Long Covid
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Long COVID or long-haul COVID (also known as post-COVID-19 syndrome, post-COVID-19 condition, post-acute sequelae of COVID-19 (PASC), or chronic COVID syndrome (CCS)) is a condition characterized by long-term
health problems A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ar ...
persisting or appearing after the typical recovery period of
COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was COVID-19 pandemic in Hubei, identified in Wuhan, China, in December ...
. Although studies into long COVID are under way, there is no consensus on the definition of the term. Long COVID has been described as having the potential to affect nearly every organ system, causing further conditions (
sequelae A sequela (, ; usually used in the plural, sequelae ) is a pathological condition resulting from a disease, injury, therapy, or other trauma. Derived from the Latin word, meaning “sequel”, it is used in the medical field to mean a complication ...
) including respiratory system disorders, nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, musculoskeletal pain, and anemia. The most commonly reported symptoms of long COVID are fatigue and memory problems. Many other symptoms have also been reported, including malaise,
headaches Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result ...
,
shortness of breath Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing disc ...
,
anosmia Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from hyposmia, which is a decreased sensitivity to some or all smells. Anosmia can be due to a nu ...
( loss of smell),
parosmia Parosmia (from the Greek παρά ''pará'' and ὀσμή ''osmḗ'' "smell") is a dysfunctional smell detection characterized by the inability of the brain to correctly identify an odor's "natural" smell. Instead, the natural odor is usually tr ...
(distorted smell), muscle weakness, low-grade
fever Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
, and
cognitive dysfunction Cognitive disorders (CDs), also known as neurocognitive disorders (NCDs), are a category of mental health disorders that primarily affect cognitive abilities including learning, memory, perception, and problem solving. Neurocognitive disorders i ...
. Overall, it is considered by default to be a diagnosis of exclusion. Estimates of the prevalence of long COVID vary based on definition, population studied, time period studied, and methodology, generally ranging between 5% and 50%. Health systems in some countries and jurisdictions have been mobilized to deal with this group of patients by creating specialized clinics and providing advice.


Terminology and definitions


Overview

''Long COVID'' is a patient-created term which was reportedly first used in May 2020 as a hashtag on
Twitter Twitter is an online social media and social networking service owned and operated by American company Twitter, Inc., on which users post and interact with 280-character-long messages known as "tweets". Registered users can post, like, and ...
by Elisa Perego, an archaeologist at
University College London , mottoeng = Let all come who by merit deserve the most reward , established = , type = Public research university , endowment = £143 million (2020) , budget = ...
. Long COVID has no single, strict definition. It is normal and expected that people who experience severe symptoms or complications such as
post-intensive care syndrome Post-intensive care syndrome (PICS) describes a collection of health disorders that are common among patients who survive critical illness and intensive care. Generally, PICS is considered distinct from the impairments experienced by those who surv ...
or
secondary infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
s will take longer to recover than people who did not require hospitalization (called ''mild COVID-19'') and had no such complications. It can be difficult to determine whether an individual's set of ongoing symptoms represents a normal, prolonged convalescence, or extended 'long COVID'. One rule of thumb is that long COVID represents symptoms that have been present for longer than two months, though there is no reason to believe that this choice of cutoff is specific to infection with the SARS-CoV-2 virus.


World Health Organization clinical case definition

The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) established a
clinical case definition In epidemiology, a clinical case definition, a clinical definition, or simply a case definition lists the clinical criteria by which public health professionals determine whether a person's illness is included as a ''case'' in an outbreak investi ...
in October 2021, published in the journal ''
The Lancet Infectious Diseases ''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823. The journal publishes original research articles ...
'':


British definition

The British
National Institute for Health and Care Excellence The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas: * the use of health technologies withi ...
(NICE) divides COVID-19 into three clinical case definitions: *'' acute COVID-19'' for signs and symptoms during the first four weeks after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the first, and *''long Covid for new or ongoing symptoms four weeks or more after the start of acute COVID-19'', which is divided into the other two: **''ongoing symptomatic COVID-19'' for effects from four to twelve weeks after onset, and **''post-COVID-19 syndrome'' for effects that persist 12 or more weeks after onset. NICE describes the term ''long COVID'', which it uses "in addition to the clinical case definitions", as "commonly used to describe signs and symptoms that continue or develop after acute COVID-19. It includes both ongoing symptomatic COVID-19 (from four to twelve weeks) and post-COVID-19 syndrome (12 weeks or more)". NICE defines post-COVID-19 syndrome as "Signs and symptoms that develop during or after an infection consistent with COVID‑19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post‑COVID‑19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed".


American definition

In February 2021, the U.S.
National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
(NIH) director Francis Collins indicated long COVID symptoms for individuals who "don't recover fully over a period of a few weeks" be collectively referred to as "Post-Acute Sequelae of SARS-CoV-2 Infection" (PASC). The NIH listed long COVID symptoms of fatigue, shortness of breath,
brain fog Clouding of consciousness (also known as brain fog or mental fog) occurs when a person is slightly less wakeful or aware than normal. They are not as aware of time or their surroundings and find it difficult to pay attention. People describe this ...
, sleep disorders, intermittent fevers, gastrointestinal symptoms, anxiety, and depression. Symptoms can persist for months and can range from mild to incapacitating, with new symptoms arising well after the time of infection. The
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC) term ''Post-Covid Conditions'' qualifies long Covid as symptoms four or more weeks after first infection.


Symptoms

A multinational online survey with 3,762 adult participants with illness lasting more than 28 days found that recovery takes longer than 35 weeks for 91% of them. On average, participants experienced 56 symptoms (standard deviation ± 25.5) in nine organ systems. Symptoms varied over time, and the most common symptoms after six months were fatigue,
post-exertional malaise Post-exertional malaise (PEM) is a worsening of chronic fatigue syndrome symptoms that occurs after exertion. PEM involves increased fatigue, and an exacerbation of other symptoms. PEM is often severe enough to be disabling, and is triggered by o ...
and
cognitive dysfunction Cognitive disorders (CDs), also known as neurocognitive disorders (NCDs), are a category of mental health disorders that primarily affect cognitive abilities including learning, memory, perception, and problem solving. Neurocognitive disorders i ...
. Symptom
relapse In internal medicine, relapse or recidivism is a recurrence of a past (typically medical) condition. For example, multiple sclerosis and malaria often exhibit peaks of activity and sometimes very long periods of dormancy, followed by relapse or ...
occurred in 86% of adult participants triggered by physical or mental effort or by stress. Three groups of symptoms were identified: initial symptoms that peak in the first two to three weeks and then subside; stable symptoms; and symptoms that increase markedly in the first two months and then stabilize. Symptoms reported by adults with long COVID include: *Fatigue, including extreme fatigue (see also: CFS) *Long-lasting cough *Muscle weakness *Low-grade
fever Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
*Inability to concentrate (
brain fog Clouding of consciousness (also known as brain fog or mental fog) occurs when a person is slightly less wakeful or aware than normal. They are not as aware of time or their surroundings and find it difficult to pay attention. People describe this ...
) *Memory lapses *
Mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental hea ...
problems, such as changes in mood or depression *Sleep difficulties *Headaches *Joint pain *Prickling pain ( paresthesia) in hands and feet *
Diarrhoea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
*Bouts of
vomit Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenterit ...
ing *Loss of, or changes in, sense of smell (
anosmia Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from hyposmia, which is a decreased sensitivity to some or all smells. Anosmia can be due to a nu ...
or
parosmia Parosmia (from the Greek παρά ''pará'' and ὀσμή ''osmḗ'' "smell") is a dysfunctional smell detection characterized by the inability of the brain to correctly identify an odor's "natural" smell. Instead, the natural odor is usually tr ...
) *Loss of, or changes in, sense of taste *
Sore throat Sore throat, also known as throat pain, is pain or irritation of the throat. Usually, causes of sore throat include * viral infections * group A streptococcal infection (GAS) bacterial infection * pharyngitis (inflammation of the throat) * to ...
and or difficulties swallowing *Circulation disorders, including new onsets of
diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...
and hypertension *Heartburn (
gastroesophageal reflux disease Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...
) *
Skin rash A rash is a change of the human skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cr ...
*Shortness of breath *Chest pains *
Palpitations Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart. Symptoms include a rapi ...
*Kidney problems (including, acute kidney injury and chronic kidney disease) *Changes in oral health (teeth, saliva, gums) *
Tinnitus Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...
*
Hearing loss Hearing loss is a partial or total inability to Hearing, hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to Language ...
*Blood clotting (including
deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enla ...
and
pulmonary embolism Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream ( embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathin ...
) *Erectile dysfunction * Substantial
exercise intolerance Exercise intolerance is a condition of inability or decreased ability to perform physical exercise at the normally expected level or duration for people of that age, size, sex, and muscle mass. It also includes experiences of unusually severe pos ...
more than 3 months after infection; postexertional malaise has been reported in long COVID-19 similar to CFS


Epidemiology

Estimates of the
prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of long COVID vary widely. The estimates depend on the definition of long COVID and the population studied. An April 2022 meta-analysis estimated that the pooled prevalence of post-COVID conditions was 43%, with estimates ranging between 9% and 81%. People who had been hospitalised with COVID saw a higher prevalence of 54%, while this number dropped to 34% for nonhospitalised people. Prevalence generally decreased with a longer follow-up time. In people age 0–18 years the prevalence of long COVID conditions – like mood symptoms, CFS and sleep disorders – appears to be at ~25% overall. In a large population
cohort study A cohort study is a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as birth or graduation), performing ...
in Scotland, 42% of respondents said they had not fully recovered after 6 to 18 months after catching COVID, and 6% indicated they had not recovered at all. The risk of long COVID was associated with disease severity; people with asymptomatic infection did not have increased risk of long COVID symptoms compared to people who had never been infected. Those that had been hospitalised had 4.6 times higher odds of no recovery compared to nonhopitalised people. In June 2022, a
CDC The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
study based on electronic health records showed that "one in five COVID-19 survivors aged 18–64 years and one in four survivors aged ≥65 years experienced at least one incident condition that might be attributable to previous COVID-19" or long COVID. An analysis of private healthcare claims showed that of 78,252 patients diagnosed with 'long COVID', 75.8% had not been hospitalized for COVID-19.


Children

Long COVID is uncommon in children and their features differ from adults: In a retrospective cohort study from October 2022 of almost 660,000 US children tested for SARS-CoV-2 by antigen or polymerase chain reaction, the incidence of at least 1 systemic, syndromic, or medication feature of long COVID (1-6 months afterwards) was 42% among viral test–positive children versus 38% among viral test–negative children, that is there was an incidence proportion difference of only 3.7%. Long COVID was identified more in those cared for intensive care unit during the acute illness phase, children younger than 5 years, and those with complex chronic conditions. Neurological symptoms, such as headache, vertigo, and paresthesiae were not significant findings in this study, as opposed to in adults. A 2021 study from the UK
Office for National Statistics The Office for National Statistics (ONS; cy, Swyddfa Ystadegau Gwladol) is the executive office of the UK Statistics Authority, a non-ministerial department which reports directly to the UK Parliament. Overview The ONS is responsible for th ...
with 20,000 participants, including children and adults, found that, in children who tested positive, at least one symptom persisted after five weeks in 9.8% of children aged two to eleven years and in 13% of children aged 12 to 16 years. A 2022
University College London , mottoeng = Let all come who by merit deserve the most reward , established = , type = Public research university , endowment = £143 million (2020) , budget = ...
study in the UK found that children ages 11–17 who had a positive PCR test were more likely to have three or more symptoms three months after their diagnosis compared to those with a negative test.


Causes

It is currently unknown why most people recover fully within two to three weeks and others experience symptoms for weeks or months longer. The exact processes that cause long COVID remain uncertain, but research has established that long COVID is associated with changes in fatty acid metabolism and mitochondrial dysfunction. A number of mechanisms have been suggested. A March 2021 review article cited the following pathophysiological processes as the predominant causes of long COVID: *direct toxicity in virus-infected tissue, especially the lungs *ongoing inflammation due to post-infection immune system dysregulation *vascular injury and ischemia caused by virus-induced
hypercoagulability Thrombophilia (sometimes called hypercoagulability or a prothrombotic state) is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels). Such abnormalities can be identified in 50% of people who ...
(tendency to form internal clots) and thromboses (internal blood clots) *impaired regulation of the renin-angiotensin system related to the effect of SARS-CoV-2 on
ACE2 Angiotensin-converting enzyme 2 (ACE2) is an enzyme that can be found either attached to the membrane of cells (mACE2) in the intestines, kidney, testis, gallbladder, and heart or in a soluble form (sACE2). Both membrane bound and soluble ACE2 a ...
-containing tissue In October 2020, a review by the United Kingdom's
National Institute for Health and Care Research The National Institute for Health and Care Research (NIHR) is the British government’s major funder of clinical, public health, social care and translational research. With a budget of over £1.2 billion in 2020–21, its mission is to "im ...
hypothesized that ongoing long COVID symptoms may be due to four syndromes: *permanent damage to the
lungs The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side ...
and
heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
, *
post-intensive care syndrome Post-intensive care syndrome (PICS) describes a collection of health disorders that are common among patients who survive critical illness and intensive care. Generally, PICS is considered distinct from the impairments experienced by those who surv ...
, *Post-viral fatigue, sometimes regarded as the same as
myalgic encephalomyelitis Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME) or ME/CFS, is a complex, debilitating, long-term medical condition. The causes and mechanisms of the disease are not fully understood. Distinguishing core symptoms are ...
/ chronic fatigue syndrome (ME/CFS) *continuing COVID-19 symptoms, and *damage to the blood which deprives the body of oxygen. Other situations that might cause new and ongoing symptoms to include: *the virus being present for a longer time than usual, due to an ineffective immune response; *reinfection (e.g., with another strain of the virus); *damage caused by
inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
and a strong immune response to the infection; *
post-traumatic stress Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a ...
or other mental sequelae, especially in people who had previously experienced anxiety, depression, insomnia, or other mental health difficulties; *inhibited oxygen exchange as a result of persistent circulating
blood plasma Blood plasma is a light amber-colored liquid component of blood in which blood cells are absent, but contains proteins and other constituents of whole blood in suspension. It makes up about 55% of the body's total blood volume. It is the intr ...
microclots A thrombus (plural thrombi), colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of ...
; and *development of various autoantibodies after infection.


Similarities to other syndromes

Long COVID is similar to
post-Ebola syndrome Post-Ebola virus syndrome (or post-Ebola syndrome) is a post-viral syndrome affecting those who have recovered from infection with Ebola. Symptoms include joint and muscle pain, eye problems, including blindness, various neurological problems, ...
and the post-infection syndromes seen in
chikungunya Chikungunya is an infection caused by the ''Chikungunya virus'' (CHIKV). Symptoms include fever and joint pains. These typically occur two to twelve days after exposure. Other symptoms may include headache, muscle pain, joint swelling, and a ra ...
and
myalgic encephalomyelitis/chronic fatigue syndrome Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating long-term medical condition. People with ME/CFS experience lengthy flare-ups of the illness following relatively minor physical or mental activity. This is known as ...
(ME/CFS), which is often triggered by infection and immune activation and was previously also known as "post-viral fatigue". The pathophysiology of long COVID may be similar to these other conditions. Some long COVID patients in Canada have been diagnosed with ME/CFS, a "debilitating, multi-system neurological disease that is believed to be triggered by an infectious illness in the majority of cases". There is need for more research into ME/CFS; Anthony Fauci, chief medical adviser to the US government, said that COVID-19 is a "well-identified etiologic agent that should be very helpful now in getting us to be able to understand E/CFS.


Risk factors

Several risk factors have been found for long COVID: *Gender – Women are more likely to develop long COVID than men. Some research suggests this is due primarily to hormonal differences, while other research points to other factors, including chromosomal genetics, sex-dependent differences in immune system behavior; non-biological factors may also be relevant. *Age, with older people more at risk *
Obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...
*
Asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...
*Depression or anxiety *Post-traumatic stress *The number of symptoms during acute COVID


Diagnosis

Xenon MRI is being used to study long COVID, because it provides patients and physicians with explanations for previously unexplained observations. Xenon MRI can measure gas exchange and provide information on how much air is taken up by a patient's bloodstream, which is being researched in long-haul COVID patients. Xenon MRI can quantify three components of lung function: ventilation, barrier tissue uptake and gas exchange. Xenon-129 is soluble in pulmonary tissue, which allows the evaluation of lung functions such as perfusion and gas exchange (an advantage over helium). Ventilation measures how the air is distributed in the lung and can provide the locations of potentially compromised lung areas if no xenon reaches those areas. Barrier tissue uptake and gas exchange measure how much air diffuses across the alveolar-capillary membrane. Xenon MRI helps determine how well air is taken in by the lungs, absorbed into lung tissue, and taken up by the blood.


Prevention

A September 2021 study published in ''The Lancet'' found that having two doses of a COVID-19 vaccine halved the odds of long COVID. However, a May 2022 study published by ''Nature'' that examined VA Saint Louis Health Care System records from January to December 2021 of more than 13 million people, including 34,000 people vaccinated against COVID-19 who had breakthrough infections, found that COVID-19 vaccination reduced long COVID risk by about 15%. Another study found the odds of developing long covid is reduced by 75% with 2 vaccines and by 85% with 3 doses.


Treatment and management

, there is no established pharmaceutical treatments for long COVID. There are however trials in progress for possible treatments. Management of long COVID depends on symptoms, with current guidelines recommending multidisciplinary rehabilitation to improve symptoms and quality of life. Rest, planning and prioritising is advised for people with fatigue. People who suffer from post-exertional system exacarbation may benefit from activity management with pacing. People with allergic-type symptoms such as rashes on the skin may benefit from
antihistamines Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides re ...
. Patients should also be routinely screened for mental health conditions, such as post-traumatic stress, which has been associated with fatigue severity.


Health system responses


Australia

In October 2020, a guide published by the
Royal Australian College of General Practitioners The Royal Australian College of General Practitioners (RACGP) is the professional body for general practitioners (GPs) in Australia. The RACGP is responsible for maintaining standards for quality clinical practice, education and training, and re ...
(RACGP) says that ongoing post-COVID-19 infection symptoms such as fatigue, shortness of breath and chest pain will require management by GPs, in addition to the more severe conditions already documented. In December 2021, research by a
health economics Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. Health economics is important in determining how to improv ...
expert at
Deakin University Deakin University is a public university in Victoria, Australia. Founded in 1974, the university was named after Alfred Deakin, the second Prime Minister of Australia. Its main campuses are in Melbourne's Burwood suburb, Geelong Waurn Ponds, ...
suggests that even without fully understanding the
Omicron variant Omicron (B.1.1.529) is a variant of SARS-CoV-2 first reported to the World Health Organization (WHO) by the Network for Genomics Surveillance in South Africa on 24 November 2021. It was first detected in Botswana and has spread to become the ...
's effects yet, a further 10,000 to 133,000 long COVID cases are likely to emerge on top of the current approximately 9450 in
New South Wales ) , nickname = , image_map = New South Wales in Australia.svg , map_caption = Location of New South Wales in AustraliaCoordinates: , subdivision_type = Country , subdivision_name = Australia , established_title = Before federation , es ...
and 19,800 in
Victoria Victoria most commonly refers to: * Victoria (Australia), a state of the Commonwealth of Australia * Victoria, British Columbia, provincial capital of British Columbia, Canada * Victoria (mythology), Roman goddess of Victory * Victoria, Seychelle ...
, after border and other restrictions had been recently lifted. The RACGP released new guidelines for general practitioners to manage a large number of new long COVID patients.


South Africa

In October 2020, the DATCOV Hospital Surveillance Department of the National Institute for Communicable Diseases (NICD) looked into a partnership with the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) (an open-access research and data resource) in order to conduct clinical research into the impact PASC may have within the South African context. As of 30 January 2021, the project has yet to receive ethical approval for the commencement of data collection. Ethics approval was granted on 3 February 2021 and formal data collection began on 8 February 2021.


United Kingdom

In Britain, the
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
set up specialist clinics for the treatment of long COVID. The four Chief Medical Officers of the UK were warned of academic concern over long COVID on 21 September 2020 in a letter written by
Trisha Greenhalgh Patricia Mary "Trisha" Greenhalgh (born 11 March 1959) is a British professor of primary health care and a practising general practitioner. Early life and education Greenhalgh attended Folkestone Grammar School. She gained a BA in Social ...
published in ''
The BMJ ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
'' signed by academics including
David Hunter David Hunter (July 21, 1802 – February 2, 1886) was an American military officer. He served as a Union general during the American Civil War. He achieved notability for his unauthorized 1862 order (immediately rescinded) emancipating slaves ...
,
Martin McKee Clifford Martin McKee, CBE (born 12 July 1956), is professor of European public health at the London School of Hygiene and Tropical Medicine. Biography He was educated at the Royal Belfast Academical Institution and trained as a doctor at ...
, Susan Michie, Melinda Mills, Christina Pagel, Stephen Reicher, Gabriel Scally,
Devi Sridhar Devi Lalita Sridhar FRSE (born 1984) is an American public health researcher, who is both professor and chair of global public health at the University of Edinburgh, Scotland. Her research considers the effectiveness of public health intervent ...
,
Charles Tannock Dr Timothy Charles Ayrton Tannock (born 25 September 1957) is a British psychiatrist, Conservative Party politician and former Member of the European Parliament (MEP) for London. Education Tannock was educated at Bradfield College, before g ...
, Yee Whye Teh, and Harry Burns, former CMO for Scotland. In October 2020, NHS England's head Simon Stevens announced the NHS had committed £10 million to be spent that year on setting up long COVID clinics to assess patients' physical, cognitive, and psychological conditions and to provide specialist treatment. Future clinical guidelines were announced, with further research on 10,000 patients planned and a designated task-force to be set up, along with an online rehabilitation service – "Your Covid Recovery". The clinics include a variety of medical professionals and therapists, with the aim of providing "joined-up care for physical and mental health". NHS Long COVID clinics have been found to positively impact quality of life and support the management of symptoms, although further research is required to improve these services. The
National Institute for Health Research The National Institute for Health and Care Research (NIHR) is the British government’s major funder of clinical, public health, social care and translational research. With a budget of over £1.2 billion in 2020–21, its mission is to "impr ...
has allocated funding for research into the mechanisms behind symptoms of long COVID. In December 2020,
University College London Hospitals University College Hospital (UCH) is a teaching hospital in the Fitzrovia area of the London Borough of Camden, England. The hospital, which was founded as the North London Hospital in 1834, is closely associated with University College London ...
(UCLH) opened a second long COVID clinic at the
National Hospital for Neurology and Neurosurgery The National Hospital for Neurology and Neurosurgery (informally the National Hospital or Queen Square) is a neurological hospital in Queen Square, London. It is part of the University College London Hospitals NHS Foundation Trust. It was the ...
for patients with post-COVID neurological issues. The first clinic had opened in May, primarily focused on respiratory problems, but both clinics refer patients to other specialists where needed, including
cardiologist Cardiology () is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular ...
s,
physiotherapist Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patien ...
s and
psychiatrist A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
s. By March 2021 there were 69 long COVID clinics in the English NHS, mostly focussing on assessing patients, with more planned to open. There were fears that community rehabilitation services did not have capacity to manage large numbers of referrals. On 18 December 2020, the
National Institute for Health and Care Excellence The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas: * the use of health technologies withi ...
(NICE), the
Royal College of General Practitioners The Royal College of General Practitioners (RCGP) is the professional body for general (medical) practitioners (GPs/ Family Physicians/ Primary Care Physicians) in the United Kingdom. The RCGP represents and supports GPs on key issues including ...
(RCGP) and the
Scottish Intercollegiate Guidelines Network Healthcare Improvement Scotland (HIS) is the national healthcare improvement organisation for Scotland. It is a public body which is part of the Scottish National Health Service, created in April 2011. History NHS Quality Improvement Scotland ( ...
(SIGN) published a guide to the management of long COVID. The guideline was reviewed by representatives of the UK doctors #longcovid group, an online support group for COVID long-haulers, who said that it could be improved by introducing a more comprehensive description of the clinical features and physical nature of long COVID, among other changes. In November 2021 complaints were reported from NHS staff that neither their employers nor their trades unions were supportive, though the British Medical Association was pushing for long COVID to be classed as an
occupational disease An occupational disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevale ...
. In May 2022 demand for occupational therapy led rehabilitation services in Britain was reported to have increased by 82% over the previous six months as occupational therapists were supporting people whose needs have become more complex because of delays in treatment brought about by the pandemic. Half of occupational therapists surveyed were supporting people affected by lasting Covid symptoms.


United States

On 23 February 2021, the
National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
director,
Francis Collins Francis Sellers Collins (born April 14, 1950) is an American physician-geneticist who discovered the genes associated with a number of diseases and led the Human Genome Project. He is the former director of the National Institutes of Health (N ...
, announced a major initiative to identify the causes and ultimately the means of prevention and treatment of people who have long COVID. Part of this initiative includes the creation of the COVID-19 Project, which will gather data on neurological symptoms associated with PASC. On 28 April 2021, the Subcommittee on Health of the U.S. House of Representatives' Committee on Energy and Commerce held a hearing about long COVID. In February 2022, it was announced that at least sixty-six hospitals and health systems had launched COVID recovery programs to aid patients who experience long term or lingering symptoms.


Society and culture

Some people experiencing long COVID have formed groups on social media sites. In many of these groups, individuals express frustration and their sense that their problems have been dismissed by medical professionals. There is an active international long COVID patient advocacy movement. Founded by Lisa McCorkell and other scientists who are also long COVID patients, the Patient-Led Research Collaborative has carried out surveys to gather data on long COVID symptoms, and has received funding for five long Covid research projects led by patients themselves.


See also

* *
Impact of the COVID-19 pandemic on neurological, psychological and other mental health outcomes There is increasing evidence suggesting that COVID-19 causes both acute and chronic neurological or psychological symptoms. Caregivers of COVID-19 patients also show a higher than average prevalence of mental health concerns. These symptoms resul ...
– both acute and chronic neurological, psychiatric, olfactory, and mental health conditions *
Multisystem inflammatory syndrome in children Multisystem inflammatory syndrome in children (MIS-C), or paediatric inflammatory multisystem syndrome (PIMS / PIMS-TS), or systemic inflammatory syndrome in COVID-19 (SISCoV), is a rare systemic illness involving persistent fever and extreme i ...
– pediatric comorbidity from COVID-19 *
Post viral cerebellar ataxia Post-viral cerebellar ataxia also known as acute cerebellitis and acute cerebellar ataxia (ACA) is a disease characterized by the sudden onset of ataxia following a viral infection. The disease affects the function or structure of the cerebellum ...
– clumsy movement appearing a few weeks after a viral infection * Post-Ebola virus syndrome – symptoms that persist after recovering from Ebola *
Post-polio syndrome Post-polio syndrome (PPS, poliomyelitis sequelae) is a group of latent symptoms of poliomyelitis (polio), occurring at about a 25–40% rate (latest data greater than 80%). These symptoms are caused by the damaging effects of the viral infection ...
– delayed reaction appearing years after acute polio infection resolves


References


Further reading


General


Long-term effects of coronavirus (long COVID)
at UK
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

News
from
BBC News BBC News is an operational business division of the British Broadcasting Corporation (BBC) responsible for the gathering and broadcasting of news and current affairs in the UK and around the world. The department is the world's largest broadca ...


Journal articles

* * * * * *


External links

* (21 October 2020) – UK Government film about long COVID.
Living with Covid19
A review of what is known about long COVID by the NIHR. *
RECOVER: Researching COVID to Enhance Recovery
(U.S.
National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
) {{DEFAULTSORT:Long Covid Impact of the COVID-19 pandemic on other health issues Coronavirus-associated diseases COVID-19