Long COVID-19 refers to the lasting symptoms of SAR-CoV-2 infection two or more weeks post-viral infection. The five most common symptoms of Long COVID-19 include fatigue, headache, attention disorder, hair loss, and dyspnea (shortness of breath). After recovering from COVID-19, 80% of people develop one or more long-term symptoms.
If you are feeling sick, or have been exposed to someone who has COVID-19, you should get tested and seek medical attention if your condition worsens. A membership with Mira can help you access affordable urgent care, virtual care appointments, lab tests, prescriptions, and more. Sign up and get care today!
What is Long COVID?
Long-term effects are health issues that are caused by an illness, disease, or treatment that last for several months or years after infection. Long-term effects from a disease can be physical, mental, or emotional and can occur even if the initial illness or disease is no longer present in the body.
As of July 2021, “long COVID,” also known as post-COVID conditions, can be considered a disability under the Americans with Disabilities Act (ADA). Researchers have been using many different terms to refer to the long-term side effects of COVID-19, including but not limited to:
- Long COVID-19
- Post-acute COVID-19
- Persistent COVID-19 symptoms
- Chronic COVID-19
- Long-term COVID-19 effects
- Post COVID-19 syndrome
- Ongoing COVID-19
- Post-acute sequelae of SARS-CoV-2 infection (PASC)
Based on a systematic review and meta-analysis, 55 clinical manifestations of Long COVID have been reported. Below we outline the possible symptoms of Long COVID and the prevalence of each symptom, which is the percent of Long COVID patients who experienced each symptom.
Long COVID-19 Symptoms and Prevalence
|1 or > symptoms|
|Nausea or vomit|
|Hearing loss or tinnitus|
|Resting heart rate increase|
|Reduced pulmonary diffusing capacity|
|Healthcare-related mental health|
|Obsessive-compulsive disorder (OCD)|
|Post-traumatic stress disorder (PTSD)|
Post-COVID Fatigue Syndrome
According to a survey done by Indiana University School of Medicine, the most common long-hauler symptom is fatigue. Additionally, 91% of respondents in the Confirmed Case Long-Hauler Survey of 1,500 individuals reported that they experienced extreme and chronic fatigue.
The Centers for Disease Control and Prevention (CDC) refers to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) as a significantly lowered ability to do usual activities before the illness. Many individuals with ME/CFS also experience sleep issues and problems with thinking and memory.
Muscle and Body Pains
A common long-hauler symptom is muscle or body aches. Some individuals report that this pain occurs in the lower back and is usually sharp. These body aches can be differentiated from an injury in that they are typically accompanied by fatigue and other symptoms.
Another long COVID-19 symptom is shortness of breath or difficulty breathing. According to Johns Hopkins Medicine, COVID-19 results in initial lung damage and scarring.
The lung damage caused by infection with COVID-19 can take between 3 months and 12 months to heal. This may result in compromised respiratory function during this period of time. The severity of the disease, pre-existing health conditions, and treatment all affect the extent of lung damage.
Many individuals who had COVID-19 and recovered have been experiencing heart-related complications. Johns Hopkins Medicine explains that heart damage from COVID-19 can occur due to a lack of oxygen, inflammation of the heart (myocarditis), or stress cardiomyopathy.
Post-Intensive Care Syndrome
Individuals who were hospitalized in an Intensive Care Unit from any disease, including COVID-19, are at higher risk for delirium or confusion, problems paying attention, and issues with concentration. These symptoms typically last for 3-9 months after spending time in the hospital. Many patients described issues with short-term memory, learning new information, and comprehension.
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A study published in April 2020 found that of 184 ICU patients with COVID-19 induced pneumonia, 31% had thrombotic complications, where blood clots create blockages in veins and arteries.
According to Weill Cornell Medicine, ICU patients who have been given blood thinners continued to develop blood clots that included Deep Vein Thrombosis (DVT), clots in the legs, lungs, and cerebral arteries. Doctors are currently working on alternative treatments for these blood clots.
A study led by Patient-Led Research Group characterized over 200 total symptoms related to hormonal changes in a survey of 640 long-term coronavirus patients. These symptoms include testicular pain, urinary problems, erectile dysfunction, and menstrual changes.
Symptoms of this nature may arise due to low hormone levels (estrogen and testosterone) caused by long COVID-19. Estrogen plays a key role in regulating women’s health, and having abnormally low levels can lead to infertility, osteoporosis (low bone density), lack of sex drive, and depression. Similarly, testosterone is a key regulator in men’s health with low testosterone being associated with low sperm count, erectile dysfunction, and poor immune response among other symptoms.
Loss of smell and taste
An estimated 80% of people with COVID-19 experience a loss of smell, and many more experience a disruption or loss of taste as well. In several patients, these symptoms have persisted long after recovery from the disease itself.
The research reported by Scientific American reports that the coronavirus uses the ACE2 receptors to enter cells. Among these cells are olfactory cells that support the sensation of smell in important ways. Therefore, disruption of these cells may lead to the loss of olfactory sensation in some coronavirus patients.
Similarly, taste receptors on the tongue carry the ACE2 receptor that COVID-19 uses to enter cells. If these cells are disrupted by infection, then it may offer some insight as to why coronavirus patients lose their sense of taste.
Who is Most At-Risk for Long COVID-19 ?
Initial research on the disposition of long COVID-19 concluded that patients with more severe COVID-19 infection were more likely to develop long COVID-19. 80 percent of people hospitalized due to the coronavirus experience long COVID-19 symptoms. On the contrary, long COVID-19 symptoms only occurred in 5 percent of non-hospitalized coronavirus patients.
A new analysis from the CDC has found that long COVID is disproportionality affecting women and BIPOC populations. Current research found that racial minority groups were disproportionately affected and had more severe illness. Therefore higher rates of long COVID-19 amongst BIPOC communities are plausible.
Additionally, researchers are surprised by the gender skewing of long COVID-19, with women significantly outnumbering men with a 4:1 ratio. Studies have yet to pinpoint what is leading to the gender disparity, but some investigators are examining the link between autoimmune problems and long COVID-19.
Duration of Long COVID-19
According to the Confirmed Case Long-Hauler Survey, 82% of respondents reported symptoms lasting over two months, 41.9% of respondents experienced symptoms for over three months and 12.5% of respondents experienced symptoms for over four months.
The duration of COVID-19 varies depending on the case. Although most people with COVID-19 get better within weeks of illness, others have post-COVID conditions that last for different lengths of time. Current research estimates one in seven COVID-19 patients experiences long-term side effects 12 weeks after infection, and by seven months, many patients have still not yet recovered.
Now, with telehealth, you can talk to your doctor if you are worried about the continuation of your symptoms and how to recover if you are experiencing persistent symptoms. Seek immediate medical attention if you have:
- Symptoms of a blood clot
- Trouble breathing
- Chest pain or pressure
- Rapid weight loss or gain
- Inability to eat or drink
- Gastrointestinal problems
- Trouble staying awake
Three Types of Long COVID-19
Long COVID-19 can be broken down into three main categories: symptoms from cell damage, symptoms from chronic hospitalization and symptoms after recovery.
Symptoms from Cell Damage
When you become infected with the COVID-19 virus, it causes direct damage to the cells in your body. The coronavirus latches its spiky surface proteins to the receptors on healthy cells. The viral protein hijacks healthy cells, eventually killing some of them. With direct cell damage, people with COVID-19 never fully recover and can have ongoing symptoms.
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Symptoms from Chronic Hospitalization
Symptoms from chronic hospitalization arise when an individual with COVID-19 is in the hospital or intensive care unit (ICU) and bed-bound for weeks. Being bed-bound causes muscle weakness as well as cognitive brain dysfunction. Additionally, there is inherent psychological stress that develops similarly to post-traumatic stress disorder due to chronic hospitalization.
Symptoms after Recovery
COVID-19 causes a wide variety of symptoms and they can vary from person to person. This is due to the way each individual’s immune system reacts to COVID-19. Symptoms that linger and develop during recovery are a product of the interplay between the immune system and inflammatory markers, which provide insight into a person’s immune system and related immune reactions.
Long COVID-19 and Children
Older people and people with many serious medical conditions are the most likely to experience lingering COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for weeks to months after infection.
Post-COVID conditions appear to be less common in children and adolescents than in adults. Still, studies have reported long-term symptoms in children with both mild and severe COVID-19, including children who previously had multisystem inflammatory syndrome (MIS-C). The most common symptoms in children have been:
- Tiredness or fatigue
- Trouble sleeping (insomnia)
- Trouble concentrating
- Muscle and joint pain
What Does it Feel Like to Have Long-Term Side Effects From COVID-19? An Interview With A Coronavirus Survivor
We interviewed Allie Lamonaco, a coronavirus long-hauler, to understand what it feels like to have long-term COVID-19 symptoms. Below is our Question and Answer session where she explains her experience with COVID-19.
Q: How long ago did you have coronavirus and how long did your symptoms last?
A: “I got COVID on March 22nd when I had to fly home from my study abroad because the US was closing the border. I started experiencing symptoms on March 31st, and I am still experiencing symptoms 114 days later.”
Q: Did you get tested and what type of test did you get?
A: “At the time I couldn't get a test because they weren't readily available but my doctor diagnosed me with Covid due to all my symptoms matching it. Approximately 3 weeks later I was able to get tested and tested negative but was told that was likely the result because the test was so far removed from initial symptoms. I got a nasal swab test."
Q: What effects did you experience or are you currently experiencing?
A: “My initial symptoms were a fever of about 100-101, chills, crazy fatigue (sleep 14+ hours then need a nap in the day, unable to do much but lie in bed), shortness of breath (had to take breaths in the middle of sentences), intense chest pain, tachycardia (heart rate over 140 when standing/ doing the light activity), nausea, lack of appetite, lack of smell, muscle and joint pain, brain fog/confusion, migraine.
Now, over 100 days later my main issues are: still having a fever of about 100 now for 100 days, though it only spikes a few times a day now rather than being constant. My worst ongoing symptom is chest pain and tachycardia, still with light activity my heart rate will soar to 160-170 and usually trigger shortness of breath and fatigue as a result.
A strange and annoying ongoing symptom is the brain fog - when I‚m talking I have trouble finding the word I mean to say - like everything is on the tip of my tongue which gets frustrating. I still get migraines and some other pain but the only ongoing symptoms that really still affect me are fever and heart-related issues.
Most doctor's appointments have concluded that this is just Post Covid Syndrome or Covid running its course but I had some bloodwork that showed a high ANA level which usually indicates an autoimmune disease so I went for additional tests to see if Covid triggered autoimmune disease. I haven't gotten the results back yet.”
Q: What advice would you give to people who have not gotten coronavirus?
A: “Before Covid, I was a healthy 21-year-old with no underlying issues, and extensive testing after the fact has not detected an underlying problem that is causing these extensive complications from Covid. So this could happen to anyone. I urge everyone - especially young people - to take this as seriously as possible. I am so thankful to be seeing improvements and to never have needed extensive hospital care/ventilation etc. so I think I'm still a mild/moderate case.
But this is not something you're guaranteed to bounce back quickly from just because you're young and healthy, this disease has completely incapacitated me for almost 4 months, and has had me feeling like each system in my body is shutting down with symptoms ranging from neurological to gastrointestinal.
This completely took me out‚ there were nights where I was so scared to fall asleep because all I felt was pain, and my parents would walk by my room as I was sleeping to check I was still ok.
Even if your state is opening, take any precautions possible to protect yourself from this because trust me, you do not want to experience it. Wear a mask, minimize the number of people you come in contact with, and avoid putting yourself in unessential danger.
I know we all want life to go back to normal to see and hug our friends, but putting your social life semi-on hold may be the thing that saves you from this. So please, consider it. And stock up on vitamins!”
Where can I find support for dealing with COVID-19 side effects?
Extended periods of social distancing and physical isolation caused by the COVID-19 pandemic can all put strains on our mental and emotional wellbeing. According to the U.S. Department of Health and Human Services, the stress of a pandemic can result in negative effects on mental health. Some people have reported difficulty with concentration, irregular sleep patterns, heightened stress, worsening of preexisting chronic and mental health problems, and fear of getting ill.
Below are tips for maintaining mental health, adapted from a video talk with Gordon, The National Institute of Mental Health.
- Avoid using alcohol and drugs as coping mechanisms
- Maintain routines in terms of diet, meals, and exercise. Check out our article on how to stay active during quarantine
- Explore yoga, meditation, breathing exercises, and other wellness activities
- Stay connected with friends and family by talking on the phone, getting together outside at 6 feet apart, and joining large zoom gatherings
- Don't hesitate to seek help if you are having trouble coping with the changes brought about by COVID-19
- The Disaster Distress Hotline provides support for people dealing with emotional distress from a disaster.
- Call 1-800-985-5990
- Text TalkWithUs to 66746
- National Suicide Prevention Hotline assists people who are worried about a friend, family member or thinking about suicide
- Call 1-800-273-8255
- NYC Well connects individuals with a free mental health counselor
- Call 1-844-863-9314
- Text WELL to 65173
- Facebook groups: These groups aim to provide resources and support for coronavirus survivors. Survivors are able to post about shared experiences, get resources, and ask for advice.
- Survivor Corps is a public Facebook group with about 85.5k members.
- CORONAVIRUS SURVIVOR CORPS is a private Facebook group with about 8k members.
Source: National Institute of Mental Health (adapted from https://www.nogalesinternational.com)
Extended periods of social distancing and physical isolation caused by the COVID-19 pandemic can all put strains on our mental and emotional wellbeing. According to the U.S. Department of Health and Human Services, the stress of a pandemic can negatively affect mental health. Some people have reported difficulty concentrating, irregular sleep patterns, heightened stress, worsening preexisting chronic and mental health problems, and fear of getting ill.
Enter Mira! If you need extra support during this stressful time, a $25 per month membership with Mira gives you access to $5 virtual care visits and $15 behavioral health appointments with the click of a button.
Alexis Bryan MPH, is a recent graduate of Columbia’s Mailman School of Public Health. She is passionate about increasing access to care to improve health outcomes. Outside of work, she loves to travel, read, and pay too much attention to her plants.