By Daniel G. Graetzer, Ph.D.
Faculty Member, School of Health Sciences
Long-haul COVID-19, otherwise known as long COVID, is a growing health problem for people infected with the coronavirus. This disease is difficult to precisely define and diagnose, but it is estimated that long COVID affects five to 25 million Americans and about 200 million people worldwide.
What Are the Symptoms of Long COVID?
Typically, long COVID symptoms occur for several months after a patient is first infected with the coronavirus and recovers from the acute phase of COVID-19. The symptoms of long COVID include:
- Difficulty breathing
- Fatigue or malaise
- Difficulty thinking or concentrating (“brain fog”)
- Chest pains
- Fast-beating or pounding heart
- Joint or muscle pain
- Pins-and-needles feeling
- Sleep problems
- Dizziness on standing (lightheadedness)
- Mood changes
- Change in sense of smell or taste
- Changes in menstrual period cycle
Long COVID can also result in one or more serious physical and/or mental health problems, including organ damage, depression, and anxiety.
Possible Causes of Long COVID
Although much more research needs to be done, long COVID is probably due to the coronavirus hiding within body tissues after the initial infection. The virus can then evade the body’s natural immune defenses and cause chronic, extreme inflammation from ongoing viral replication.
It is also possible that dysbiosis – imbalances in the normal complement of microbes with the respiratory and digestive tracts – may cause this inflammation or the activation or reactivation of other viruses. Autoimmunity, where the immune system creates antibodies that attack body tissues, may be occurring in a person with long COVID, along with microclots that prevent oxygen delivery to various tissues and organs.
Long COVID Symptoms May Differ Depending Upon Which Variant Caused COVID-19 in a Patient
Long COVID symptoms may differ with different variants of the coronavirus. Preliminary data indicates that fatigue and the loss of smell (anosmia), taste (ageusia) and hearing were most prevalent during the first year of the pandemic when the original “wild” form of the coronavirus was spreading around the world. Muscle pain, labored breathing, cognitive issues, anxiety and depression were reported much frequently when the alpha variant was dominant in the first quarter of 2021.
The omicron variant is very good at evading the body’s natural immune defenses that have been stimulated by COVID-19 vaccines. That ability to evade detection makes it possible for patients infected with the omicron variant to experience more long COVID health problems. Variants that lead to a more localized infection that does not spread throughout the body as much as other variants may result in fewer long COVID cases.
A mild coronavirus infection – such as what we’ve seen with the highly transmissible omicron variant – could possibly cause long COVID. Even carriers (infected people who do not show symptoms and may not even know they were infected) can experience continual or recurring long COVID.
Related link: From Delta to Omicron: How Coronavirus Variants Behave
Long COVID Policies and Legislation
In 2021, the American Medical Association adopted a policy to support the development of an ICD-10 code or family of codes to recognize Post-Acute Sequelae of SARS-CoV-2 (PASC or long COVID) and other novel (new) post-infection syndromes as a distinct diagnosis. ICD-10 codes are critical to clinical decision making because they:
- Standardize diagnostic criteria for research and medical record keeping throughout the world
- Improve treatment options and disease outcomes
- Lower insurance costs
- Improve insurance claims processing
- Reduce medical errors such as with medication prescriptions
Long COVID is now a disability under the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, and Section 1557 of the Patient Protection and Affordable Care Act if it substantially limits one or more major life activities. This legislation was created with guidance from the Office for Civil Rights of the Department of Health and Human Services and the Civil Rights Division of the Department of Justice.
Examples where long COVID limits major life activities include:
- Lung damage resulting in shortness of breath, fatigue and/or related limited respiratory function
- Intestinal pain, vomiting and nausea that substantially limits gastrointestinal function
- Memory lapses and “brain fog” that substantially limits brain function and concentration
Vaccination May Lower the Risk of Developing Long COVID
Vaccination can be helpful in lowering the risk of long COVID. According to University of California professor Dr. Steven Deeks, vaccinated persons appear to have about a 50% lower average risk of developing long COVID than unvaccinated persons.
Related link: COVID-19 vs. Natural Immunity: Which Is Better?
We Should Not Be Complacent about COVID-19 Yet
Overall, COVID-19 survivors experience the symptoms of long COVID differently; the course of recovery is generally not related to the severity of an initial infection. Most patients make a nearly full recovery from COVID-19 within 12 weeks, but some people unfortunately do not. Their long COVID symptoms may change over time or new symptoms may develop.
Humanity has now weathered more than two years of COVID-19, but it is not yet time to be complacent. Bill Gates recently warned that the worst of the pandemic may be yet to come; he estimates is that there is a greater than 5% chance that a more transmissible and lethal coronavirus variant may emerge. How future variants will impact initial and lingering COVID symptoms is unfortunately even more difficult for healthcare providers and governments to predict and prepare for.