While many people with COVID-19 don’t become seriously ill, even a mild case or an asymptomatic infection can potentially lead to chronic illness. Long COVID (also commonly known as post-COVID conditions and long-hauler syndrome) comprises a wide range of lingering, returning, or brand new health problems experienced more than four weeks after your initial infection. Long COVID can manifest as various types and combinations of health problems that can differ in duration.

At a special meeting of the American Medical Association in June 2021, delegates recognized long COVID (officially called Post-Acute Sequelae of SARS-CoV-2 infection) as a distinct diagnosis. At this conference, Devang Sanghavi, M.D., an intensivist and the medical director of the MICU at Mayo Clinic in Jacksonville, Florida, discussed what patients need to know about long-hauler syndrome. 

Categories of Long COVID

According to Dr. Sanghavi, “COVID-19 itself has direct cell damage because of the virus, and this can cause lingering or ongoing symptoms.” Because of this, he continued, long COVID can be divided into three categories:

• Patients who don’t fully recover and experience ongoing symptoms 
• Patients with symptoms related to chronic hospitalization, especially in ICU, resulting in muscle weakness, cognitive dysfunction, and psychosocial stress 
• Patients whose symptoms manifest after recovery from the initial illness

“There are various patient factors at play,” he explained, and “symptoms that linger on are produced after the recovery because of this interplay between inflammatory markers and the immune system.”

Higher Severity Needs Faster Attention

Symptoms can be assessed based on their severity and duration. Severe acute symptoms require immediate medical attention, while chronic (long-term) symptoms can be evaluated in depth to determine if they are related to a prior COVID infection or to a new condition entirely. 

It’s possible for another condition to be “masquerading as long COVID,” Sanghavi said. “If a patient had no symptoms before and now has new symptoms, you don’t want to label it as long COVID…before you rule out other conditions.”

All Organ Systems Affected

“Symptoms of long COVID are like COVID-19 itself because it affects all organ systems,” said Dr. Sanghavi. In addition to basic systemic symptoms such as fatigue and post-exertional malaise, other body system effects can include:

• Neurological symptoms such as anxiety, depression, insomnia, cognitive dysfunction (or brain fog), and loss or distortion of the senses of smell and taste 
• Cardiac symptoms such as heart palpitations and vascular issues, including blood clots
• Respiratory symptoms like shortness of breath (from damage to the lungs)
• Gastrointestinal issues such as loss of appetite and diarrhea
• Renal (kidney) issues like acute kidney injury, which can lead to the need for dialysis
• Epidermal (skin) symptoms such as rashes and hair loss

“No organ system is spared from long COVID,” Dr. Sanghavi stressed.

How Long COVID Affects Children

In the early days of the pandemic, there was scarce data on the long-term effects of COVID on children. Now, said Dr. Sanghavi, there is “clear evidence” that, while the number of cases appears to be lower, children can develop long COVID, and their symptoms are similar to those of adults. Some of these include:

• Fatigue
• Brain fog
• Difficulty concentrating
• Insomnia

Reports indicate that most of these symptoms go away within a couple of months.

Women Are Affected More Than Men

“Recent studies have shown that there is an increased percentage of females, as compared to males, who have long-COVID syndrome,” said Dr. Sanghavi, noting that this is a global phenomenon. “This is across Asia, Europe, and America, and similar trends are being seen.

Predominantly middle-aged females become affected from long COVID more than males. We still need to focus more on this particular topic to discern why this is happening.” 

Vaccination Helps Prevent and Reduce Long COVID

COVID-19 vaccines are “safe and effective,” Sanghavi said, and, while some breakthrough infections are to be expected, “what is reassuring is that patients who were vaccinated, in those rare instances where they got a breakthrough infection, those patients are 50% less likely to develop long COVID or post-COVID syndrome.”

You’re Not Alone – Seek Help and Take Precautions

It’s important that long-COVID patients not feel isolated, alienated, or hopeless, said Sanghavi. “There is no reason why patients should not seek care and help. There are millions of others like them who are suffering and have similar symptoms.” Many hospitals have established multidisciplinary clinics specifically designed to help patients who are dealing with long-COVID symptoms.

Sanghavi emphasizes that everyone is in this together–patients, medical professionals, and scientists alike. “Our best minds in the field of medicine are working to crack the code and find better treatment options for long-COVID patients,” he said. “The best way to avoid long COVID is to fight COVID-19,” by taking all possible precautions.

“There are three vaccines available in the United States,” he said, “so pick your choice and get vaccinated. Get a booster dose whenever that is available and protect yourself from this virus.”

*Berg, S. (2021, Oct. 22). What Doctors Wish Patients Knew About Long COVID. American Medical Association.    https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-long-covid 

Much about the novel coronavirus, i.e., COVID-19, is still not fully understood. As research progresses and our knowledge of the virus increases, information can change rapidly. We strive to update all of our articles as quickly as possible, but there may occasionally be some lag between scientific developments and our revisions.