Anju Goel, MD, MPH, is a board-certified physician who specializes in public health, communicable disease, diabetes, and health policy.
Long COVID is a systemic, enduring result of a SARS-CoV-2 infection. The varied and often debilitating symptoms persist for weeks or even months after recovery from acute illness.
There is no definitive list of symptoms someone must show—or clarity about how severe these symptoms must be—in order for them to be considered a “long-hauler,” the term for people with long COVID. For some, it may be an extension of traditional COVID-19 symptoms, like fatigue, trouble breathing, and loss of the ability to smell or taste. For others, it may involve new symptoms, like chest pain or memory problems. Anyone can be a long-hauler, but it’s more common among those who were previously hospitalized for COVID-19. The condition is often self-diagnosed.
While research is ongoing, a study published in March 2021 shows that a third of people who contract a mild case of COVID-19 still experience symptoms up to three months after their initial infection. Other studies suggest that one in 10 people will experience symptoms for at least a year. Among patients who had COVID-19 severe enough to require hospitalization, about 70% continue to experience at least one symptom in the months following infection, according to a roundup of key literature featured by the Infectious Diseases Society of America.
Much of the research and support surrounding long COVID is being spearheaded by those who’ve experienced it. Nonprofit groups like Survivor Corps keep long-haulers abreast of Post COVID Care Centers (PCCCs) opening across the country to address the complex challenges of life after COVID-19.
Doctors still haven’t pinpointed what causes lasting symptoms of COVID-19. We do know that the virus triggers a heightened inflammatory response in the body, called cytokine storm, which can lead to severe outcomes. But more research is needed to understand the exact cause of long COVID.
Anyone, despite age or pre-existing health conditions, can develop lasting symptoms. However, a recent study found that patients with COVID-19 who experienced more than five symptoms during their first week of illness were more likely to become long-haulers. The most predictive symptoms included fatigue, headache, difficulty breathing, hoarse voice, and muscle pain. Older adults and women were also more susceptible to long COVID.
Not all long-haulers have the same symptoms. According to the Centers for Disease Control and Prevention (CDC), the five most common symptoms are fatigue, shortness of breath, cough, joint pain, and chest pain. Reports have identified upwards of 50 other symptoms associated with previous COVID-19 infection. Some long-haulers have reported feeling brain fog, mental health issues, tinnitus, and even fragrance allergies.
Because we’re just starting to learn more about the long-term complications of COVID-19, it’s hard to say how long these lingering symptoms will last. Studies suggest that a third of people with mild cases experience symptoms anywhere from three weeks to three months after initial infection. And among those who are hospitalized, the risk may be closer to 70%. Other research suggests 1 in 10 people have symptoms for a year.
It’s not likely. According to the CDC, someone with COVID-19 is thought to be contagious for 10 days after their symptoms begin. In a small number of cases, people who experience severe COVID-19, including immunocompromised people, may be contagious for up to 20 days. So symptoms of long COVID don’t necessitate isolation.
Many hospitals and health systems are creating Post COVID Care Centers (PCCCs) to offer a multifaceted approach to rehabilitation. Long-haulers may be referred to respiratory or cardiac specialists to develop a treatment plan. Some courses of care may include antidepressants, blood thinners, cardiac medications, steroids, or pain medication. Outside of medication, some long-haulers experience benefits from breathing exercises, smell training, mental health support, and physical therapy.
You should get the vaccine regardless of whether you’ve previously had COVID-19. Experts aren’t sure yet how long COVID-19 infection provides you with natural protection. However, if you’ve been seriously ill and were treated with monoclonal antibodies or convalescent plasma, the CDC recommends you wait 90 days post-treatment to get the vaccine. Some long-haulers have even reported experiencing improvements in their symptoms after receiving the vaccine.
Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603–605. doi:10.1001/jama.2020.12
Ramakrishnan A, Zreloff J, Moore MA, et al. Prolonged symptoms after covid-19 infection in outpatients. Open Forum Infectious Diseases. 2021;8(3):ofab060. doi:10.1093/ofid/ofab060
Sudre C, Murray B, Varsavsky T et al. Attributes and predictors of long COVID. Nat Med. 2021. doi:10.1038/s41591-021-01292-y
Centers for Disease Control and Prevention. Post-COVID Conditions. Updated April 8, 2021.
Centers for Disease Control and Prevention. FAQS.