Most COVID-infected people look forward to the day they can get back to their symptom-free life. However, for some people, that day seems to keep running further away. With over 426,624,859 confirmed cases of COVID-19 (February 2022), enough evidence has shown that some people face long-term health effects from the virus.
By now, it’s clear that each person experiences COVID, and its recovery, differently. Most people who catch the coronavirus disease recover completely within a few weeks. However, that is not always the case. Some individuals continue to experience COVID-19 symptoms even after their initial recovery. They refer to themselves as “long haulers.” The condition itself is called long COVID-19 or post-COVID-19 syndrome.
Long COVID-19 refers to lingering health problems lasting for a certain period after initial diagnosis. These symptoms can remain for months, increasing the risk of developing long-term health issues. The severity of the initial infection does not seem to be related to the duration of recovery. That means even those with mild versions of the disease could face these long-term problems.
According to a study published in November 2021, more than 40% of COVID-19 survivors worldwide had long-term effects. In addition, based on the number of infections recorded globally by mid-October, more than 100 million people experienced lingering health concerns due to the COVID-19 virus.
In this article, we will look into what long COVID is. Then, we will dive deeper into its causes, who it affects, its symptoms, duration, diagnosis, prevention, and treatment. In addition, we will discuss the vaccines’ effect on long COVID.
What Is Long COVID
Most people that catch COVID recover relatively quickly. However, some people have persistent symptoms that last for weeks or months after the infection has gone. This problem goes by several names. Common terms for this condition include long COVID, post-COVID-19 syndrome, or long-term COVID. In addition, the National Institutes of Health refer to it as post-acute sequelae of SARS-CoV-2 infection (PASC).
The World Health Organization (WHO) refers to long COVID as the illness that happens to people with a history of either probable or confirmed SARS-CoV-2 infection. It is usually within three months from the onset of the coronavirus with symptoms and effects that last for at least two months. These symptoms can’t be explained by any alternative diagnosis.
Most peoples’ COVID-19 symptoms resolve within four weeks. Others might experience lingering health problems. However, the vast majority will no longer test positive but will still suffer the virus’s long-lasting consequences.
Depending on how long symptoms stay, they can be called one of two things, either Ongoing symptomatic COVID or Post-COVID Syndrome. Ongoing symptomatic COVID refers to symptoms that remain for more than four weeks. Post-COVID Syndrome refers to persistent symptoms that continue for more than 12 weeks, and no other condition could explain them.
Causes of Long COVID
The exact cause of having long-term symptoms of COVID-19 is not yet known. The chances of having long COVID don’t seem to be linked with the severity of the initial infection. However, it is clear that certain risk factors, such as diabetes, high blood pressure, smoking, and other conditions, might lead to more serious symptoms. Even those with initially mild symptoms could have long-term problems.
Different processes are likely going on in different people, leading to the varying symptoms of long COVID. A probable cause could be related to SARS-CoV-2 attacking the body in various ways. The virus gets into cells and damages them. Damage can occur in the lungs, nervous system, heart, liver, etc. The damage could be responsible for the health issues that linger after COVID-19 illness.
In addition, COVID-19 increases the risk of blood cells clumping up and clotting. Large clots cause heart attacks and strokes, but with COVID-19, most heart damage comes from very small clots that block capillaries in the heart muscle. Other organs, like the lungs, liver, legs, kidneys, are affected by blood clots. COVID-19 could also weaken blood vessels and cause them to leak. This can lead to long-lasting problems in the kidneys and liver. However, much more research is still needed to identify the cause of long COVID.
Who Gets Long COVID?
Long COVID doesn’t just affect a single population. This condition affects people of all ages, those with good health, and those who already have health issues. Those previously hospitalized with COVID-19 can have long COVID, but so can those with mild symptoms. Around 10% of people with COVID-19 will experience long-term symptoms. Research has found that this 10% is particularly true for those between 18 and 49. However, the odds increase to 22% for those 70 or older.
In the UK, the Office of National Statistics estimated that 1.3 million individuals were experiencing self-reported long COVID. This amounts to over 1 in 50 or 2.1% of the population. In addition, 42% of people were experiencing long COVID symptoms more than a year after their initial infection of the virus. This study also found that the condition is most common in women, those between the ages of 35 and 69, individuals with underlying conditions or disabilities, those that work in social and health care or teaching and education, and those living in poorer areas.
A study published in Cell identified four biological factors linked with a greater risk of developing long COVID. These factors included Type 2 diabetes (at the time of the diagnosis), unusual levels of SARS-CoV-2 RNA in the blood (which correlates to the severity of the infection), presence of specific autoantibodies, and signs of the Epstein-Barr virus.
Another study published in Nature Communications found an association between antibody signature and long COVID. Researchers found that after the infection of COVID-19, two types of antibodies started to circulate in the blood: immunoglobulin M (IgM) and Immunoglobulin G (IgG). At first, the IgM levels increase rapidly to help fight the infection. IgG, on the other hand, increases later and provides long-term immunity. When comparing antibody levels in blood samples, it was found that those who developed long COVID tended to have lower levels of IgM at the outset of infection and lower levels of IgG3 six and 12 months after infection compared to those who did not develop the illness.
In addition, these researchers found that antibody levels, along with certain factors like asthma or age, could be used to determine the risk of developing long COVID. These findings could help improve care for long Covid patients.
Children are less likely to develop long COVID; however, it is still possible. More data regarding the prevalence of long COVID in children are still needed. A study found that 14% or up to one in seven children and young people infected with COVID-19 may still have symptoms linked to the virus 15 weeks later.
Symptoms of Long COVID
There is a broad spectrum of long COVID symptoms, some being more common than others. Some symptoms are minor, but others might put a patient in need of continuous care and, if severe, readmission to the hospital. The symptoms are many and can change over time.
According to the ONS, by far, the most common symptom people with self-reported long COVID experience is fatigue, affecting about 51% of people. Other common symptoms include loss of smell (37%), shortness of breath (36%), and problems concentrating (28%). Other common signs and symptoms include (but are not limited to) joint pain, cough, chest pain, brain fog, difficulty sleeping, muscle pain, headache, heart palpitations, loss of smell or taste, depression, anxiety, delirium (in older people), fever, dizziness, rashes, stomach aches, diarrhea, loss of appetite, weight loss, tinnitus, sore throat, pins and needles, and more. In fact, long COVID has over 200 symptoms.
Some people experience severe issues such as breathing difficulties, heart complications, stroke, chronic kidney impairment, and Guillain-Barre syndrome, a condition that results in temporary paralysis. In addition, it has been reported that some adults and children experience a condition called multisystem inflammatory syndrome after their COVID-19 infection, in which some organs and tissues can become significantly inflamed. For example, children who develop this serious complication could be left with severe heart damage.
Postural orthostatic tachycardia syndrome (POTS) is an autonomic nervous system symptom that could develop after the COVID-19 infection and persist. This condition affects the circulation of the blood, leaving patients with other neurologic symptoms such as continuing headache, fatigue, insomnia, to name a few.
There are many more symptoms that someone with long COVID could be suffering from. In addition, there is still a lot to unfold regarding how COVID-19 will affect people’s health over time. More studies are needed to identify the relationship between the condition and the symptoms.
How Long Will Long COVID Last?
If you suffer from long COVID, this question probably continues to circulate in your mind: how long will long COVID last? Well, the answer isn’t quite clear yet. The duration of long COVID varies from person to person. In addition, the severity of the initial illness isn’t necessarily related to the length of recovery.
More research is needed, and time needs to pass to identify how long post-COVID-19 syndrome lasts. However, there is reassuring evidence that the symptoms tend to improve over time in most cases. If ongoing or new symptoms occur and you are concerned, you can seek medical advice and support.
The Challenge of Diagnosing Long COVID
The diagnosis of long COVID could be tricky. With no standard definition, a wide variety of symptoms, and no specific guidelines to manage them, long COVID is difficult to distinguish from other conditions.
There are no standard tests that doctors use. They could start by ruling out other probable causes of symptoms, like testing for diabetes, iron deficiency, and other conditions, before providing a long COVID diagnosis. However, researchers are trying to find new ways to test for long COVID.
Prevention and Treatment of Long COVID
The best method to avoid long COVID is by preventing coronavirus infection in the first place. This could be done by practicing coronavirus precautions and getting vaccinated.
It’s very easy to say that the treatment for long COVID is to just ‘give it time’ if you don’t have long COVID. Unfortunately, no single medication or treatment is used to treat long COVID. However, you can refer to doctors and therapists to help address the symptoms. Many large medical centers in various areas worldwide have opened clinics for long COVID assessment and care. In addition, support groups are available. Don’t write off symptoms such as anxiety, depression, or insomnia as ‘all in your head.’ Refer to doctors as they can help.
There are some extra management tips to help with symptoms of long COVID. These tips depend on your symptoms. Physical therapy, breathing exercises, staying active, and other tools could help. Keep in mind, however, that it is a gradual recovery.
Long COVID and Vaccines
Growing evidence has indicated that vaccines could reduce the risk of developing long COVID. In an evidence briefing published by the UK Health Security Agency (UKHSA) in which 15 long COVID studies were reviewed, it was found that those who were infected with COVID after having two doses of Pfizer, Moderna, or AstraZeneca, or one dose of the Janssen vaccine, were half as likely to have lasting (≥28 days) COVID symptoms when compared to those unvaccinated, or only had one dose. In addition, a reduction in longer-term long COVID symptoms (up to six months) was found.
Evidence shows that those vaccinated after their infection with COVID could have reduced long COVID effects. Three out of four studies in the UKHSA review looked at long COVID before and after vaccination. It was found that the vaccinated people had improvements in their symptoms (either directly or over several weeks) than those not vaccinated. Yet, there were a few individuals that had worsened symptoms. More studies are needed to know the effects of vaccination on long COVID.
Coronavirus affects people differently. While most peoples’ symptoms resolve relatively quickly, others might experience long-term effects from their initial COVID-19 infection. The exact cause for why someone might develop long COVID is not entirely known yet. Long COVID doesn’t just affect a single population, and it has a wide variety of symptoms.
How long post-COVID-19 syndrome lasts varies from person to person, so a specific recovery duration is unidentified. It is challenging to diagnose long COVID since there is no specific test. In addition, its symptoms could overlap with other conditions. Medical professionals do several tests to rule out the possibility of these other conditions.
The best way to prevent long COVID is by avoiding a COVID-19 infection in the first place. If someone has long COVID, treating it using a single medication or treatment is unlikely. Instead, you can contact your doctors and therapists and visit a long COVID clinic to address the symptoms. You can also try some home tools to aid in easing symptoms. Finally, vaccination is important as it can also help.
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