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ATP is produced by the mitochondria via aerobic metabolism, meaning oxygen must be present

doi:10.1016/s0083-6729(00)59012-8

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[16] There is a particularly marked decline in sleep-related GH secretion, resulting in loss of the nocturnal pulsatile GH secretion seen in younger individuals and lack of a clear night-day GH rhythm

How long COVID presents in patientsand the lack of a biomarker to effectively detect itadds to the difficulty in diagnosing and treating the condition