What We Know About Long COVID
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Following COVID-19 infection, symptoms typically clear up within a couple of weeks for most otherwise healthy people. For others, long-lasting symptoms following COVID-19 infection can drag on for months or even years. This condition is called the Post-Acute Sequelae of COVID-19 (PASC) or Post-COVID condition.
Unfortunately, there is no official definition for this condition. People with PASC fall into one of two groups, says Folusakin Ayoade, M.D., an infectious disease expert who runs a clinic for PASC patients at the University of Miami Health System’s outpatient clinic.
Patients with COVID-19 symptoms lasting 4 to 12 weeks are considered to have “subacute” or “post-acute COVID-19 syndrome.” Those with ongoing symptoms beyond 12 weeks have “long COVID,” “long hauler’s syndrome,” or “post-COVID-19 syndrome.” These are considered two different stages of post-COVID conditions.
If your symptoms persist for at least four weeks, even after you’ve tested negative for COVID, you likely have PASC or even Long COVID.
What are the symptoms of long COVID?
People with post-COVID conditions may experience any combination of the following lingering symptoms, which may come and go or gradually resolve completely.
- Brain fog (difficulty thinking or concentrating)
- Chest pain
- Difficulty breathing
- Dizziness when standing up
- The feeling of pins and needles on the skin
- Heart palpitations
- Joint or muscle pain
- Kidney issues
- Loss of, or change in, smell and/or taste
- Menstrual cycle changes
- Persistent fatigue
- Shortness of breath
- Sleep problems
- Stomach pain
- Symptoms worsen after physical or mental exertion
“The two most common symptoms reported by most patients are probably brain fog and fatigue,” Dr. Ayoade says. The majority of these patients were never hospitalized for their initial COVID-19 infections.
In some cases, long COVID can affect multiple organs or trigger autoimmune conditions.
Those who survived severe COVID illness are at higher risk for such complications. Multi-organ effects can involve many body systems, leading to health conditions like diabetes, heart, or neurological conditions.
Who gets long-haul COVID symptoms?
Researchers aim to understand why some populations develop these long-lasting conditions at higher rates and why some people never experience post-COVID symptoms.
Because PASC has no standard method of diagnosis and is often self-reported, estimates of the percentage of people who develop post-COVID conditions vary, according to the CDC.
- 13.3% report long COVID symptoms one to three months later
- 2.5% report long COVID symptoms after three months or later
- Among hospitalized COVID patients, more than 30% report symptoms six months later
Most people with post-COVID conditions had previously tested positive for COVID-19. We know that those who suffered severe COVID-19 illness, especially those who were hospitalized or needed intensive care, are more likely to report post-COVID conditions. But, some asymptomatic individuals and those who experienced mild, short-lived infection may also develop post-COVID symptoms that drag on without explanation.
People who are not vaccinated against COVID-19 may be at higher risk of developing long-lasting symptoms following infection.
Others at higher risk include people with underlying health conditions and those who experienced multisystem inflammatory syndrome while ill. Post-COVID conditions are less common in children and adolescents than in adults.
Do you have long COVID?
There is no test or imaging scan to confirm that any symptoms or conditions you’re experiencing were caused by COVID-19 infection. “The diagnosis of PASC is mainly based on patient-reported persistent symptoms,” says Dr. Ayoade.
See your health care provider if you experience such symptoms and they last longer than four weeks. The CDC offers tips to prepare for your post-COVID doctor visit. Your provider can determine to the best of their knowledge if your current symptoms were triggered by COVID or if you have another unrelated medical condition requiring diagnosis and treatment.
Living with long COVID
There is no cure for PASC, but symptoms tend to resolve themselves over time.
As of July 2021, post-COVID conditions are considered a disability under the Americans with Disabilities Act. While this status may affirm that your long-COVID suffering is not “all in your head,” you may face daily challenges at work and home while managing persistent symptoms.
To feel better, you can reduce the severity of each symptom with medicines and therapies that have traditionally been effective for these conditions, such as taking acetaminophen or ibuprofen for headaches.
“My advice to patients is to pursue symptomatic relief, which may include specialist consultations to address individual problems and focused tests to rule out co-existing organic disease process,” says Dr. Ayoade. “A few treatment options include antidepressants and anti-anxiety medications for mood disorders, Gabapentin or Pregabalin for neuropathy, smell training for anosmia (change in or loss of smell/taste), and for fatigue, physical therapy aimed at increasing exercise tolerance.”
If you’re struggling with post-COVID conditions, take care of yourself to recover faster.
Ten ways to improve your overall health and wellbeing:
- Get more physical activity.
- Manage underlying conditions (like cardiovascular risks, asthma, diabetes, or kidney disorders).
- Don’t socially isolate yourself.
- Prioritize your emotional and mental well-being.
- Get enough quality sleep.
- Maintain a healthy weight.
- Improve your diet. (Try these nutrition tips to reduce chronic inflammation.)
- Reduce your alcohol intake.
- Develop life hacks and memory tools to compensate for brain fog.
- Keep your brain engaged with hobbies, socializing, and mentally stimulating activities.
If you need help, now is the time to seek it.
If you’re fighting long-haul COVID symptoms and underlying health conditions, speak with your healthcare providers about how to best manage your overall health. They might recommend modifications to your medications, diet, or other lifestyle changes to reduce your risk factors and improve your quality of life.
Don’t know what to eat to improve your health and manage your underlying health conditions? Speak with a registered dietitian for trusted nutrition information.
Let your family and friends know how they can support your recovery from long COVID. Maybe they can manage some tasks on your behalf for now or simply be there when you need a good laugh or a serious conversation.
COVID support groups can also provide encouragement and tips for managing long-haul symptoms.
Contact a mental health provider if you’re struggling with overwhelming stress, feelings of hopelessness, social isolation, or thoughts of self-harm.
Understanding and treating long COVID
The exact causes of PASC are not well understood. Some of the suspected triggers include:
- immune responses to the coronavirus
- low-grade viral activity
- underlying health conditions
- organ damage
“Several high-quality studies are going on to find answers to many unanswered questions,” Dr. Ayoade says. “The most important questions are ‘Why do some have PASC, while others don’t?’ and ‘What are the mechanisms underlying its pathophysiology?’
We need to address these questions first. Then, effective treatment options and strategies will promptly follow. I am optimistic the wait will not be too long.Dr. Ayoade
The American Heart Association recently awarded grants to 10 U.S. research programs with the goal of unraveling the mechanisms behind long COVID. At the Miller School, a team of medical professors and researchers received a $1 million grant from the association to investigate evidence of an overzealous inflammatory response from the SARS-CoV-2 virus.
The multidisciplinary research team is working with the COVID-19 Long-haulers Clinic at the Miami Veterans Affairs Healthcare System to obtain blood samples and heart and lung MRI images of 150 clinic patients. The investigation relates to previous studies of battle fatigue in military veterans, which can persist long after they return from the field.
At the Miller School’s Interdisciplinary Stem Cell Institute lab, the team is inducing a COVID-19-like response in animal lab models by infecting them with a virus that mimics SARS-CoV-2.
These collaborative research efforts will test the hypothesis that long COVID begins with low-density lipoprotein receptor viral bonding, leads to inflammation and NETosis (cell death), disrupts cholesterol balance, and culminates in the form of coronary artery disease.
If they observe this pattern repeatedly in the mouse model, and if the patient samples confirm these observations, the team’s findings will help the medical community learn how to better treat long COVID patients.
Dana Kantrowitz is a contributor for UHealth’s news service.