What is Long COVID?
It is now over two years since COVID-19 first appeared in the United States. Not long after, it became apparent that symptoms of this acute viral infection could last for months, and patients could develop new symptoms, or experience a prolonged relapse of prior symptoms. This prolonged state of symptoms beyond the first four weeks after infection has been termed long COVID or as post-COVID conditions. Anyone who has been infected with the COVID-19 virus, even those with few or no symptoms, can experience long COVID.
There is no test to diagnose long COVID and people can have a wide variety of symptoms, affecting all organ systems, thus making it challenging for healthcare providers to make a diagnosis and to estimate the number of patients currently afflicted with long COVID. It is thought that 1 in 13 persons in the US have been infected with COVID-19. A recent CDC study found that 20% of adults who had COVID-19 were still experiencing long COVID symptoms three or more months later. This translates to a conservative estimate of 5 – 8 million people in the US. Whatever the exact numbers are, that is a huge number of people experiencing new chronic health conditions greatly impacting our well-being, our healthcare system, and our economy.
What are the Symptoms of Long COVID?
Symptoms of long COVID are similar to those seen with the acute COVID-19 virus infection. A recent study in the scientific journal Nature Medicine compared long-term symptoms observed in over 480,000 non-hospitalized patients with confirmed COVID-19 infection, with almost 2 million individuals with no history of such infection. It showed that long COVID can be associated with a multitude of symptoms affecting all parts of our bodies.
Most commonly, there is inability to concentrate or “brain fog,” depression, anxiety, headaches and difficulty sleeping. Often there is long-lasting loss of smell and taste. Fatigue is common, as is feeling weak after mild exercise. Breathing problems include shortness of breath at rest, as well as coughing, sneezing, and chest pain with breathing. Abnormally rapid or slow pulse rates and blood clots reflect damage to the heart. Stomach and bowel problems include loss of appetite, weight loss, bloating, vomiting and diarrhea. Kidney problems at times requiring dialysis have been reported, as well as low thyroid hormone and decreased pancreatic enzyme production. A new finding in the Nature Medicine study is the high number of individuals reporting reproductive disfunction, including low sex drive, impotence and menstrual irregularity.
Who is at Risk for Long COVID?
Because of the multiple organ systems involved, researchers highly suspect that these symptoms that linger or recur after the acute viral infection reflect direct damage by the virus to various organs, such as the lungs and heart, or a malfunction of a person’s immune system triggered by the virus, or both. Our inability to predict who will wind up with long COVID only adds to the uncertainty we currently have with this condition. However, we do know who is more likely to develop long COVID. People who have experienced more severe COVID-19 infection, especially those hospitalized or needing respirators, are at especially high risk. So are people with pre-existing health conditions, such as diabetes, obesity, immune disorders, or heart and lung disease. Populations generally at higher risk for long COVID are those more likely to get COVID-19 in the first place, including the unvaccinated, the elderly, and those with high work exposure or poor access to health care. Although the reasons are not clear, middle-aged women are afflicted with long COVID more often than men. Children can show symptoms of long COVID; the good news is that the number of cases is much lower than in adults and most of the symptoms tend to go away in a few months.
Preventing Long COVID
The best way to prevent long COVID is to protect yourself and others from becoming infected with COVID-19. The best way to do this is to get vaccinated and to keep up to date with booster vaccinations. This is especially important for people at high risk, including the elderly and those with underlying medical conditions. Research has found that people who are vaccinated and have experienced a prior or subsequent infection with COVID-19 are 15-30% less likely to develop symptoms of long COVID, compared to those that are unvaccinated.