#41; and non-pharmacological &#40;food supplements&#44; vitamin B<span class="elsevierStyleInf">12</span>&#44; vitamin D&#44; omega 3&#41;&#46; Psychological and emotional support is also essential for these patients&#44; and the need for multidisciplinary rehabilitation services must be considered &#40;occupational therapy&#44; physical therapy&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0250" class="elsevierStylePara elsevierViewall">Persistent symptomatology and adverse events are frequent following SARS-CoV-2 infection&#44; particularly&#44; though not exclusively&#44; after hospitalisation for severe COVID-19&#46; Given the increase in cases and their potential impact on health care systems&#44; there is a need to develop specific health plans and clinical follow-up programs with a multidisciplinary nature&#46; This will help guarantee adequate care for this group&#44; as achieving the quality care that these patients deserve may seem a challenge due to the excess demand on the national healthcare system at the current moment&#46; Likewise&#44; to improve clinical practice in this field&#44; it is crucial to promote research strategies that make it possible to improve our knowledge of the pathophysiological aspects of the syndrome&#44; harmonise diagnostic criteria&#44; and develop effective therapies&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data availability</span><p id="par0255" class="elsevierStylePara elsevierViewall">Data will be made available on request&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0260" class="elsevierStylePara elsevierViewall">This paper received support from the <span class="elsevierStyleGrantSponsor" id="gs0005">Center for Biomedical Research Network</span> &#40;CIBERObn&#44; <span class="elsevierStyleGrantNumber" refid="gs0005">CB06&#47;03&#47;0018</span>&#41; from ISCIII-Madrid &#40;Spain&#41;&#44; co-financed by the <span class="elsevierStyleGrantSponsor" id="gs0010">European Regional Development Fund</span> &#40;ERDF&#41;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0265" class="elsevierStylePara elsevierViewall">Mar&#237;a Rosa Bernal-L&#243;pez receives support from the &#8220;Nicol&#225;s Monardes&#8221; program &#40;C1-0005-2020&#41;&#44; from the Government of Andalusia&#44; and from the &#8220;Miguel Servet Tipo II&#8221; program &#40;CPII&#47;00014&#41;&#44; from ISCIII-Madrid &#40;Spain&#41;&#44; and Almudena L&#243;pez-Sampalo&#44; from &#8220;R&#237;o Hortega&#8221; &#40;CM21&#47;00110&#41;&#46; The two latter programs are co-financed by the European Regional Development Fund &#40;ERDF&#41;&#46;</p></span></span>"
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          "titulo" => "Definition of long COVID-19 syndrome"
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    "fechaAceptado" => "2021-10-12"
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          "clase" => "keyword"
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            0 => "Persistent COVID-19"
            1 => "Post-acute COVID"
            2 => "Long COVID"
            3 => "COVID-19 sequels"
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          "clase" => "keyword"
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            0 => "COVID-19 persistente"
            1 => "COVID-19 posagudo"
            2 => "COVID de larga duraci&#243;n"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">As the coronavirus-2019 disease &#40;COVID-19&#41; pandemic&#44; caused by the infection with severe acute respiratory syndrome &#40;SARS-CoV-2&#41; coronavirus type 2&#44; has progressed&#44; persistent COVID-19 syndrome is an increasingly recognized problem on which a significant volume of medical literature is developing&#46; Symptoms may be persistent or appear&#44; after an asymptomatic period&#44; weeks or months after the initial infection&#46; The clinical picture is as markedly heterogeneous and multisystemic as in the acute phase&#44; so multidisciplinary management is required&#46; In addition&#44; their appearance is not related to the severity of the initial infection&#44; so they can affect both mild patients&#44; even asymptomatic&#44; and seriously ill patients who have required hospitalization&#46; Although it can affect people of any age&#44; it is more common in middle-aged women&#46; The sequelae can generate a high impact on the quality of life&#44; and in the work and social environment&#46; The objective of this paper is to review persistent COVID-19 syndrome&#44; to know its clinical manifestations and the strategies for the management and follow-up of these patients&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A medida que ha avanzado la pandemia de la enfermedad por coronavirus 2019 &#40;COVID-19&#41;&#44; originada por la infecci&#243;n por el coronavirus de tipo 2&#44; causante del s&#237;ndrome respiratorio agudo severo &#40;SARS-CoV-2&#41;&#44; el s&#237;ndrome de COVID-19 persistente es un problema cada vez m&#225;s reconocido y sobre el que se est&#225; desarrollando un importante volumen de publicaciones&#46; Los s&#237;ntomas pueden ser persistentes o aparecer&#44; tras un periodo asintom&#225;tico&#44; semanas o meses despu&#233;s de la infecci&#243;n inicial&#46; El cuadro cl&#237;nico es tan marcadamente heterog&#233;neo y multisist&#233;mico como en la fase aguda&#44; por lo que se requiere un manejo multidisciplinar&#46; Adem&#225;s&#44; su aparici&#243;n no est&#225; relacionada con la gravedad de la infecci&#243;n inicial&#44; por lo que pueden afectar tanto a pacientes leves&#44; incluso asintom&#225;ticos&#44; como a enfermos graves que han requerido hospitalizaci&#243;n&#46; Aunque puede afectar a personas de cualquier edad&#44; es m&#225;s frecuente en mujeres de edad media&#46; Las secuelas pueden generar un elevado impacto en la calidad de vida&#44; y en el &#225;mbito laboral y social&#46; El objetivo de este trabajo es hacer una revisi&#243;n sobre el s&#237;ndrome de COVID-19 persistente&#44; conocer sus manifestaciones cl&#237;nicas y las estrategias para el manejo y seguimiento de estos pacientes&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#243;pez-Sampalo A&#44; Bernal-L&#243;pez MR&#44; G&#243;mez-Huelgas R&#46; S&#237;ndrome de COVID-19 persistente&#46; Una revisi&#243;n narrativa&#46; Rev Cl&#237;n Esp&#46; 2022&#59;222&#58;241&#8211;250&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">F&#58; female&#59; H&#58; hospitalisation&#59; M&#58; male&#59; NH&#58; no hospitalisation&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Acute phase &#40;H&#47;NH&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Persistence of symptoms &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chopra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">488&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 51&#46;8&#37;F&#58; 47&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Dyspnoea 23&#37;&#59; cough 15&#46;3&#37;&#59; anosmia&#47;ageusia 13&#46;1&#37;&#59; chest pain 9&#46;0&#37;&#59; inability to return to daily activities 32&#46;4&#37;&#59; emotional impairment 38&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carfi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Italy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Longitudinal prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 63&#37;F&#58; 37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fatigue 53&#46;1&#37;&#59; dyspnoea 43&#46;4&#37;&#59; joint pain 27&#46;3&#37;&#59; chest pain 21&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carvalho-Schneider et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">France&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Longitudinal prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 46&#37;F&#58; 54&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asthenia 40&#37;&#59; dyspnoea 30&#37;&#59; anosmia&#47;ageusia 23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambispective cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;733&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 52&#37;F&#58; 48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fatigue&#47;muscle weakness 63&#37;&#59; insomnia 26&#37;&#59; anxiety&#47;depression 23&#37;&#59; alopecia 22&#37;&#59; anosmia 11&#37;&#59; palpitations 9&#37;&#59; arthralgia 9&#37;&#59; loss of appetite 8&#37;&#59; dysgeusia 7&#37;&#59; dizziness 6&#37;&#59; diarrhoea 5&#37;&#59; chest pain 5&#37;&#44; and headache 2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Romero-Duarte et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational longitudinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">962&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 46&#46;3&#37;F&#58; 53&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyspnoea 28&#37;&#59; fatigue 22&#46;1&#37;&#59; anosmia 20&#46;8&#37;&#59; musculoskeletal pain 15&#46;3&#37;&#59; diarrhoea 10&#46;3&#37;&#59; dysgeusia 7&#46;2&#37;&#59; fever 7&#37;&#59; anxiety 6&#46;8&#37;&#59; chest pain 6&#37;&#59; abdominal pain 5&#46;3&#37;&#59; headache 5&#46;3&#37;&#59; insomnia 4&#46;9&#37;&#59; anxiety 4&#46;4&#37;&#59; paraesthesia 3&#46;4&#37;&#59; movement disorder 3&#46;4&#37;&#44; y disorientation&#47;confusion 2&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodriguez-Ledo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain &#40;online survey&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 21&#37;F&#58; 79&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HNH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">187 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asthenia 83&#46;6&#37;&#59; general discomfort 79&#46;3&#37;&#59; headache 63&#37;&#59; myalgia 60&#46;7&#37;&#59; low mood 56&#46;6&#37;&#59; arthralgia 56&#46;4&#37;&#59; dyspnoea 56&#46;2&#37;&#44; and chest pain 54&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Augustin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Germany&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Longitudinal prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">958&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 46&#46;4&#37;F&#58; 53&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">H&#58; 2&#46;9&#37;NH&#58; 97&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anosmia 12&#46;4&#37;&#59; dysgeusia 11&#46;1&#37;&#59; fatigue 9&#46;7&#37;&#44; and dyspnoea 8&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peghin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Italy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambispective cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">559&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 46&#46;6&#37;F&#58; 53&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HNH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fever 73&#46;7&#37;&#59; anosmia&#47;dysgeusia 60&#46;3&#37;&#59; cough 47&#46;9&#37;&#44; and fatigue 43&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Go&#235;rtz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HollandBelgium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">H&#58; 5&#46;3&#37;NH&#58; 94&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fatigue 87&#37;&#59; dyspnoea 71&#37;&#59; chest pain 44&#37;&#59; headache 38&#37;&#59; muscle pain 36&#37;&#59; palpitations 32&#37;&#44; and cough 29&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Principal studies of follow-up in patients with post-COVID-19 symptoms&#46;</p>"
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                  \t\t\t\t">Quality of life&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SF-36 survey&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dyspnoea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Pain&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Modified Fatigue Impact Scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Global Physical Activity Questionnaire&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Emotional disorders&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hospital Anxiety and Depression Scale&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sleep disorders&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Pittsburgh Sleep Quality Index&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Modification to the Memory Failures of Everyday Questionnaire&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Covid-19&#58; what do we know about &#8220;long covid&#8221;&#63;"
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                        0 => array:2 [
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                            3 => "C&#46; Lumbreras-Bermejo"
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                            1 => "S&#46; Crewther"
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                    0 => array:2 [
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                            0 => "F&#46; Callard"
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                      "titulo" => "Gu&#237;a cl&#237;nica para el paciente Long COVID&#47;COVID"
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