text: A clinical primer for the expected and potential post COVID 19 syndromes In late 2019 a novel coronavirus SARS CoV 2 COVID 19 spread unchecked across the worlds population With tens of millions infected the long term consequences of COVID 19 infection will be a major health care focus for years after the contagion subsides Most complications stem from direct viral invasion provoking an over exuberant inflammatory response driven by innate immune cells and activation of the clotting cascade causing thrombosis Injury to individual organs and their protective linings are frequent presentations in respiratory cardiovascular and neurological systems Reviewing the historical context of postviral fatiguing symptoms seems relevant to understanding reports of uneven recoveries and persistent symptoms that are emerging as long haul COVID 19 The pandemic is also an unprecedented sociocultural event transforming how people consider their health gather in groups and navigate their daily lives The unprecedented sociocultural stresses of the pandemic will have an invisible ubiquitous and predictable impact on neurologic endocrine and immune functioning even in people untouched by the virus COVID 19 may also have a surprise or two in store with unique clinical presentations and novel mechanisms of injury which are yet to clearly emerge Although challenging and unfortunate these times also represent a unique opportunity to start to unravel the physiology that underlie how viruses may trigger cancers neurological disease and postviral fatiguing syndromes 