Long COVID

Given the huge list of symptoms, we won’t get into all of them here. But, Dr. Carnavali says, there are several long COVID symptoms that are particularly common:

• Intense, persistent fatigue, which can make a normal daily routine feel impossible at times
• “Brain fog”—a catch-all term for memory problems, difficulty concentrating, or just feeling like your usual mental sharpness is dulled
• Racing heartbeat and dizziness that hit after you stand up—what doctors call postural orthostatic tachycardia syndrome (POTS for short)

“Those would be top of the list,” Dr. Carnavali says, “but the reality is, we have people come in with all kinds of symptoms.”

Some of the other common issues can be grouped according to the body system they’re disrupting, per the CDC:

• Heart and respiratory symptoms, like shortness of breath, chronic cough, and chest pain
• Nervous system symptoms, including sleep problems; recurring headaches; pins-and-needles sensations (often in the hands and feet); and changes in sense of smell and taste
• Mental health issues like feeling depressed or anxious
• Digestive symptoms, like diarrhea, constipation, or stomach pain
• Persistent joint or muscle pain
• Stubborn skin problems, including rashes or swollen, discolored toes (a.k.a. COVID toes)

Those are some of the possible symptoms, but, again, the experience of long COVID is different for everyone. People can have a combination of symptoms, and the severity ranges, too: It can be fairly mild and manageable, or completely debilitating. Many people find that physical or mental activity can worsen their symptoms (a problem called post-exertional malaise, or PEM). On top of that, Dr. Carnavali says, the course of long COVID can take different directions: Symptoms can be steady, worsen over time, or get better for a period then come roaring back.

Long COVID symptoms can sometimes be similar to another poorly understood post-viral illness called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which can cause fatigue that’s not improved by rest, dizziness, pain, and issues with thinking and sleeping.

So in other words, It’s complicated. For the average person, Dr. Carnavali’s advice is to take a simpler view: If, after a bout of COVID, you develop a new (or worsening) symptom you just can’t shake, call your doctor. Even if it’s not long COVID, Dr. Carnavali notes, some other underlying condition might be the culprit.

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The short answer is anyone infected with SARS-CoV-2 can develop long COVID—including adults of all ages and kids. It can strike after a mild infection, or even one that causes no symptoms at all. But based on the existing research, some people seem to be at greater risk than others:

• People who had severe COVID, especially if they were hospitalized
• People with certain chronic health conditions, including diabetes, asthma, and heart disease
• Women. A number of studies have found higher rates of long COVID among women than men. A 2023 Census Bureau survey found that of US adults who’d ever had COVID, 36% of women said they’d developed long COVID symptoms—versus 24% of men.
• Hispanic Americans. In that same Census survey, US adults who identified as Hispanic had the highest rate of long COVID symptoms of any racial/ethnic group (at 36% of the total respondents).
• People who haven’t been vaccinated (more on this later)

It’s not always clear why certain people are at increased risk—women being a case in point, Dr. Carnavali says. Researchers have speculated that it might be related to the immune system response to the virus, which tends to be pretty fierce in women and may go overboard in some cases. In general, theories on the causes of long COVID revolve around the immune system. Which brings us to…

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COVID isn’t the only virus that can cause lasting problems. Other viruses and bacterial infections can cause symptoms that linger for months, or beyond including herpesviruses (which cause cold sores, chicken pox, and shingles) and streptococcus (which is a type of bacteria responsible for strep throat and rheumatic fever). There are probably multiple reasons why this happens and scientists haven't nailed them all down yet, but here are some of the leading ideas on what might be driving long COVID symptoms:

• Viral persistence. Some studies have found that people with long COVID are more likely to still have bits of coronavirus protein floating around in their blood, versus people who fully recover. Those viral stragglers might draw an ongoing immune reaction, which could lead to chronic inflammation in the body, and certain symptoms.
• Autoimmunity. Once a person’s immune system has gone full tilt to fight the coronavirus, it may sometimes get stuck in the “on” position and directly attack the body’s own tissue. Women are more prone to autoimmune diseases than men, so some researchers suspect this may be one reason they’re also more likely to develop long COVID. People who’ve had COVID are known to be at higher risk for autoimmune conditions, like type 1 diabetes, which jumped up during the pandemic.
• Reactivated viruses. Some really common viruses continue to live in the body after they infect people (like the Epstein-Barr virus that can cause mono). Usually, they hang out in a “dormant” state and cause no problems—unless the immune system loses its ability to keep them in check. There’s evidence that in some people with long COVID, formerly sleeping viruses have been awakened, which may be related to certain symptoms, like fatigue.
• Gut bacteria. The huge collection of friendly bacteria in our guts have lots of important jobs, including giving the immune system a hand. Some research suggests that the particular makeup of your gut bacteria may play a role in your chances of developing long COVID.

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There’s no specific test that can tell you long COVID is the source of your misery, Dr. Carnavali says. Instead, he explains, it’s typically a “diagnosis of exclusion.” That is, doctors will ask about symptoms, perform a physical exam and maybe order tests—like a chest X-ray or electrocardiogram of the heart—to rule out other causes.

If you have symptoms you suspect are COVID-related, Dr. Carnavali says your best bet is to get an appointment at a long COVID clinic if you happen to live near one. (The nonprofit Long COVID Alliance maintains a national directory of them.) Otherwise, start with your primary care doctor.

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Since the exact causes of long COVID aren’t clear, current treatments usually aim to ease symptoms, Dr. Carnavali says. Depending on what that looks like, you may need to see one or more specialists (though that also hinges on practical realities like insurance coverage and access). Some examples of ways to treat or manage long COVID:

• Medically guided breathing exercises for ongoing breathing problems; supervised exercise for certain symptoms (like heart palpitations or fatigue, if a person can handle the exertion); and physical therapy for joint and muscle pain
• Lifestyle changes to cope with problems like fatigue and brain fog. That could mean changing your bedtime routine to get more restful sleep, or taking short breaks during the day to lighten the load on your brain. Dr. Carnavali says that figuring out how to pace yourself throughout any given day, rather than pushing through, can be really helpful for fatigue and post-exertional malaise. That’s something many people with ME/CFS have learned, he notes, and the CDC has more on that.
• Counseling and support groups for mental health symptoms like depression or anxiety
• Medications that address certain symptoms, like breathing problems, rapid heartbeat, or pain

Researchers are currently studying many other possibilities for getting ahead of long COVID, including:

• Paxlovid and other antiviral medications (based on the fact that remaining or reactivated viruses might cause symptoms in some people)
• Diets aimed at promoting a healthy balance of gut bacteria
• Melatonin supplements and light therapy for sleep problems
• Drugs that are already used for other conditions. One example is naltrexone, a medication for substance misuse that, in low doses, is sometimes used to help with conditions like ME/CFS. In studies, it’s shown promise for easing long COVID symptoms like fatigue and brain fog.

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Yes—but, by definition, it takes time. In one 2022 survey of US adults, almost 20% of those who’d ever had COVID said they’d developed long-haul symptoms. By the time of the survey, roughly half had recovered. Another study, of long COVID patients in France, found that nearly all saw their symptoms improve, but for more than 90%, it was a slow process over the course of two years.

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There’s good news on this front. Evidence is growing that COVID vaccination cuts the risk of long COVID (probably, in part, because you’re less likely to get really sick with the initial infection). And staying up to date on the recommended shots might boost that protection. A 2024 study published in the New England Journal of Medicine found that rates of long COVID declined after the first year of the pandemic, and vaccination is the main reason (changes in the coronavirus variants are another). Of vaccinated adults who contracted COVID during the “omicron era” (which began in late 2021), 3.5% developed long COVID symptoms over the next year—versus nearly 8% of unvaccinated people.

“The best way to prevent long COVID is to prevent infection in the first place,” Dr. Carnavali says, adding that vaccinations will “help you significantly.” But there's also no guarantee, which is why other protective tactics, too—like masking in potentially risky situations and practicing good air hygiene—are important. Beyond that, Dr. Carnavali says, everyone can help contain COVID spread by staying home when they’re sick.

One more thing: There’s no point where you’re not at risk of long COVID. No matter how many times you’ve already had COVID and been lucky enough to dodge lasting symptoms, you can still get long COVID next time.

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There has definitely been progress in understanding and managing long COVID since that 2020 Times op-ed. But living with the condition can still be tough—if you can’t find effective treatment, can’t work, or can’t do all of the things that used to make you happy. In general, Dr. Carnavali notes, our society isn’t always great at supporting (or believing) people who are chronically ill but don’t “look” sick.

That said, there are resources out there. If you’ve been diagnosed with long COVID, you can check out COVID.gov to see if you qualify as an individual with a disability (and should be given workplace accommodations, for example). The CDC has a checklist to help you get the most out of your healthcare appointments. And there are numerous support/advocacy groups for people with long COVID and parents of kids with the condition, like the Long COVID Alliance, Long COVID Families, and the Longhauler Advocacy Project.

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