Long COVID: Long-Term Effects, What Causes It & Treatment

Clinical review: Manuel Reis
Registered Nurse
January 2023
  1. Long-term effects 
  2. What causes it
  3. Who is at most risk 
  4. Prevention
  5. Treatment

Long COVID is a characterized by the persistence of COVID symptoms and other health effects long after initial infection with SARS-CoV-2. Some common symptoms of long COVID include excessive fatigue, muscular pain, coughing, decreased mental alertness and/or shortness of breath. It is also typically referred to as post-COVID syndrome. 

According to the World Health Organization[1], a patient must meet the following criteria to be diagnosed with long COVID: 

  • Continue to have symptoms 3 months after the first symptoms appeared 
  • Have a confirmed or probably SARS-CoV-2 infection 
  • Symptoms or health problems that last for over 2 months 
  • Other conditions that can cause the symptoms have been ruled out 

This syndrome of symptoms has been observed in people who have been infected with other viruses, like the SARS infection and the Spanish flu. Although these patients do not have the active virus within their body, they continue to present with symptoms that affect their quality of life. This syndrome is considered to be a possible sequela of COVID-19. 

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Long-term effects 

The main symptoms of long COVID present as a syndrome (or an expected pattern), and can include: 

  • Excessive fatigue
  • Muscular pain 
  • Cough 
  • Headache 
  • Stuffy nose 
  • Shortness of breath 
  • Pain or pressure in the chest 
  • Palpitations 
  • Loss of taste or smell 
  • Diarrhea or abdominal pain
  • Confusion or difficulty concentrating

These symptoms can appear during the initial infection and persist, or they can emerge later or, even when the patient has been cured of COVID-19 and tests are negative. It is also possible for symptoms to fluctuate over time, with flare-ups of symptoms that become temporarily worse. 

If you experience symptoms that couuld be a sign of a serious health condition, like palpitations, chest pain or shortness of breath, you should seek medical attention immediately. 

What causes it

Post-COVID syndrome continues to be studied, just like all the other complications that can happen due to COVID, and the exact cause is still not fully known. It has been noted that there are symptoms that appear in some patients even after being cured. It is possible that that this syndrome is a result of changes in the body that occurred due to the virus. 

In mild to moderate cases, long COVID has been associated to a "storm" of inflammatory substances, like cytokines, that appear during infections. Cytokines are produced in high qunatiites during infections, and they can accumulate within the nervous system, causing various characteristic symptoms of this syndrome.

Patients that present with a more serious COVID-19 infection are more likely to have damage to other parts of the body, lik ethe lungs, heart, brain and muscles.

Who is at most risk 

According to a study completed in 2020, the risk for post-COVID syndrome is higher in: 

  • Older adults, especially over the age of 70 
  • Women 
  • People who had 5 or more symptoms of COVID-19 in the first week of infection 

In addition, people with asthma also have a higher likelihood of developing long COVID. 

Can it happen in children? 

Long COVID can potentially affect anyone infected who has been infected with SARS-CoV-2. However, it appears to be less common in children and adolescents. It has been more observed in children with a moderate to severe infection. 

Symptoms may present similarly to those of an adults, like excessive fatigue, headache, difficulty concentrating, muscular pain, insomnia and cough. 

How to prevent long COVID

Currently, the only way to prevent post-COVID syndrome is by avoiding infection with the SARS-CoV-2 virus. To prevent infection, you should follow the recommended guidelines, like wearing a mask, frequent hand hygiene, and social distancing. You should also be up-to-date with your COVID vaccines. 

How it is treated 

There is still no specific treatment approach for long COVID, therefore all patients who present with the above symptoms should be assessed by a doctor. Treatment is usually aimed at relieving or reducing symptoms intensity, which this can be done with medications, lifestyle changes or monitoring by a specialist. 

People with lingering chest pain or palpitations, for example, are often referred to a cardiologist, while people with excessive fatigue, coughing or shortness of breath are referred to a lung specialist. Other specialties can also be consulted, such as gastroenterology, neurology and even physiotherapy. 

How to relieve symptoms

Although there is no specific treatment that can address all cases of long COVID, there are some measures that can be taken to relieve mild symptoms:

  • Excessive fatigue: You should gradually return to your activities of daily living and slowly incorporate exercise. You should start with low-impact activities that are short as recommended by your doctor. Energy-boosting foods like green tea or cinnamon can help, but they should be taken with caution, especially by people with cardiac symptoms or disease. 
  • Muscular pain: You should rest and avoid high-impact activities. Applying heat and massaging muscles with analgesic essential oils like peppermint or rosemary can also relieve soreness. 
  • Coughing: You should drink plenty of fluids throughout the day to keep the throat hydrated. Sucking on a honey or ginger hard candy and help relieve coughing, as well as drinking soothing, anti-inflammatory teas like ginger tea with honey. Check out other home remedies for coughs
  • Headache: You should rest and ensure you are getting plenty of sleep at night. Apply cold compresses on your forehead for 10 to 20 minutes and drink soothing, anti-inflammatory teas like ginger or chamomile tea. Learn more about common causes of headaches and how to relieve them. 
  • Difficulty concentrating: Using vitamins can boost mental functioning, however these should only be used as directed by a doctor or registered dietitian. You should engage in memory-stimulating exercises, like crosswords or reading.

Despite these measures, all symptoms of post-COVID syndrome should be evaluated by a doctor, as there may be changes that require medical treatment. You should only use the above measures to complement the treatment prescribed by your doctor. 

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Edited by Tua Saude editing team in January 2023. Clinical review completed by Manuel Reis - Registered Nurse in January 2023.

References

  • VANCE, Heather et al.. Addressing Post-COVID Symptoms: A Guide for Primary Care Physicians. Journal of the American Board of Family Medicine. Vol.34, n.6. 1229-1242, 2021
  • OMS. What we know about Long-term effects of COVID-19. 2020. Available on: <https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update-36-covid-19-long-term-effects-en.pdf?sfvrsn=799db660_15&download=true>. Access in 27 Jan 2021
Show more references
  • OMS. A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. Available on: <https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1>. Access in 29 Dec 2021
  • SUDRE, Carole H. et al. Attributes and predictors of Long-COVID: analysis of COVID cases and their symptoms collected by the Covid Symptoms Study App. medRxiv. 2020
  • BRITISH HEART FOUNDATION. Long Covid: the symptoms and tips for recovery. Available on: <https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/long-covid>. Access in 29 Dec 2021
  • CDC. Post-COVID Conditions. Available on: <https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html>. Access in 29 Dec 2021
  • NHS. Long-term effects of coronavirus (long COVID). Available on: <https://www.nhs.uk/conditions/coronavirus-covid-19/long-term-effects-of-coronavirus-long-covid/>. Access in 29 Dec 2021
  • OMS. WHO recommends follow-up care, low-dose anticoagulants for COVID-19 patients. Available on: <https://www.who.int/news-room/feature-stories/detail/who-recommends-follow-up-care-low-dose-anticoagulants-for-covid-19-patients>. Access in 27 Jan 2021
  • MAZZA, Mario Gennaro et al.. Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors. Brain, Behavior, and Immunity. 2020
  • ISLAM, Mohammed F. et al.. Post-viral fatigue and COVID-19: lessons from past epidemics. Fatigue: Biomedicine, Health & Behaviour. 2020
  • ELSEVIER. Into the looking glass: Post-viral syndrome post COVID-19. 2020. Available on: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320866/>. Access in 27 Jul 2020
Clinical review:
Manuel Reis
Registered Nurse
Manuel graduated in 2013 and is licensed to practice under the Ordem dos Enfermeiros de Portugal, with license #79026. He specializes in Advanced Clinical Phytotherapy.