a risk profile similar to that of well-established physical risk factors, such as obesity and smoking (Holt-Lunstad, Smith & Layton, 2010) .
The physical consequences for those who are infected could be significant. This is especially true of patients who require treatment within the Intensive Care Unit (ICU), which is estimated to be approximately 10% of all patients who are actively infected (Remuzzi & Remuzzi, 2020) . Long term physical problems following critical care are common and include poor balance, muscle weakness, chronic pain and fatigue . These problems may be particularly exacerbated in patients with COVID-19, as the treatment pathway often includes increased sedation usage and muscle relaxants, resulting in limited active mobilisation: two activities (or lack thereof) which have direct implications for long term physical and cognitive outcomes in critically ill patients (Pun et al 2019) .
The long-term social consequences of COVID-19 could also be catastrophic and have major implications for health. This pandemic is likely to bring financial recessions in many countries, with mass unemployment already reported in areas such as the US (OECD 2020). Decades of evidence have shown the socioeconomic gradient which poor health takes; as such we may see widening health inequalities during this pandemic. The implementation of social distancing is also a mechanism by which socio-economic health inequalities could increase across all generations.
Many people on low pay or those who are self-employed, may struggle to cope without income for many months; this may result in people risking their health to ensure that they have an adequate income. School closures are likely to have a disproportionate negative impact on attainment and wellbeing for children living in socioeconomically deprived areas. Finally, there also appears to be an uneven demographic spread of the virus. For example, ICU admission data from the UK demonstrates that there is a disproportionate number of patients from Black, Asian, Minority and Ethnic groups admitted as a result of COVID-19 (Intensive Care National Audit and Research Centre, 2020). This combination of social problems is likely to cause long lasting health consequences, which could lead to problems for a generation if they are not adequately and sensitively managed.
The short -term impact of having a family member admitted to hospital with COVID-19 or supporting a family member who is isolated, cannot be underestimated. These individuals are likely to face significant stress and anxiety. This anxiety is exacerbated with the restriction of
This article is protected by copyright. All rights reserved hospital visitation which has been implemented internationally; families can no longer be present to understand the illness and its trajectory, and even at the end of life, family members may not have the opportunity to be present. We know that these families will experience high rates of posttraumatic stress disorders and complicated grief (Kentish-Barnes et al 2015).
The long-term consequences for family members of survivors will be challenging. Within the critical care literature, it is well documented that family members have to make significant adjustments to working life, with up to 20% having to stop working altogether, due to high caregiving responsibilities following ICU admission (Griffiths et al 2013) . The role families play in supplementing formal health and social care provision has a significant impact on the aforementioned psychological burdens but also on fatigue, financial burden and impact on working and family life (McPeake et al 2016).
We have proposed a framework describing potential strategies for supporting patients and families throughout the recovery arc (Table 1) . Although not exhaustive, it provides central pillars of care for patients recovering from long term hospitalisation and critical care following COVID-19.
The implications for nursing care are several-fold. Firstly, nursing staff are leaders in delivering fundamental care, which can have long lasting implications. For example, ensuring patients do not develop pressure areas due to limited mobility and indeed encouraging mobility when safe, will improve long term physical outcomes, as well as reducing healthcare utilisation. Nurses are also key in the management of chronic conditions, which may be exacerbated due to acute illness related to COVID-19. Patients who move through several transitions of care, which is common with the COVID-19 patient group, are more likely to have problems with re-establishment of chronic condition management (MacTavish et al 2019). Nurses can work across the MDT, coordinating care to ensure the patient care delivered is safe and appropriate in the context of acute illness.
This leadership role in improving long term outcome of patients and families also extends into the community setting. Nurses in the community are at the forefront of care delivery; as such they must have an understanding of the long-term physical, social and emotional problems which this patient group and their family members may have. Although nurses cannot manage, treat or 'fix' all of the issues discussed in this piece, they must understand how to sign-post patients to
This article is protected by copyright. All rights reserved meaningful resources, many of which will be pre-existing and based within the third sector, including charities and voluntary organisations. This type of integrated health and social care management has seen success within the critical care recovery setting in the UK and could potentially improve health related quality of life in this vulnerable group (McPeake et al 2017) .
Finally, the role of the Public Health Nurse will be crucial in the coming months and years. This group of nurses will be key to ensuring that younger, vulnerable children are adequately supported to reach their full potential in life.
For patients there is the possibility of post-traumatic growth, a phenomenon seen following serious illness, including post-critical illness, where reflection on the traumatic and acute illness allows personal growth in relationships, living life to the full, recognising personal strengths and gaining personal insight (Barskova & Oesterreich 2009 , Connerty & Knott 2013 , O'Gara et al 2018 . It aligns to the concept of meaning-making following significant life events and allows families and patients to regain control of their lives, which will be crucial to recovery post-COVID-19. Nurses are ideally placed to nurture and support this aspect of recovery.
The large numbers of healthcare workers infected, and the toll of caring for high volumes of patients who die from COVID-19, will also have an impact on both the short and long-term health and wellbeing on health care workers. As nurses, we have a critical role in leading the changes needed to support the well-being of the healthcare workforce, by ensuring we mitigate against burnout and moral injury, and focus on building resilience and at an organisational level (Dewey, Hingle, Goelz & Linzer 2020 , Wu, Connors & Everly 2020 .
More than ever, we need a competent and confident nursing workforce, who support patients in both the short and long term in these unprecedented times. Nurses also need to have the vision of the likely future health and wellbeing implications, driving forward services and health care response, to help rebuild the lives of individuals affected. 
This article is protected by copyright. All rights reserved -Emotional support community support -Ensuring access to adequate social and welfare support Palliative/Bereavement Support and Management 