Long Covid, also known as Post-Acute Sequelae of SARS-CoV-2 infection (PASC), is a condition where people who have recovered from COVID-19 continue to experience symptoms that persist for weeks, months, or even years after their initial infection. These symptoms can range from fatigue, shortness of breath, joint pain, brain fog, and more.
The impact of Long Covid on individuals and their families can be significant. Many people with symptoms are unable to work or carry out their normal daily activities. They may also require ongoing medical care and support. This can place a significant burden on healthcare systems, as well as on individuals and their families.
The impact of Long Covid on the American population
According to a study published in the Annals of Internal Medicine in January 2022, nearly one in five American adults who were infected with COVID-19 reported experiencing symptoms consistent with Long Covid. The study surveyed more than 37,000 adults who had tested positive for COVID-19 and were not hospitalized. Of those surveyed, 18.3% reported persistent symptoms for at least four weeks after their initial infection.
The study also found that people who were older, female, had a higher body mass index, or had more severe initial symptoms were more likely to experience Long Covid. The authors of the study noted that these findings highlight the need for continued research and support for people with Long Covid symptoms.
A February 2023 study published in Clinical Infectious Diseases found that people with Long Covid had the Coronavirus’s telltale spike protein in their blood 12 months after infection.
The idea of viral persistence could be a skeleton key that unlocks the mystery of all the various and seemingly unrelated symptoms that long Covid patients report. Proal pointed to autopsy-based research published in Nature in December 2022 that found the coronavirus lurking all over the body months after infection.
The remaining uncertainties can mask the scientific progress of the past few years. Scientists have a better idea of how Long Covid works, and why it might cause a wide array of seemingly unconnected symptoms.
But— and this is more important than it might seem— we know what we don’t know. We have a stronger sense of what the most important unanswered questions are and where there is genuine debate among even the experts about this bedeviling condition.
The highly charged public discourse over Long Covid can be overwhelming. There is a plethora of research being released at all times, some of it well-vetted, but some of it not. If you or someone you love has Long Covid — or you’re worried that you might get it — it can be hard to get even basic answers.
One of the clearest takeaways of the past three years is this: Long Covid does not look the same in every patient, because there are many types of Long Covid.
Scientists, however, are getting closer to resolving some of these debates. Long Covid is a real physiological syndrome. The physical evidence that some people’s bodies function differently in the long term after a COVID-19 infection is too strong to chalk up to psychosomatic symptoms or some kind of neurological disorder.
How common is it?
Post-viral syndromes are not new, but given the number of people infected over the past three years, Long Covid has been recognized as a distinct public health threat.
The scale of the crisis depends, at least in part, on how many people end up with long-term symptoms. But that is a surprisingly difficult question to answer.
What actually causes Long Covid?
More than 100 million Americans have had a recorded case of Covid-19. Most of them do not end up reporting having long-term symptoms. So why do some people develop this syndrome and others don’t? And for the first group, what is happening in their body to make them feel this way?
It likely starts with the health of the patient. People who have a severe case of Covid and are admitted to the hospital are much more likely to have symptoms that persist for months. People who have a milder initial infection are more likely to experience Long Covid if they are older, or if they were in poorer physical and mental health prior to being infected. Women also report higher rates of long Covid than men.
But knowing who may be more susceptible to Long Covid is not the same as knowing why these people have long-term symptoms. A few theories are particularly popular with people who study Long Covid.
One leading candidate is the idea that some people fail to fully eliminate the virus after infection, leaving remnants to hide away in their bodies only to later cause havoc. It is known as viral persistence and most (but not all) of the Long Covid experts I spoke with said that it is likely a factor in many, maybe even most, people having long-term symptoms.
A February 2023 study published in Clinical Infectious Diseases found that people with Long Covid had the coronavirus’s telltale spike protein in their blood 12 months after their infection.
The symptoms that an individual experiences could be related to where exactly the virus has taken up residence. If it’s in your brain, you may experience more confusion and brain fog. If it hunkers down in your muscle tissue, you might feel the chronic fatigue heavily associated with Long Covid.
But some experts are not as sure about the link between viral persistence and Long Covid, without stronger evidence that the virus is still actively replicating, which Proal and others said is the subject of study. Some people who do not report long-term symptoms have also been found to have the coronavirus’s spike protein in their blood, complicating the picture even further.
And there could be other drivers of Long Covid in play. For example, there is growing evidence that a Coronavirus infection can lead to latent viruses that people already have in their bodies, such as the herpes virus, being reactivated.
What is being done to address Long Covid?
As Long Covid continues to affect millions of people worldwide, researchers and healthcare professionals are working to better understand the condition and develop effective treatments.
The National Institutes of Health (NIH) has launched a major initiative to study Long Covid, with the aim of developing better diagnostic tools and treatments.
In addition, healthcare providers are working to provide support and care for people with Long Covid. This may include physical therapy, occupational therapy, and mental health services–to name a few. Many hospitals and clinics are also offering Long Covid clinics, where individuals can receive specialized care for their symptoms.
Final thoughts
It’s important to note that the long-term effects of COVID-19 are still not fully understood, and research is ongoing. While much is still unknown about the condition, researchers and healthcare professionals are working to better understand it and develop effective treatments.
In the meantime, it is important for individuals to continue following public health guidelines to reduce the spread of the virus and protect themselves and their loved ones.
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