Clinical Overview of Long COVID

What to know

  • Long COVID is an infection-associated chronic condition that affects one or more organ systems.
  • Primary care providers can manage Long COVID using patient-centered approaches.
  • Healthcare providers can help patients with Long COVID by validating their symptoms and connecting them to additional care, services, and supports, as appropriate.
  • Providers should promote COVID-19 vaccines as a means of preventing Long COVID.
A woman talking to a doctor holding a tablet

Introduction to Long COVID

Long COVID, also known as Post-COVID Conditions (PCC), is an infection-associated chronic condition that can occur after SARS-CoV-2 infection, the virus that causes COVID-19, and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems. 1 The definition for Long COVID will continue to be evaluated as data are collected, analyzed, and reported and our understanding of the chronic condition improves. Most patients appear to recover from their initial acute COVID-19 illness within 4 weeks, and many patients continue to recover between 4 and 12 weeks. Long COVID is associated with:

  • Development of new or recurrent symptoms and conditions after the symptoms of initial acute COVID-19 illness have resolved.
  • Symptoms that can emerge, persist, resolve, and reemerge over varying lengths of time.
  • A spectrum of physical, social, and psychological consequences.
  • Functional limitations that can affect patient wellness and quality of life and may cause disability.

Cause

It can be difficult to distinguish symptoms caused by Long COVID from symptoms that occur for alternative reasons. Long COVID is heterogeneous and may be attributed to different underlying pathophysiologic processes. 23 Possible etiologies include:

  • Organ damage resulting from acute phase infection
  • Complications from a dysregulated inflammatory state
  • Microvascular dysfunction
  • Ongoing viral activity associated with an intra-host viral reservoir
  • Autoimmunity
  • Inadequate antibody response

Risk factors

Researchers are actively studying the prevalence, mechanism, duration, and severity of symptoms following acute SARS-CoV-2 infection, as well as risk factors associated with developing Long COVID. Research shows certain groups of people are more likely to develop Long COVID, 45 including:

  • Women
  • Hispanic people
  • People who experienced more severe outcomes of COVID-19, including hospitalization or being admitted to the intensive care
  • People with underlying health conditions
  • People who did not get a COVID-19 vaccine

Prevention

Preventing severe outcomes of COVID-19 illness reduces people's risk of developing Long COVID. 5 These severe outcomes include hospitalization, admission to the intensive care unit, or intubation.

Healthcare providers can advise their patients on protecting themselves against severe COVID-19 by:

Vaccination helps prevent Long COVID

Research shows COVID-19 vaccination is an effective tool in helping to prevent Long COVID, including in children. 5678

Resources

Disclaimer

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Reports

Webinars and continuing education

Echo program

Long COVID as a disability

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Content Source:
  1. Ely EW, Brown LM, Fineberg HV; National Academies of Sciences, Engineering, and Medicine Committee on Examining the Working Definition for Long COVID. Long COVID defined. N Engl J Med. Published online 31 July 2024. doi:10.1056/NEJMsb2408466
  2. Davis HE, Assaf GS, McCorkell L, Wei H, Low RJ, Re'em Y, Redfield S, Austin JP, Akrami A. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 2021 Aug;38:101019. V Epub 2021 Jul 15. doi: 10.1016/j.eclinm.2021.101019.
  3. Melina M, Manoharan L, Elkheir N, et al - Characterising long COVID: a living systematic review: BMJ Global Health 2021;6:e005427.
  4. Adjaye-Gbewonyo D, Vahratian A, Perrine CG, Bertolli J. Long COVID in adults: United States, 2022. NCHS Data Brief, no 480. Hyattsville, MD: National Center for Health Statistics. 2023. DOI: https://www.cdc.gov/nchs/products/databriefs/db480.htm
  5. Tsampasian V, Elghazaly H, Chattopadhyay R, et al. Risk Factors Associated With Post-COVID-19 Condition: A Systematic Review and Meta-analysis. JAMA Intern Med. 2023 Jun 1;183(6):566-580. doi: 1001/jamainternmed.2023.0750.
  6. Razzaghi H, Forrest CB, Hirabayashi K, et al. Vaccine Effectiveness Against Long COVID in Children. Pediatrics. Pediatrics. 2024 Apr 1;153(4):e2023064446. doi: 10.1542/peds.2023-064446.
  7. Vahratian A, Adjaye-Gbewonyo D, Lin JS, Saydah S. Long COVID in children: United States, 2022. NCHS Data Brief, no 479. Hyattsville, MD: National Center for Health Statistics. 2023. DOI: https://dx.doi.org/10.15620/cdc:132416.
  8. Watanabe A, Iwagami M, Yasuhara J, et al. Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis, Vaccine. 2023 Mar 10;41(11):1783-1790. doi: 10.1016/j.vaccine.2023.02.008