Post Intensive Care Syndrome (PICS) and its clinical features
Post intensive care syndrome (PICS) is a constellation of new or worsening impairments in physical, mental, or cognitive abilities in critical illness survivors who have received intensive care10,13. Clinical features of the elements of PICS are cognitive, mental health and physical impairment. While PICS affects mostly the survivor, it can also affect the family member of the survivor, especially their mental health13. 
According to Harvey and Davidson 13, although not among COVID-19 survivors, the symptoms of mental (e.g. anxiety) and cognitive impairment occurred in 23-48% and 30-80% of critical illness survivors with PICS in a developed country. Similarly, physical consequences, including ICU-acquired weakness, occur in 25-80% of individuals on mechanical ventilation for more than four days13. 
Cognitive impairment resulting from PICS affects the executive function, memory, attention, visuo-spatial and processing speed, and this could persist months to years after discharge from critical care14. Cognitive impairment negatively impacts independent functioning such as driving and managing complex medication resulting in reduced quality of life14. Individuals with delirium14 and pre-existing cognitive deficits could be at a higher risk of PICS-related cognitive impairments15.
Examples of mental health impairment include anxiety, acute stress disorders, post-traumatic stress disorder, and depression. These symptoms co-occur in critical illness survivors16. Unfortunately, the nature of COVI-19 disease which entails that patients are isolated limits the presence of family members and could further worsen mental health outcomes. The impact of poor mental health and persistent delusional memories could be functionally debilitating8.
Physical impairment affects pulmonary, neuromuscular and physical functioning. Ohtake et al9 in a systematic review of 15 studies, used the International Classification of Functioning, Disability and Health (ICF) framework to identify the impairment of body functions and structures, activity limitations, and participation restrictions associated with PICS. See table 1