What Is Long COVID (PASC)?
Long COVID refers to the health problems you may have long-term after recovering from COVID-19. You may also hear long COVID called long-haul COVID, post-COVID conditions (PCC) or post-acute COVID-19. Another term is post-acute sequelae of SARS-CoV-2 infection (PASC).
Some of these health problems might linger for weeks, months, or even years. Some of the symptoms are the same as for COVID-19, while others are quite different. Nearly 1 in 5 people who've had COVID-19 have symptoms a month or longer after the infection. Among people who needed hospitalization, the stats go up to more than 30%.
Long COVID can happen to anyone, whether you’re otherwise healthy or have other health conditions. You can get it even if your earlier COVID-19 symptoms were mild or moderate. The good news is most people recover from long COVID.
Long COVID Causes
Experts don’t know why people get long COVID, but here are some of the leading theories:
- The SARS-CoV-2 virus (which causes COVID-19) becomes active again, causing symptoms to reappear.
- The immune cells become overactive, releasing high levels of inflammatory substances that can attack organs and tissues.
- The infection causes the immune system to start making autoantibodies that injure your organs and tissues.
- It's a combination of all or some of these theories.
Research continues on that, as well as on:
- Treatment and prevention
- How long it can take to recover from it
- Who is more at risk
- Whether long COVID can make heart and brain problems more likely
- How someone can build immunity after they have COVID-19
- What role vaccines play
Long COVID Risk Factors
You're more likely to get long COVID-19 if you:
- Had severe COVID-19, particularly if you had to stay in a hospital
- Have other health conditions like diabetes, asthma, or an autoimmune disease
- Are obese
- Didn't get the COVID-19 vaccine
- Had multisystem inflammatory syndrome (MIS) during or after COVID-19. This is a rare disease where different body parts, including the heat, lungs, and brain, get inflamed.
- Have female anatomy. Women are 1½ times as likely to have long COVID as men, according to a study. This might be due to hormones causing continual inflammation.
- Are over 40. Long COVID patients were 20% more likely to be over 40, according to the same study.
- Are of Hispanic or Latino heritage, according to some studies
Some people are more likely to get long COVID because they don't have access to proper health care or can't afford it. Having a low income or not being able to get enough rest during the first few weeks of having COVID-19 also seems to raise the risk of getting long COVID, according to some studies. Some people with disabilities are also more likely to get long COVID.
Long COVID Symptoms
Long COVID seems to affect each person in a different way. You might notice a wide range of health problems that could linger for a long time. Most people’s symptoms improve slowly. Common symptoms include:
- Tiredness or fatigue
- Feeling exhausted or collapsing after doing physical or mental tasks that wouldn't have bothered you before (for example, shopping at the grocery store requires a nap in the car before driving home)
Lung and heart symptoms
- Shortness of breath
- Chest pain
- Inflammation of your heart muscle
- Lung-related issues
- Rapid heartbeat
Neurological (or brain) symptoms
- Brain fog
- Numbness and tingling
- Blurred vision
- Tinnitus, or a constant ringing in your ear
- Sleep issues
- Loss of smell and taste
- A hard time with concentration and memory
- Post-traumatic stress disorder (PTSD)
- Suicidal thoughts
- Stomach pain
- Changes in poop color
- Erectile dysfunction
- Changes in your period or worsening PMS
- Joint pain
- Jaundice (yellowing of skin or whites of eyes)
- Muscle pain
- Kidney problems
- Hair loss
- Skin rashes
If you have any of these, tell your doctor about it right away. Because the array of symptoms is so vast, it's possible that your condition might be mistaken for something besides long COVID. There's not a single test you can take to find out if you have long COVID. Your doctor makes that diagnosis based on whether you had COVD-19, your symptoms, plus ruling out other causes.
When do long COVID symptoms show up?
Usually, 4 weeks after getting COVID-19. Some people get long COVID symptoms just days after getting infected with COVID-19. Others who got long COVID didn't know they were infected with COVID-19.
Long COVID in Children
Children and teens can get long COVID, even if they didn't have COVID-19 symptoms. Long COVID symptoms include:
- Anxiety or chest tightness
- Brain fog
- Hair loss
- Weight loss due to eating less, as they have no sense of smell or taste
- Not keeping up with schoolwork or sports
- Constant tiredness
- Rapid heartbeat
Multisystem inflammatory syndrome in children (MIS-C) is also a big problem. This is a serious illness from the SARS-CoV-2 virus that causes inflammation of body parts including the heart, lungs, kidneys, brain, skin, and eyes. Parents should also watch out for a rapid heartbeat or shortness of breath in their kids, both signs of possible heart damage.
Treatment depends on the symptoms your child has. Generally, kids recover faster than adults, but they may have long COVID for several months.
Long COVID Diagnosis
There's no official test to check for long COVID. There are some tests to check whether you have COVID-19.
- PCR test: A health care worker will swab your nose and send the sample to a lab for checking. You get results in a few days. This is the gold standard.
- Antigen test: This is the at-home or rapid test. Your nose is swabbed and the sample tested on the spot using a chemical. You get results in as little as 10 minutes. Generally, the antigen test is not as accurate as the PCR test. If you get a positive result, it means you likely have COVID-19. But a negative result could be false.
Diagnosing long COVID is more a case of ruling out other causes of your health issues. To do that, your doctor may run other tests, including:
- Blood tests
- Heart rate and blood pressure checks
- Chest X-ray
- An exercise tolerance test, such as a sit-to-stand test
Long COVID and Vaccines
As scientists research the causes and symptoms of long COVID, a large study in the United Kingdom looked at data on more than 1.2 million partially or fully vaccinated people.
It found that fully vaccinated people – those who had gotten both doses of COVID-19 vaccines like those made by Pfizer/BioNTech, Moderna, and Oxford/AstraZeneca – had almost 50% lower odds of having COVID symptoms at least 28 days after infection.
The study didn’t include people who got the single-dose Johnson & Johnson/Janssen vaccine, which is not widely used in the U.K.
A separate study found that getting a COVID vaccine not only reduced a person's risk of getting long COVID, it also lessened the symptoms if they did get it.
Long COVID Treatment
Currently, there’s no specific treatment or cure for people with long-haul symptoms.
For long COVID symptoms like a rapid heartbeat and fatigue, lifestyle changes or medications may help. Talk with your doctor about what might work best for you.
Changes like these might help ease long COVID symptoms:
- Take lots of small breaks throughout the day. Understand when you have the most energy and plan how you want to use it. Don’t overdo it. Break up tasks into small chunks.
- Exercise when you can. Start light and build the intensity. You can start with walks and slowly add weights to help build strength. Exercise also releases endorphins that can lift your mood.
- Use a walking stick to lean on if you’re feeling tired.
- To ease muscle or joint pain, try low-intensity flexibility exercises like yoga or tai chi, light stretches, and strength exercises. Stair-climbing and resistance bands can help improve strength.
- Try to stick to a daily routine. This will help with memory and mood issues.
- If you’re having trouble remembering things, write them down or put them in your phone, in a diary, or on a calendar.
- Try to curb distractions when you work or keep a to-do list. This can help improve your focus.
- Reach out to friends and family when you need support and help.
Before you start any exercise or diet routine, check with your doctor or a specialist like a nutritionist or physical therapist.
As long COVID symptoms may last a long time and vary in intensity, be kind to yourself through the recovery process. Know that some days may be worse than others.
If you have severe or worsening shortness of breath or chest pain, call your doctor, call 911, or go to the nearest hospital.
Living with symptoms like brain fog, breathlessness, or chest and joint pain on a daily basis can take a toll on mental health, too. Psychological treatment (therapy) may help people with long-haul symptoms manage uncertainty and anxiety and better navigate the recovery process.
How long does long COVID last?
It can last weeks, months or even years, depending on the symptoms. Data from the U.K.'s Office of National Statistics showed that of the 1.9 million people self-reporting that they had long COVID, 92% had had symptoms for at least 3 months and 41% had had symptoms for at least 2 years.
Long COVID Complications
Some people with long COVID may get new health problems, like diabetes, heart complications, blood clots, or neurological issues (fatigue, brain fog, headaches) because of organ damage to the heart, lungs, kidneys, skin, or brain.
Long COVID Depression
You might feel your mental health is worse after having COVID-19. This is not unusual, and the feeling may lift on its own in a few days or weeks. But if it doesn't, this could be a sign of depression. Among the symptoms, you may:
- Have a low mood lasting 2 weeks or more
- Not get any enjoyment out of life
- Feel sad or hopeless
- Feel tired or lack energy
- Feel angry
- Find it difficult to concentrate on everyday things like reading a book or watching a movie
- Sleep a lot more than usual, or be unable to sleep
- Eat a lot more than usual or not be able to eat
- Have suicidal thoughts
If you have these symptoms for more than 2 weeks, talk to your doctor.
Doctors are still trying to figure out what causes long COVID depression. It may be due to:
- Physical problems you have from your other COVID-related illnesses
- Financial or psychological problems due to COVID (for instance, you lost your job, can't pay your bills, or have been isolated from others)
- Inflammation in the brain brought on by the COVID-19 virus
Long COVID and your heart
When you get long COVID-19, the SARS-CoV-2 virus attacks your body and the cells and muscles in your heart in several ways. Temporary or permanent heart problems could look like:
Heart issues from lack of oxygen. When the virus takes root in your lungs, it causes inflammation. This causes air sacs responsible for oxygen exchange to fill with fluid. When this happens, it cuts down the amount of oxygen that can pass into the bloodstream.
To make up for this, the heart has to pump a lot harder to get enough oxygen-rich blood to the rest of your body. This can take a toll on your heart, and it could fail if it’s overworked.
Myocarditis. This happens when there’s inflammation in the heart. The SARS-CoV-2 virus can attack the endothelial cells – cells that line the inner walls of blood vessels like veins and arteries. This can also cause inflammation within the blood vessels, damage very tiny ones, or cause blood clots. This can disrupt blood flow between the heart and the rest of your body.
You can also develop myocarditis because of the immune response your body puts up to fight off COVID-19.
Stress cardiomyopathy. When you’re infected with COVID-19, the virus can stress out your body and flood it with chemicals called catecholamines. This surge can shock your heart and affect its ability to pump properly. But this is usually temporary. Your heart will recover once your infection clears up.
Arrhythmia and atrial fibrillation. The virus can affect your heart rate, especially if you have long COVID. It can cause it to beat too fast or too slowly; or to beat too fast in a specific pattern, known as atrial fibrillation.
POTS (postural orthostatic tachycardia syndrome). This is a condition in which your heart starts beating really fast when you stand up after lying on your back. You might feel very tired or dizzy or have trouble breathing. In serious cases, the sudden change in heart rate could cause a fainting spell (called syncope).
Heart attack symptoms. Long COVID can cause heart attack-like symptoms such as:
- Shortness of breath
- Heart palpitations
- Chest pain
- Changes in your EKG (electrocardiogram) or your echocardiogram – an ultrasound of your heart
When your doctor runs a test called an angiogram to check for major blockages in your heart's blood vessels, they might not see anything. Doctors are trying to understand more about this.
If you think you might be having a heart attack, don’t try to wait it out or look for home remedies. Get emergency medical help right away.
Long COVID Prevention
The best way to avoid long COVID is to limit the spread of COVID-19 infection and get vaccinated as soon as you can.
The CDC recommends that everyone 6 months and older get the COVID-19 vaccine and everyone get boosters when they are eligible. The vaccines are safe and work well to prevent and limit the spread of the virus. If you have COVID-19, wait until the illness clears before getting the shot. If you’re not sure, ask your doctor.
Also, wear a mask and try to stay at least 6 feet away from other people when you're out in public if you are in an area with a high COVID-19 level, or if you or a loved one is at increased risk from COVID-19. Avoid very crowded places. Wash your hands often with soap and water, or use alcohol-based sanitizer.
When to See a Doctor
If your symptoms continue for 3 months or longer after your initial COVID virus infection (with these symptoms lasting for at least 2 months with no other explanation), you should see your doctor about a possible long COVID diagnosis.
How to prepare for your appointment
- Write down a brief history of your COVID-19 experience plus the symptoms you've had since you had COVID.
- Make a list of the medications you're on. Take this list and the history to your appointment.
- Bring a list of questions to ask. These could include:
- "What treatment(s) are best for my symptoms?"
- "Will exercise help? What kind of exercise and how often?"
- "If I haven't got the COVID vaccine before, would getting it now help with my symptoms?"
- Consider bringing a friend with you to the appointment to take notes. If that's not allowed, take notes during or after the appointment.
- Be sure you understand what the next steps are. For instance, if the doctor orders more tests, know what they are for and when you'll get results.
The CDC website offers a health care appointment checklist for long COVID that you could download.
Living With Long COVID
The most-reported long COVID symptoms are fatigue, shortness of breath, joint pain, and brain fog. Here are some ways to cope with them:
Fatigue: See how you can break up tasks into smaller chunks, and don't be afraid to take a rest in between.
Shortness of breath: When you feel breathless, find a comfortable position to recover (for instance, sitting on a chair and leaning forward, or lying on your side with your head on a pillow). Practice deep breathing exercises when you feel out of breath.
Brain fog: Take notes, either on paper or on a phone app, to remember things. Make a plan before doing new tasks, and break them down into small steps.
Joint pain: Use over-the-counter creams and pills to relieve pain. Try gentle stretching exercises.
Note: Exercise might help to improve some of these symptoms but could also make them worse for people who have post-exertional malaise (when symptoms get worse after even a small physical or mental effort). Before starting any exercise program, check with your doctor.
Most people recover from long COVID. One study found that most cases of long COVID in people with mild COVID-19 symptoms cleared up within a year.
Long COVID as a disability
Long COVID can be a disability under the Americans with Disabilities Act if it "substantially limits one or more major life activities, " according to the U.S. Department of Health and Human Services. These activities can include caring for yourself, walking, sitting, standing, breathing, writing, thinking, etc. These limitations don't have to be permanent.
If your long COVID qualified as a disability, your workplace or a business place may have to make accommodations for you; for instance, providing seating if you couldn't stand up for long periods of time, or giving fueling assistance if you couldn't pump your own gas.
But not every long COVID case is considered a disability. For further information, check out this link from HHS.
Caring for Someone With Long COVID
- Show you care. A lot of times, people with long COVID feel no one takes their symptoms seriously. Really listen to what they tell you, and ask questions about how they are feeling.
- Ask how you can help. Sometimes, people want help with physical tasks, while others might just want a listening ear. You can offer to do household chores, run errands, or go with them to the doctor. But ask first before doing anything.
- Be flexible. Don't take it personally if your friend with long COVID cancels plans at the last minute. Fatigue may have overcome them. At the same time, don't stop inviting them out. Studies have shown that people with chronic conditions often find their social network shrinks and friends are good for mental well-being.
- Take care of yourself. If you're doing a lot of things for a loved one with long COVID, you might feel stressed out. Make time to eat right, exercise, and connect with your own circle of friends.
Long COVID may last weeks or months, sometimes years after you get COVID-19. There is no one test for it, and the symptoms vary a lot, depending on the person. There is also not one treatment. But rest, exercise, writing down things as needed, and stress management may help. Most people eventually recover from long COVID.