Chris is a 79-year-old woman with a background of type 2 diabetes, hypertension, reflux, bowel cancer, osteoporosis and AF.

She has been generally well and stable on medical management for the past few years. Her latest HbA1c was 7%, and blood pressure was 140/80mmHg. 

Her medications include insulin degludec/insulin aspart (Ryzodeg) 70/30 12 units bd, metformin 500mg mane, perindopril 8mg mane, rabeprazole 20mg mane, denosumab subcutaneously six monthly, metoprolol 50mg bd, rivaroxaban 20mg daily and spironolactone 12.5mg mane. Her bowel cancer was managed with a colectomy, with no requirement for chemotherapy.

In August 2022, Chris develops COVID-19 (when triple vaccinated), manifesting with sore throat, fever, cough and fatigue. She receives nirmatrelvir and ritonavir (Paxlovid) within five days of symptom onset. Post COVID-19 fatigue and loss of taste are still present three months later. A review of biochemistry shows a considerable decline in kidney function (see box 1).