Long COVID: What Is It, What To Expect, And How To Manage Symptoms
Long COVID is a complex condition that can cause a significant impact on daily life, work, social obligations, and more. We look at what to expect from symptoms and how to manage them, as well as what we do and don’t know about this condition.
Long COVID is a term used to describe symptoms and effects that persist after an infection with COVID-19. This is a chronic condition that can include a variety of different symptoms, often affecting multiple systems within the body. Symptoms often include fatigue, brain fog, shortness of breath, and/or a persistent cough.
Long COVID is thought to occur in at least 10% of people with a previous COVID-19 infection, though some estimates are higher. While the specifics vary from person to person, an individual may be diagnosed with long COVID – also known as post-COVID syndrome or long-haul COVID – if symptoms are present for 3 months or longer after a COVID-19 infection.
How Long Does COVID-19 Incubate?
The incubation period of a viral infection refers to the window of time between when you are exposed to the virus and when you begin to notice symptoms.
The incubation period of COVID-19 ranges from around 3 -14 days. In the earlier days of COVID-19, the average incubation period was found to be 6.5 days. However, the average incubation period has notably shortened with newer variants of the virus. For example, the average incubation period of the Omicron variant is closer to 2-4 days.
There are a few other factors that may influence variability in the incubation period, including age, underlying conditions, and environment where the virus was transmitted.
However, these factors are not yet well understood by researchers.
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How Long Are You Contagious With COVID?
In general, you are most contagious with COVID-19 for one to two days before the start of symptoms and about a week afterwards, but this does vary from person to person. A recent study found that people are most contagious on the fourth day of symptoms, with infectiousness beginning to wane from there.
However, you may be contagious with COVID-19 for up to 20 days or even longer. Some research has found that those with more severe cases of COVID, or those who are immunocompromised, may be more likely to be infectious for longer.
How Long Does COVID Last?
A COVID-19 infection typically causes symptoms for one to two weeks. Some people may only experience symptoms for a few days, or not at all. Others may experience persistent symptoms for several weeks, or even years after contracting the virus. If symptoms are present 3 months or longer after infection, this is considered long COVID.
COVID Vs Long COVID: What’s The Difference?
While long COVID is directly related to the COVID-19 virus, there are a few significant differences between the two conditions.
There are several possible symptoms of both COVID-19 and long COVID, but they may differ. While some people with long COVID experience a continuation of their COVID-19 symptoms, others may notice new or different symptoms with long COVID.
While COVID-19 is contagious, long COVID is not, and does not spread between people. There is also no test for long COVID (while tests are available for the COVID-19).
How Long Does it Take to Recover From Long COVID?
The recovery time for those with long COVID can range from 3 months to several years. Long COVID is a newer condition, and due to its chronic or ongoing nature and variability in individual cases, it is currently challenging for researchers to identify a clear average.
One study found that a significant number of people recovered from long COVID after 6 months, and many others recovered after 12 months, with estimates of between 22% and 75% of individuals having recovered after 12-24 months with long COVID. Keep in mind that long COVID is a very specific condition, with symptoms, severity, and recovery time varying significantly from person to person.
What Are the Symptoms of Long COVID?
More than 200 different possible symptoms have been linked to long COVID. Some people may only experience one symptom, while others may experience several. Symptoms may stay the same or change over time.
Common symptoms of long COVID may include:
- Fatigue
- Brain fog, memory loss, or difficulty thinking or concentrating
- Persistent cough
- Shortness of breath or other respiratory difficulties
- Lightheadedness
- Insufficient recovery after exercise or activity
Additional symptoms may include:
- Loss of taste or smell
- Trouble sleeping
- Headaches
- Irregular heartbeat or heart palpitations
- Constipation
- Bloating
- Diarrhea
- Depression
- Anxiety
- Chest pain
- Joint pain
- Changes in menstrual cycle
- Sensitivity to light or noise
Long COVID has also been linked with the diagnosis of other chronic conditions, which may include:
- Autoimmune disease
- Mood disorders
- Anxiety disorders
- Postural orthostatic tachycardia syndrome (POTS)
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
- Fibromyalgia
- Mast cell activation syndrome (MCAS)
- Lung disease
In some cases, symptoms may be hard to define or explain, or may not initially seem connected to COVID.
Brain Fog
One of the most prevalent symptoms of long COVID, and one of its most frustrating and debilitating, is brain fog. Often used to describe various cognitive impairments, brain fog may include sluggish thinking or not thinking clearly, forgetfulness, trouble focusing, or difficulty finding words.
Research has found that around half of those with long COVID report cognitive dysfunction, including brain fog or poor memory. Another study showed that individuals who experience brain fog after an acute COVID-19 affection have significantly lower levels of serotonin – which plays an essential role in memory, cognition, learning, and mood – than those without brain fog.
Other possible factors leading to brain fog for those with long COVID may include an abnormal immune response and increased inflammation, or the possibility that the COVID virus may potentially cross the blood-brain barrier, directly affecting brain cells.
Fatigue
Fatigue is the most frequently reported symptom by those with long COVID. This may not look exactly the same for everyone, as some may feel constantly tired, while others may become easily exhausted after physical activity.
There are also a number of similarities between long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and some individuals may be diagnosed with both conditions. Approximately half of people with long COVID may also meet the criteria for ME/CFS.
ME/CFS is a condition that often occurs after a viral or bacterial infection, and that is characterized by significant fatigue, a reduced ability to engage in pre-illness levels of activities, and often poor sleep and brain fog, among other symptoms.
Breathing Difficulties
Respiratory symptoms including trouble breathing or shortness of breath are common among those with long COVID. Imaging studies have shown that shortness of breath and lung abnormalities to be among the many, though not all, individuals with long COVID who have breathing difficulties.
Lung abnormalities and respiratory problems for those with long COVID, like many symptoms of the condition, may be caused by an overactive immune response and excess inflammation.
Lingering Cough
Coughing is one of the most common and recognizable symptoms of COVID-19, and a persistent cough is also prevalent in long COVID cases. There are a few possible causes for lingering cough, as coughing is a reflex that your body uses to help protect your respiratory system from damage caused by irritants or invaders, including viruses like COVID-19.
In long COVID, the inflammatory processes your body uses to help protect you from illness may persist, continuing to trigger the cough reflex. Persistent inflammation in the nasal passages, sinuses, lungs, or even in the nervous system may be responsible for an ongoing cough.
Managing Long COVID
Managing long COVID can quickly become complicated because it typically involves multiple different organ systems and a broad range of symptoms. One of the most important things to keep in mind is that long COVID is different for every individual. While this might seem overwhelming, it also means that treatment approaches can be personalized for you and your specific case.
Research is ongoing to help us better understand possible patterns, causes, what kinds of treatments may help with different long COVID symptoms.
How is Long COVID Diagnosed?
Unlike the COVID-19 virus, there is no specific test for long COVID. In order to diagnose long COVID, your doctor will review your health history, including any underlying medical conditions, as well as your current symptoms and how long they have been ongoing.
To help determine whether long COVID is likely in your case, your doctor will want to know about your history of COVID-19 (including when you had it, how many times you had it, and what your symptoms were). However, a previous positive COVID-19 test is not required in order to diagnose long COVID.
Your practitioner will also want to rule out other possible causes of your symptoms, and will conduct a physical exam to assess things like your heart rate and blood pressure. Depending on your individual case and symptoms, your doctor may order any number of tests to help procure a clearer picture of what is going on. These may include cognitive tests if you have brain fog, psychological evaluations if you’re experiencing changes in mood, or chest X-rays if you have respiratory symptoms, as a few examples.
Based on the information garnered from taking a health history and ruling out other causes, your practitioner may then diagnose you with long COVID.
How is Long COVID Treated?
There are a number of different treatment options for long COVID, and the ones that work best for you will often depend on your symptoms and other individual factors. Your practitioner can help you come up with a personalized treatment plan, which may also involve guidance from other specialists (such as a cardiologist or a neurologist).
Long COVID treatment options may focus on managing symptoms, healing potential underlying causes, or both. A comprehensive treatment plan should ideally involve both.
Treatment options may include:
Gentle exercise protocols
Exercise routines can help to enhance cognition and may improve long COVID symptoms for many people. However, many individuals with long COVID find that their symptoms worsen after physical exertion. A gentle, cautious, personalized protocol involving exercise and/or physical therapy may be an effective approach.
Pulmonary rehabilitation or breathing exercises
At-home breathing exercises and pulmonary rehabilitation (like physical therapy for your lungs) may help with the management of respiratory symptoms like shortness of breath.
Cough suppressants
Over-the-counter or prescription medications can help to reduce coughing symptoms.
Inhalers
Some people may benefit from prescription inhalers to aid with symptoms including persistent cough or tightness in the chest.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Some may use NSAIDs to help manage symptoms of chest pain or discomfort associated with long COVID.
Low dose naltrexone
Naltrexone is a medication that is typically used to treat alcohol or opioid addictions. In much lower doses, it has been shown to help reduce inflammation and improve immune system function and symptoms in those with conditions including ME/CFS and fibromyalgia. Low dose naltrexone may also help to reduce symptoms including fatigue for those with long COVID.
Counseling or therapy
For those experiencing anxiety or depression as a consequence of long COVID, counseling or therapy may be helpful. It may also prove beneficial to individuals without these symptoms to have somebody to talk to about their condition.
Dietary changes
Switching up your nutritional regimen with foods intended to reduce inflammation and/or improving immune system function may help to improve long COVID symptoms.
Supplements
Gut health support
Because disruptions to the gut microbiome are thought to be one factor behind or cause of long COVID, supporting the gut (for example with probiotics) may be helpful for some people.
One option for obtaining care for long COVID is to work with a house call doctor. For those who are experiencing disruptive fatigue, anxiety, and other symptoms that can be debilitating, having a practitioner come to you can be a much more comfortable and convenient option compared to traveling to a clinic or hospital.
How do you know if this is the right choice for you? Here are some pros and cons of in-home care for long COVID.
Pros of working with a house-call doctor:
- More convenient: Avoid the costs and time associated with travel and parking by working directly with a doctor in the comfort of your own home.
- More personalized: House-call doctors are often able to spend more time with you than in-clinic doctors, and this may allow them to offer more personalized care.
- Less exposure to viruses: Especially for those who are immunocompromised, or simply concerned about contracting another virus when trying to heal from long COVID, remaining safely at home is a more cautious option when it comes to germ exposure.
Cons of working with a house-call doctor:
- Less insurance coverage: Many in-house doctors do not accept insurance coverage, so costs may be more likely to be out-of-pocket.
- Less access to tests, equipment, and resources: The clinical setting offers more access to specialized tests and equipment. Depending on your individual case and needs, this may make in-clinic care a better option for you.
Current Research: What We Do and Don’t Know About Long COVID
Long COVID is a major area of interest for researchers, as it continues to affect people all around the world. At this time, there are still many things that we do not know, however scientists are constantly learning more.
We know that long COVID is a complex, multisystemic (affecting multiple systems) condition. While various estimates and data have been published, we are still looking at very broad ranges when it comes to the likelihood or prevalence of long COVID and the average duration of illness.
Many experts agree that long COVID is likely multifactorial, meaning that it results from multiple factors or causes. Researchers are exploring several of these possible factors and causes, including immune system dysregulation, autoimmunity, imbalance in the gut microbiome (gut dysbiosis), impaired neurological signaling, and abnormal blood clotting.
Excess inflammation is thought to play an important role in long COVID, but we still have more to uncover regarding what is causing excess inflammation for some individuals, but not others. Future research will hopefully help to paint a clearer picture of the development of long COVID, and strategies for both prevention and treatment.
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