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BackgroundThere are limited data describing the long-term outcomes of severe COVID-19. We aimed to evaluate the long-term psychosocial and physical consequences of severe COVID-19 for patients.MethodsWe conducted a multicentre observational cohort study; between 3 and 7 months posthospital discharge, patients who had been admitted to critical care due to severe COVID-19 were invited to an established recovery service. Standardised questionnaires concerning emotional, physical and social recovery, including information on employment, were completed by patients. Using propensity score matching, we explored outcomes between patients admitted to critical care with and without COVID-19, using data from the same recovery programme.ResultsBetween July 2020 and December 2020, 93 patients who had been admitted to critical with COVID-19 participated. Emotional dysfunction was common: 46.2% of patients had symptoms of anxiety and 34.4% symptoms of depression. At follow-up 53.7% of previously employed patients had returned to employment; there was a significant difference in return to employment across the socio-economic gradient, with lower numbers of patients from the most deprived areas returning to employment (p=0.03). 91 (97.8%) COVID-19 patients were matched with 91 non-COVID-19 patients. There were no significant differences in any measured outcomes between the two cohorts.InterpretationEmotional and social problems are common in survivors of severe COVID-19 infection. Coordinated rehabilitation is required to ensure patients make an optimal recovery.

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The diastereoselectivity of the ortho ester Claisen rearrangement of chiral propargylic alcohols has been investigated for alcohols 6-12 (eq 3). The results of this study, summarized in Table II, show that aryl-substituted propargyl alcohols 11 and 12 react stereorandomly. However, alkyl-substituted propargyl alcohols 6-10 show a preference for formation of the 2S*,4S* diastereomer, with stereoselectivity increasing with increasing steric bulk of R. In the most favorable case (compound 10), a 95:5 mixture of diastereomeric products is produced. The diastereoselectivity of the process was established by the use of scalemic alcohols (fi)-(+)-8, (S)-(-)-10, and CR)-(+)-10, which were obtained by resolution of the racemates (Schemes II and III). As shown in Scheme IV, (R)-(+)-8 and (S)-(-)-10 were each converted into the known acid (S)-(+)-28. Given the known relationship between the stereogenicity of a chiral propargylic alcohol and the chiral aliene resulting from Claisen rearrangement, it may be deduced that (S)-8 and (fi)-10 react via the derived E ketene acetals to give, preferentially, the 2S,4S /3-allenic esters. For the alkyl series, the results are explained by a mechanism (Scheme I) wherein the E and Z ketene acetals are in rapid equilibrium, with the E isomer reacting significantly more rapidly than the Z isomer. The observed effect of size of R on the stereoselectivity of the reaction is explained in terms of 1,3-interactions in the two alternative reacting conformations of the ketene acetal (Scheme I, E vs E'). For propargyl alcohols 11 and 12, it is postulated that Claisen rearrangement is sufficiently accelerated by the aryl substituent that ketene acetal formation becomes the rate-limiting step; the observed 1:1 product ratios in these cases are believed to be a reflection of the ratio of double-bond isomers in the initial ketene acetal. It has been demonstrated that the ester and allenic functions may be manipulated independently, so that the chiral /3-allenic esters may be used as "chiral methylmalonaldehyde" synthons.