What do we know?

When the Covid-19 pandemic started, everyone was worried about the immediate effects because they were so severe. After a while, many people who were sick got better. Unfortunately, some are still experiencing lasting side effects months, if not years, after. This has been dubbed “long Covid.” What does this entail? Does it get better?

People with mild to moderate Covid-19 were sick for about two weeks and then started feeling better. However, some individuals have lingering health problems after they’ve recovered from the acute phase of the illness. So, if they were tested, the person would test negative for the coronavirus but are still suffering with debilitating symptoms. The experience has been dubbed “long Covid,” however the technical term is Post-Acute Sequelae of SARS-CoV-2 infection (PASC). People living with the condition are often referred to as “long haulers.” The illness frustrates sufferers and baffles scientists.

What is long Covid?

A person is considered to have long Covid when they experience symptoms greater than expected for the normal recovery from Covid. Some experts believe symptoms that linger for four weeks or longer to be long Covid, while others say symptoms should persist for at least 12 weeks before a patient is diagnosed with the condition. The World Health Organization (WHO) states: “Post Covid-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of Covid-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.” The agency notes that symptoms impact everyday functioning and may fluctuate or relapse over time.

Per the Centers for Disease Control and Prevention (CDC), post-Covid conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus. It’s vital to point out that even people who didn’t have symptoms in the days or weeks after they were initially infected can have post-Covid conditions. The CDC lists more than a dozen symptoms potentially associated with long Covid, mentioning that they can be new or ongoing. Also, the condition can occur in anyone who was infected, regardless of the severity of the initial infection.

Long Covid is broken down into three categories. The first involves the direct cell damage caused by the virus, which results in lingering or ongoing symptoms. The second grouping is when a person’s symptoms are related to chronic hospitalization, like when a person has been in the hospital, typically the Intensive Care Unit (ICU), bed-bound for weeks. This causes muscle weakness, cognitive brain dysfunction, and psychosocial stress, causing post-traumatic stress disorder-like syndrome. This group is also called post-ICU care syndrome. The third type is individuals who experience symptoms after appearing to recover. Covid causes a variety of symptoms because there are various factors at play, reflecting an individual’s health, the interplay of the virus with the immune system of the person, and then the impact that both those things have on the body. These resulting symptoms are created because of this interaction between inflammatory markers and the immune system. Scientists are trying to understand precisely how this interplay works. It could be that the initial infection makes some people’s immune systems go into overdrive, attacking not just the virus but their own tissues.

What parts of the body does long Covid impact?

We do know that long Covid affects almost every single body system. However, the most common symptom is profound fatigue. Many people report feeling exhausted for hours or days after doing simple tasks. Another common complaint is “brain fog,” where individuals have difficulty with cognition and memory. Other symptoms can include shortness of breath, heart palpitations, chest pain/tightness, rapid heart rate (tachycardia), slow heart rate (bradycardia), blood clots, joint pain, headaches, dizziness, fever, loss of appetite, loss of taste/smell, changes to hearing/vision, hair loss, rashes, insomnia, hallucinations, anxiety, and depression. Some people have also had bowel issues (ex. diarrhea) and bladder problems. One condition that individuals who’ve made it through Covid might be more susceptible to is postural orthostatic tachycardia syndrome (POTS). It’s a condition that affects blood circulation where a reduction in blood volume occurs when the person stands, especially from a lying position. Symptoms include lightheadedness, fainting, and rapid heartbeat, which are relieved by lying down again. The severity of long Covid varies widely. Some people can function day-to-day, despite having symptoms. Others are completely debilitated by it.

How many people have long Covid?

It’s been challenging to determine what percentage of people who contract the Covid-19 develop long-term symptoms. Estimates range from 15 – 80%. When you think of the tens of millions of people the virus has infected, even a tiny percentage having long Covid is significant.

Since much remains unknown about long Covid, the National Institutes of Health launched a research initiative to study the potential consequences of being infected with the coronavirus, including long Covid. The goal is to identify causes, treatment options, and prevention techniques. The organization is in the process of building a nationwide study population to conduct the research.

What are the risk factors for getting long Covid?

Certain things, such as surviving a serious acute Covid-19 infection, having comorbidities, and being older, have been linked to potentially acquiring long Covid. However, that doesn’t mean other people aren’t at risk. Many young people with no other medical problems have severe and life-altering symptoms. One study published in January 2022 identified four potential risk factors that could lead to developing the condition. These include having Type 2 diabetes, the level of viral RNA produced by the initial coronavirus infection, the presence of Epstein-Barr virus in the blood, and having specific autoantibodies (antibodies that mistakenly attack tissues or organs in the body). Other studies suggest that women may be more predisposed to long Covid because it predominantly affects middle-aged females.

How is long Covid diagnosed?

There isn’t a standard test to diagnose long Covid, so doctors have to rule out other possible causes for symptoms first. An essential step is determining whether someone was infected with the coronavirus. Usually, this is done with a positive coronavirus test or the presence of antibodies in someone who wasn’t vaccinated. If a person has a cluster of symptoms that other causes can’t explain, it can help to lead to a diagnosis.

If you think you have long Covid, don’t delay seeking help because the earlier you get care, the better it most likely will be. Keep in mind that since long Covid symptoms can be like those of other diseases, it’s important to see your doctor and rule out other problems.

What is the treatment for long Covid?

In response to the number of people suffering from the condition, post-Covid recovery programs and clinics have appeared nationwide. Many are taking a multidisciplinary approach to provide patients with individualized care, intending to address all symptoms appropriately. To aid in regaining lung function, breathing exercises and respiratory therapy can help. Physical therapy can assist in rehabilitation, but it will involve slow-paced gradual increases in activity. Recovery will likely take time and probably include setbacks.

How long is “long-term”?

Since the virus is still new, the answer is unknown. To hopefully find a solution, scientists are looking at the long-term effects seen in related viruses, like the one that causes severe acute respiratory syndrome (SARS). Many people who have recovered from SARS have developed chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens with physical or mental activity and doesn’t improve with rest.

What about long Covid in children?

Although not as common, children and adolescents can develop long Covid. Children are considered to have long Covid if persistent symptoms last at least four weeks after the initial infection. However, the population most scientists are concerned about are those that have symptoms 12 weeks or more after their initial infection. Similar to adults, fatigue and brain fog are the most reported symptoms. While headaches and abdominal complaints are more common in this demographic, children are less likely to have lung damage. Some kids are experiencing a severe complication called multisystem inflammatory syndrome in children (MIS-C), which can cause severe heart damage. While the complication isn’t common, since heart inflammation is a concern, especially among young athletes returning to sports, all kids should be screened for any signs of heart damage to ensure it is safe for them to resume activity.

How to avoid long Covid?

The best way to avoid long Covid is to prevent infection with the coronavirus in the first place. To do this, practice recommended safety precautions and get the Covid-19 vaccine. It’s essential to point out that the vaccines are safe and effective. While some patients may experience breakthrough infections, they’re 50% less likely to develop long Covid.

No one wants to get Covid-19, but most people will recover without any problems. The issue is for those that develop long Covid because there’s still so much we don’t know yet. As we move forward, more information will be available. In the meantime, do what you can to avoid dealing with it.