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The most common symptoms of COVID-19 are respiratory issues, fever, and a loss of the sense of taste or smell. While most people recover from COVID-19 in a few weeks, an increasing number of people experience a wide range of symptoms that can last for weeks or months.
Since COVID-19 is fairly new, scientists are still understanding how it can impact people. Nonetheless, it is becoming increasingly clear that some people do not recover from COVID-19 in a few weeks and develop what is commonly known as long COVID-19. Long COVID-19 has also been referred to as post-acute COVID-19 syndrome (PACS) and “long-haul COVID.”
COVID-19 is caused by a coronavirus called SARS-CoV-2. Long COVID-19 seems to impact every individual differently, and it can have a wide variety of symptoms. A review of 50 studies found that people with long COVID-19 have reported more than 100 long-term symptoms affecting the lungs, brain, heart, kidneys, and skin. People with long COVID-19 also commonly experienced general pain, fatigue, cognitive impairment, and psychological disorders.
The World Health Organization (WHO) notes that common symptoms include fatigue, shortness of breath, and cognitive dysfunction (“brain fog” or issues with memory or concentration). These symptoms can change in type and severity over time. Some people may feel better and then relapse, or experience worse symptoms again.
The Centers for Disease Control and Prevention (CDC) notes that people with long COVID-19 may experience post-exertional malaise (PEM), or a worsening of their symptoms about 12 to 48 hours after even light physical or mental activity.
Scientists believe the wide variety of long COVID-19 symptoms could be caused by different aspects of viral infection. These include:
The virus that causes COVID-19 has been detected in the lungs of infected people, showing that the virus can directly infect and damage lung tissue, leading to worse lung function. Preexisting lung disease is one of the risk factors for developing severe COVID-19, and lung disease can get worse with COVID-19 infection.
One study of 143 people with COVID-19 who were admitted to a hospital in April or May 2020 found that nearly 73 percent had interstitial pneumonia (inflammation and fluid buildup in the lungs) while they were in the hospital. The study’s researchers followed up about two months after these participants had noticed their first COVID-19 symptoms. At that time, 43 percent still had difficulty breathing (dyspnea), although all of them had been discharged from the hospital several weeks before.
Another study of 55 people who had been hospitalized with COVID-19 reported that about 25 percent still showed signs of lung dysfunction three months after being discharged from the hospital.
These studies show that the lung damage caused by COVID-19 can last for long periods of time, contributing to breathing difficulty and decreased lung function.
People with COVID-19 experience various symptoms affecting the brain and cognition. While some people with COVID-19 recover from these symptoms after a few weeks or months, cognitive issues associated with long COVID-19 can last for months before fully resolving.
A review of studies showed that headaches and dizziness are some of the most common central nervous system symptoms in people hospitalized for COVID-19. One such study in Spain found 14 percent of people surveyed experienced headaches and about 6 percent had dizziness early in COVID-19 infection.
It is not yet clear how the virus interacts with the central nervous system. These symptoms may be due to viral infection of the central nervous system or caused by inflammation from infection that can damage the brain.
The virus that causes COVID-19 can infect the olfactory nerve in the brain, which allows you to smell and also contributes to your sense of taste. Viral infection of this nerve can lead to anosmia, or the loss of sense of smell.
One preprint study showed that 60 percent of women and 48 percent of men still had a decreased ability to smell approximately 200 days after they experienced their first COVID-19 symptoms. The researchers noted that the loss of smell usually also occurs with loss of taste (ageusia) and can last for months, making it a key symptom of long COVID-19.
Some people with COVID-19 describe feeling “off” and having issues with concentration, memory, and completing common daily tasks. This is sometimes referred to as “brain fog.”
Researchers aren’t sure exactly how COVID-19 leads to brain fog. Some suggest it could be due to reduced oxygen supply to the brain caused by lung damage. It could also be an effect of inflammation of the brain, a lack of proper blood flow to the brain due to inflamed blood vessels, or infection of the brain itself from the coronavirus.
COVID-19 can also cause symptoms like body aches and headache, which can simply make it difficult to get enough rest. Many people with long COVID-19 also report fatigue that can make it hard to concentrate and think clearly.
Cardiovascular disease is a risk factor for developing severe COVID-19. The coronavirus that causes COVID-19 can injure the heart either through direct infection of the cells in the heart, excessive inflammation during infection that damages the heart, or the increased risk of blood clots (which may increase the risk of a heart attack). Some antiviral drugs used to treat COVID-19 may also cause damage to the heart.
People with heart damage from COVID-19 tend to be older and have additional health conditions like diabetes, hypertension, previous heart disease, and heart failure. People with COVID-19 who experience cardiovascular symptoms have a greater chance of needing mechanical ventilation. They also have a higher mortality rate while hospitalized.
Studies show cardiac injury appears to affect 20 percent to 30 percent of people hospitalized for COVID-19. Myocarditis, or the inflammation of the heart muscle, is also a prevalent issue in COVID-19. Some studies show that nearly 80 percent of people hospitalized for COVID-19 still had heart abnormalities two to three months after initial infection, and about 60 percent still had myocarditis.
Heart problems do not only affect those with severe COVID-19. One study showed that 37 percent of people who were infected with the virus that causes COVID-19 were diagnosed with myocarditis 10 weeks later, even though only half of those people ever experienced any noticeable COVID-19 symptoms.
Heart damage caused by the COVID-19 virus can contribute to long-term symptoms, like chest pain, trouble breathing, and heart palpitations. Injury to the heart is also associated with other health issues, such as injury to the kidneys. People with long COVID-19 who are experiencing heart problems may need to consult a cardiologist to receive appropriate health care.
One set of symptoms that has been described in people who have had COVID-19 is postural orthostatic tachycardia syndrome (POTS). People with POTS experience a rapid heartbeat when they stand up. A person with this condition can feel their pulse rise 30 or more beats per minute, even if they are not dehydrated and do not have any common reasons for increased heart rate.
Kidney damage caused by the coronavirus may continue to affect people with long COVID-19, and they may require continued kidney treatment. Some people with severe kidney damage may require dialysis.
Scientists don’t yet know exactly how COVID-19 injures the kidneys. Some researchers believe kidney injury could be caused by direct infection of the kidneys, an out-of-control immune system response that damages the kidneys, low oxygen due to lung damage, or an increased risk of blood clots.
Gastrointestinal symptoms, or those affecting the stomach, intestines, and digestion, are common in those with long COVID-19. Digestive symptoms of long COVID-19 may include loss of appetite, nausea, acid reflux symptoms, abdominal bloating, or diarrhea.
People with long COVID-19 may experience various effects on the skin.
An outpatient clinic was established in Italy to care for people who had dermatological (skin) symptoms of COVID-19 after they were discharged from the hospital. Of the 104 people treated, 30 percent still experienced skin symptoms three months after hospital discharge, while about 11 percent still experienced symptoms six months after hospital discharge. The most common symptom seen in this clinic was telogen effluvium, which is a form of hair loss.
COVID-19 is associated with various types of rashes and skin issues. Two separate international registries for dermatological symptoms of long COVID-19 found that some of the most common skin issues were certain rashes and pernio.
Also called chilblains, pernio involves inflammation of the small blood vessels in the fingers and toes, which can lead to itching and blisters or sores. Pernio is one of the most common skin symptoms for people with long COVID-19, although it also occurs in people with mild COVID-19. In one study of people with pernio from long COVID-19, it lasted a median of 15 days. Others in the study experienced pernio for more than 60 days.
Morbilliform is a rash that resembles measles. It has been reported as a common skin symptom experienced by people with long COVID-19.
Retiform purpura is a rash caused by the disruption of small blood vessels, which can lead to skin irritation and skin death. In a study of 171 people who developed new skin symptoms from COVID-19, retiform purpura was only seen in people who had been hospitalized with severe COVID-19.
People suffering from long COVID-19 may experience unique mental health challenges. Those with severe COVID-19 who were treated in an intensive care unit may develop post-intensive care syndrome (PICS). This syndrome encompasses a range of mental health problems, cognitive issues, and physical impairments stemming from prolonged isolation and fear during their hospital stay. Since many people hospitalized in intensive care with COVID-19 cannot have family or friends visit, these effects can be particularly strong. Being unable to visit their loved one in the hospital can cause mental health issues for family members and caregivers as well.
PICS may coincide with other symptoms of long COVID-19 and can make all symptoms seem worse or further impact mental health.
Additionally, one review of 13 studies including over 1,000 people around the world found that about 16 percent of people with severe COVID-19 also experienced post-traumatic stress disorder (PTSD). Long-term mental health impacts from COVID-19, like PICS or PTSD, can contribute to other health effects from long COVID-19.
For those experiencing mental health problems, the CDC recommends the following resources:
On myCOVIDteam, the social network for people with long COVID-19 and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with COVID-19.
Have you experienced long COVID-19? What symptoms have you had? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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Robert Hurd, M.D.
is a professor of endocrinology and health care ethics at Xavier University. Review provided by VeriMed Healthcare Network.
Learn more about him here.
Ashley Knox
is a doctoral candidate at the University of Colorado, where she studies the noncoding RNAs involved in gammaherpesvirus pathogenesis.
Learn more about her here.
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