What to know about long COVID

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Long COVID refers to when people continue to experience symptoms of COVID-19 and do not fully recover for several weeks or months after the start of their symptoms.

Some research suggests that people with mild cases of COVID-19 usually recover within 1–2 weeks of contracting the initial SARS-CoV-2 infection. For severe cases of COVID-19, recovery can take 6 weeks or longer.

Currently, researchers may define post-acute COVID-19 as symptoms extending beyond 3 weeks since onset and chronic COVID-19 as symptoms extending beyond 12 weeks since onset.

Other researchers refer to long COVID as COVID-19 symptoms that last for longer than 2 months.

A 2020 survey by the Centers for Disease Control and Prevention (CDC) suggests that it may take weeks for COVID-19 symptoms to resolve and for people to return to their usual state of health. This is also true for young adults with no chronic medical conditions.

In contrast, over 90% of people discharged from the hospital with influenza usually recover within 2 weeks.

Mounting evidence suggests that many people may continue to experience symptoms related to COVID-19 long after their initial infection with the SARS-CoV-2 virus.

Although it is still unclear how many people have experienced long COVID, data from the COVID Symptom Study app suggest that 1 in 10 people with the illness experience symptoms for 3 weeks or longer.

Data from the United Kingdom’s Office for National Statistics found similar results, with roughly 1 in 10 respondents who tested positive for COVID-19 exhibiting symptoms lasting for a period of 12 weeks or longer.

This means that across the world, there may be more than 5 million cases of long COVID.

One study found that more than three-quarters of COVID-19 patients in a hospital in Wuhan, China, still had at least one symptom 6 months after their discharge from the hospital.

This is consistent with a 2020 study from Italy that found that 87.4% of COVID-19 patients reported experiencing at least one symptom 2 months after their discharge from the hospital.

A 2020 Swiss study also notes that as many as 1 in 3 people with milder cases COVID-19 were still experiencing symptoms after 6 weeks.

Using a statistical model, a preprint 2020 study found that long COVID is more likely to occur in older adults, people with a higher body mass index (BMI), and females.

It also notes that individuals who experience more than five symptoms during the first week of illness are more likely to develop long COVID.

Some evidence also suggests that many people with long COVID are healthcare workers.

The CDC note a variety of symptoms for COVID-19. They also note that the symptoms that people most commonly report in long COVID are:

• fatigue
• shortness of breath
• cough
• joint pain
• chest pain

People may also experience:

• brain fog, wherein they find it more difficult to think clearly and focus
• depression
• muscle pain
• headache
• fever, which may come and go
• heart palpitations, or a feeling of the heart pounding

People may also develop long-term complications that affect the organs. These complications are less common but may include:

• inflammation of the heart muscle
• abnormal lung function
• severe kidney injury
• a rash
• hair loss
• problems with smell and taste
• sleep issues
• memory and concentration difficulties
• anxiety
• mood changes

Researchers are not certain what causes the prolonged effects of COVID-19, but some possible causes of long COVID may include:

• a reduced or lack of response from the immune system
• relapse or reinfection of the virus
• inflammation or a reaction from the immune system
• deconditioning, which is a change in physical function due to bed rest or inactivity
• post-traumatic stress

Some research indicates that the lingering problems associated with long COVID-19 may be the result of injury to multiple organs, including the lungs, heart, and brain.

For example, a 2020 study that analyzed postmortem samples from individuals who died of COVID-19 suggests that severe lung damage may explain the symptoms of long COVID-19.

COVID-19 may also cause long lasting changes to the immune system, which can affect these organs. These changes, particularly in the lungs, may last longer than the time it takes for the body to remove the virus.

Furthermore, research from the National Institute for Health Research notes the possibility that the symptoms that people describe may be due to a number of different syndromes.

These could include post-intensive care syndrome, post-viral fatigue syndrome, and long-term or post-COVID-19 syndrome. Some people may be experiencing more than one syndrome at the same time.

If a person is experiencing long COVID, they may have received a COVID-19 diagnosis if they had access to a coronavirus test.

However, a positive test for COVID-19 is not necessary for the diagnosis of long-COVID. This is because many people never underwent testing, and this may serve as a barrier for people who had the virus early on in the pandemic.

To diagnose long COVID, a doctor may take a full medical history and assess all COVID-19 symptoms, from the beginning of the infection to the current symptoms. The doctor may check:

• blood pressure
• temperature
• heart rate and rhythm
• lung and breathing function

Although there is no specific test to diagnose long COVID, doctors may run tests to rule out any other possible causes of the symptoms. Testing may vary depending on which symptoms a person has but may involve blood tests to check:

• full blood count
• electrolytes
• kidney function
• liver function
• troponin, to test for heart muscle damage
• inflammation levels
• muscle damage
• D-dimer, to check that no blood clots are present
• heart health
• iron levels

Other tests may include:

• a chest X-ray
• a urine test
• an electrocardiogram, to check for heart problems

Home remedies for managing long COVID may include the following:

• taking over-the-counter pain relievers, such as acetaminophen, to relieve painful symptoms or fever
• resting and relaxing
• setting achievable targets to reach

Taking care of general health is also important. This may involve:

• following a healthy diet
• getting quality sleep
• limiting alcohol intake
• limiting caffeine intake
• not smoking

However, because the symptoms of long COVID can fluctuate and vary, people may require individualized rehabilitation plans, not a one-model-fits-all approach. These plans could involve making major or long-term lifestyle changes.

Experts emphasize that doctors should listen to their patients, document their symptoms, understand how they change, be alert to new symptoms, and provide appropriate care.

People may also find it helpful to connect with a support network, particularly if long COVID is affecting their mental health, financial security, or social well-being.

People experiencing long COVID can call a doctor for advice.

However, a person needs medical help if they experience any of the following:

• breathlessness that worsens
• unexplained chest pain
• a new state of confusion
• weakness
• changes in vision, hearing, or speech

If anyone needs immediate medical attention, someone can call 911 and inform them that they have symptoms that may relate to COVID-19.

As more people discuss their experience of long COVID, some countries are beginning to provide more support. In the U.K., for example, a COVID Recovery resource from the National Health Service (NHS) is now available, in addition to support groups such as LongCovidSOS.

In the United States, the following support groups may provide help for those experiencing long COVID symptoms:

• Body Politic
• Survivor Corps
• Long COVID Support

There are now dedicated clinics for those with long COVID. The Survivor Corps website provides an interactive map of the U.S. that highlights post-COVID care centers in each state.

It is currently unclear how long recovery from long COVID may take. Research reports that people may experience symptoms 60–90 days after the initial infection, and some people may experience symptoms for longer than this.

Other viruses aside from SARS-CoV-2 can also cause long lasting symptoms. According to the British Heart Foundation, the symptom duration of other viruses suggests that long COVID symptoms may resolve within 3 months. People may continue to feel tired for up to 6 months.

However, these are rough estimates, and recovery times may be different for each individual.

Due to how novel the condition of long COVID is, researchers and healthcare professionals are still working to understand the causes, treatment options, and potential recovery times.

Some people with COVID-19 symptoms may recover in a few weeks. However, recovery may take much longer for others.

Long COVID is the term for COVID-19 symptoms that continue for weeks or months after the initial infection.

People can discuss a treatment plan with a doctor. Taking steps to look after their health and well-being — such as by following a healthy diet, getting plenty of rest, and doing gentle exercise — may all help a person manage long COVID.

Medical treatment may be necessary to treat any secondary infections or complications.