Long COVID, which has been found to impact roughly 14% of people who experience a COVID infection, continues to impact many. COVID has not gone away, with the currently most prevalent strain, JN.1, making the rounds. Evidence does not show that it causes more severe disease than earlier variants. But evidence also shows that regardless of the severity of infection, long COVID will become a reality for many people as infections continue to spread. The difficulty also lies in tracking long COVID; as symptoms can range widely, it is difficult to know exactly who is experiencing long COVID. Some may have to manage symptoms for weeks, but for others, it can last months, or even years. Long COVID has become so prevalent and in some cases, debilitating, that in July 2021 the CDC officially included long COVID as a disability protected under the Americans with Disabilities Act.
Long COVID—or post-COVID conditions—is a wide range of new, returning or ongoing health problems people may experience more than four weeks after being first infected with SARS-CoV-2. There are a wide range of symptoms that are slowly revealing themselves to be associated with long COVID, with one large meta-analysis of 25 studies outlining that the prevalence of long COVID may be as high as 80% of those that have been infected with the virus. Even people who did not have any symptoms can experience long COVID, according to the Centers for Disease Control and Prevention. The CDC shares:
- Post-COVID conditions can include a wide range of ongoing health problems; these conditions can last weeks, months, or years.
- Post-COVID conditions are found more often in people who had severe COVID-19 illness, but anyone who has been infected with the virus that causes COVID-19 can experience post-COVID conditions, even people who had mild illness or no symptoms from COVID-19.
- People who are not vaccinated against COVID-19 and become infected may also be at higher risk of developing post-COVID conditions compared to people who were vaccinated and had breakthrough infections.
- There is no single test for post-COVID conditions. While most people with post-COVID conditions have evidence of infection or COVID-19 illness, in some cases, a person with post-COVID conditions may not have tested positive for the virus or known they were infected.
COVID infections are widespread, with the data from wastewater and reported test positivity (both which capture symptomatic and asymptomatic infections), reflecting that infection rates are higher than last year (+27% for wastewater and +17% for test positivity). But the CDC shares:
- Despite the increase in cases, COVID related illness requiring medical attention are roughly 21% lower than they were at the same time last year.
- COVID-19 hospitalizations are 22% lower than observed the year before.
- The percent of total deaths associated with COVID-19 are 38% lower.
With all that being said, there’s good news in better understanding what causes long COVID which will ultimately open doors in learning how to treat it.
A study, published in the journal Science, could help explain what causes symptoms that can include headaches, rashes, cough, impact to smell or taste, and more.
The study followed 113 Covid patients for up to one year after they were first infected, along with 39 healthy controls. At the six-month mark, 40 patients had developed long COVID symptoms. Blood samples of those with long COVID showed proteins that indicated that a part of the body’s immune system called the complement system remained activated long after it should have returned to normal.
“When you have a viral or bacterial infection, the complement system becomes activated and binds to these viruses and bacteria and then eliminates them,” said Dr. Onur Boyman, a professor of immunology at the University of Zurich in Switzerland and one of the study’s investigators. The system then returns to its resting state, where its regular job is to clear the body of dead cells, he said.
But if the complement system remains in its microbe-fighting state after the viruses and bacteria are eliminated, “it starts damaging healthy cells,” he said.
Other studies have also identified potential causes of long COVID, making the case that it could be any one factor that leads to long COVID or potentially a combination of the variety of impacts to the body.
- In one study, published in the October 2023 issue of the journal Cell, researchers suggested that remnants of the virus lingering in the gut of long COVID patients triggered reductions in the neurotransmitter serotonin. Lower serotonin levels, they said, could explain some neurological and cognitive symptoms.
- Another study, published in the journal Nature, found that long COVID patients had significantly lower levels of the hormone cortisol than other COVID patients and healthy controls. This may be what’s behind lingering fatigue.
While there isn’t any one treatment to end long COVID, this new information provides an avenue for researchers to learn how to effectively target the triggers. For the time being, treatment of long COVID largely focus on “re-training” the parts of the body most impacted and addressing the symptoms:
- Olfactory training: Proponents of the treatment liken it to physical therapy for the olfactory bulb. Meant to restore and repair function, treatment focuses on reestablishing brain connectivity of pathways via memories and experiences tied to scent.
- Physical therapy: For some, the symptoms of long COVID include physical pain or a decrease in strength. Physical therapy includes exercise, massage and other treatments that can address and improve these concerns.
- Medication: Prolonged headaches and coughs can often be treated with medication, as can heightened anxiety or even depression. Speak to your provider if you persistently experience these symptoms.
- Counseling: When symptoms are so severe or prolonged that they impact your day-to-day function, it can weigh heavily on your mental state. Seek help from a professional if you find yourself struggling to cope.
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