As an intensive care physician, I focus primarily on acute COVID pneumonia. My world involves monoclonal antibodies, antivirals, steroids, CT scans, oxygen delivery modalities, intubation, ventilator modes, sedatives and paralytics, life support, and end-of-life conversations. But this is a small sliver of the health impact of COVID-19. I am humbled by how little I know about the myriad manifestations of the disease, and I wanted to write and acknowledge the chronic forms.

In particular, we are seeing patients who had COVID weeks to months ago who now present with life-threatening scarring of the lungs, the so-called fibrotic stage of COVID-19. These patients recovered from their initial acute illness, but they come in with recurrent shortness of breath. Imaging and pathology remind us of pulmonary fibrosis, a rare and devastating condition with few treatments. These patients don't have any active virus and they don't test positive for COVID. Their body has fought off the disease, but at the expense of residual collateral tissue destruction and organ injury. I have seen several patients die from this, including some who were young. To me, this fibrotic stage is very scary and we know very little about it. I am grateful for those scientists and physicians beginning to study it.

Similarly, we don't know enough about "long-haul" COVID, the systemic, functional, and mental debility that some people endure for months after their acute illness. I don't tend to see these patients in my practice, but I believe the impact on their lives to be enormous. Given the number of infections our country has faced in the last few months, I think these chronic COVID symptoms will become another epidemic, the kind our health care system fares poorly at addressing. I really don't know much about it, but I worry "long-haul" COVID will be lumped into a category of diseases physicians find frustrating, baffling, and easy to discount, like fibromyalgia or chronic Lyme disease. I am glad for those patients who have spoken up to describe the brain fog, fatigue, and weakness they experience months after they've recovered from the initial COVID infection. It reminds us how much we don't know and how much we have to learn. We need to bolster our providers, resources, and expertise to address this new chronic condition.