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Virus-induced HMRD in tandem with hypoxia and m- Dys affects several cellular metabolic pathways in COVID-19 survivors (after viral clearance), which could ultimately evoke severe PASC with metabolic impairments including new onset T2DM, cardiovascular disease, chronic fatigue syndrome, brain fog, and blood clotting issues 21,143

doi: 10.3390/nu13124433 72

Older adults may have difficulty getting sufficient B12 from food or oral supplements, and injections can help maintain adequate levels

However, decaffeinated coffee and tea are acceptable drink options

James Lim Soon Chuan, Chief Scientific Officer, Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology, KK Women's and Children's Hospital, Singapore for their involvement in the diagnosis and treatment of this patient