Approximately 19% of the population is suffering from "Long COVID", also known as post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC), which often results in exercise intolerance. As COVID infections continue to be common, studying the long-term consequences of coronavirus disease (COVID) on physical function has become increasingly important. This narrative review will aim to summarize the current literature surrounding exercise intolerance following COVID infection in terms of mechanism, current management approaches, and comparison with similar conditions and will aim to define limitations in the current literature.Multiple organ systems have been implicated in the onset of long-lasting exercise intolerance post-COVID, including cardiac impairment, endothelial dysfunction, decreased VO 2 max and oxygen extraction, deconditioning due to bed rest, and fatigue. Treatment modalities for severe COVID have also been shown to cause myopathy and/or worsen deconditioning. Besides COVID-specific pathophysiology, general febrile illness as commonly experienced during infection will cause hypermetabolic muscle catabolism, impaired cooling, and dehydration, which acutely cause exercise intolerance. The mechanisms of exercise intolerance seen with PASC also appear similar to post-infectious fatigue syndrome and infectious mononucleosis. However, the severity and duration of the exercise intolerance seen with PASC is greater than that of any of the isolated mechanisms described above and thus is likely a combination of the proposed mechanisms. Physicians should consider post-infectious fatigue syndrome (PIFS), especially if fatigue persists after six months following COVID recovery. It is important for physicians, patients, and social systems to anticipate exercise intolerance lasting for weeks to months in patients with long COVID. These findings underscore the importance of long-term management of patients with COVID and the need for ongoing research to identify effective treatments for exercise intolerance in this population. By recognizing and addressing exercise intolerance in patients with long COVID, clinicians can provide proper supportive interventions, such as exercise programs, physical therapy, and mental health counseling, to improve patient outcomes.

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Background We aim to investigate the costs associated with growth in the administrators, health care staff, and physicians to provide direction to establish a sustainable and cost-effective U.S. health care system. Methods Data from the U.S. Bureau of Labor Statistics, particularly the Labor Force Statistics from the Current Population Survey, were utilized from 2009 to 2020. Wages and employment of medical and health service managers (administrators), health care practitioners and technical operations (health care staff), and physicians were used to calculate the total cost. Results Administrator wages have grown similarly to health care staff wages (−4.40 vs −3.01%, P = .454) and physician wages (−4.40 vs −3.29%, P = .672). Additionally, there has been a similar increase in health care staff employment (9.91 vs 14.23%, P = .269) and physician employment (9.91 vs 15.35%, P = .252) compared to administrator employment. Overall, the total growth in administrator cost is similar to the growth in total health care staff cost (6.23 vs 11.80, P = .104) and total physician cost (6.23 vs 13.02%, P = .079). In 2020, physicians had the highest employment growth but the smallest wage increase. Conclusion Although health care staff experienced a greater percent growth in employment and cost per employee than administrators since 2009, the cost per administrator remains greater than that of health care staff. Understanding differences in wages and costs is essential to reduce health care spending without compromising access, delivery, and quality of health care services.

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