Long COVID

What Is Long COVID?

Many people recover fully within a few days or weeks of being infected with SARS-CoV-2, the virus that causes COVID-19. But others have symptoms that linger for weeks, months, or even years after their initial diagnosis. Some people seem to recover from COVID-19 but then see their symptoms return, or they develop new symptoms within a few months. Even people who had no symptoms when they were infected can develop symptoms later. Either mild or severe COVID-19 can lead to long-lasting symptoms.

Long COVID, long-haul COVID, post-COVID-19 conditions, chronic COVID, and post-acute sequelae of SARS-CoV-2 (PASC) are all names for the health problems that some people experience within a few months of a COVID-19 diagnosis. Symptoms of Long COVID may be the same or different than symptoms of COVID-19, and some symptoms are similar to those of myalgic encephalomyelitis/chronic fatigue syndrom (ME/CFS). Long COVID can also trigger other health conditions, such as diabetes or kidney disease.

What We Know About Long COVID

What causes Long COVID?

Scientists don’t know for sure what causes Long COVID, but research is providing some clues.

• SARS-CoV-2 particles may become active again, causing symptoms to reappear.

• Overactive immune cells may release high levels of inflammatory substances that can injure organs and tissues.

• The infection may cause the immune system to start making autoantibodies that attack a person’s own organs and tissues.

Symptoms may also be caused by a combination of these and other factors. Research into these factors is ongoing.

Why are some people more likely to get Long COVID?

Scientists are uncovering risk factors for Long COVID and learning why symptoms vary from person to person. Some groups have a higher risk, including:

• People who have experienced severe COVID-19 illness, especially those who were hospitalized or needed intensive care

• People who have underlying health conditions, such as diabetes, asthma, autoimmune diseases, or obesity

• People who did not get a COVID-19 vaccine

• People who experiences multisystem inflammatory syndrom (MIS) during or after COVID-19 illness

Other factors that may be important include the following:

• Female sex

• Older age

• Immune response to initial infection

• The SARS-CoV-2 variant that caused the initial infection

Health inequities may also increase the risk of Long COVID for some racial or ethnic minority groups and some people with disabilities. Studies suggest that people with Hispanic or Latino heritage have an increased risk of Long COVID. Having a lower income or being unable to rest enough through the first few weeks after getting COVID-19 also seem to raise the risk of Long COVID.

Can children get Long COVID?

Children and teenagers can get Long COVID, whether they had COVID-19 symptoms or not.

Multisystem inflammatory syndrome in children (MIS-C) is a serious delayed complication of SARS-CoV-2 infection that may develop in children and young adults. The condition is caused by inflammation of body parts, including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal organs. Children ages 5 to 11 are most frequently affected by MIS-C.

How can I prevent Long COVID?

The best way to prevent Long COVID is to avoid getting COVID-19. The Centers for Disease Control and Prevention (CDC) has steps you can take to protect yourself and others from getting COVID-19.

CDC recommends staying up to date on COVID-19 vaccines, including boosters. People who are not vaccinated and become infected may have a higher risk of developing Long COVID than people who were previously vaccinated are. Studies also suggest that people who are vaccinated but have a breakthrough infection are less likely to report Long COVID symptoms than people who are unvaccinated.

I have COVID-19. How can I reduce my chances of getting Long COVID?

If you are not vaccinated, vaccination after you recover from COVID-19 may help to prevent Long COVID. COVID-19 vaccination may also reduce the likelihood of MIS-C in young people ages 12 to 18.

People who test positive for COVID-19 can check with their health care providers about authorized treatments that may lower their risk of severe symptoms and hospitalization. Scientists are studying COVID-19 treatments to see whether they lower the risk of long-term symptoms.

What can I do if I have Long COVID?

There is no specific treatment for Long COVID yet. You and your health care provider can work together to create a personal care plan to manage your symptoms and improve your quality of life.

Exercise may be harmful for people with Long COVID who have post-exertional malaise (PEM) — symptoms that get worse after even minor physical or mental effort. Symptoms usually appear 24 to 72 hours after activity and can last for days or even weeks. Check with your health care provider before starting physical activity if you have Long COVID.

There are tools available to help people cope with Long COVID and get the health and social support they need. There are also many support groups to help people with Long COVID symptoms connect with each other. The National Institute of Mental Health offers tips for managing stress during pandemics.

How You Can Help Fight Long COVID

Long COVID Clinical Studies

NIH launched the Researching COVID to Enhance Recovery (RECOVER) Initiative in early 2021 to identify risk factors and causes of Long COVID to help understand how it can be prevented or treated in the future. Your experiences — whether you have long-term COVID-19 symptoms, had COVID-19 and recovered, recently tested positive for COVID-19, or never had COVID-19 — are critical to helping scientists study these symptoms.

Reach out if you or someone you know might be interested in volunteering for a study. Compensation may be available. Pregnant people can participate, and children can also take part in some studies if they wish to and if they have the consent of a parent or guardian.

Participate in a Long COVID Treatment Clinical Trial

The RECOVER Initiative launched several clinical trials of potential treatments for Long COVID in 2023. More clinical trials are expected to launch soon.

• RECOVER-VITAL will test whether a longer course of Paxlovid, an antiviral drug used to treat acute SARS-CoV-2 infection, is also effective at ridding the body of chronic SARS-CoV-2 infection. The study will enroll up to 900 participants in Massachusetts and Maryland.
• RECOVER-NEURO will test brain-training and stimulation interventions for brain fog, memory and problem-solving issues, and other cognitive effects of Long COVID. The study will enroll up to 315 participants at two sites in Texas.

Participate in an Adult Long COVID Observational Study

• NIH’s RECOVER Initiative includes several studies about the long-term, ongoing health effects that some people experience after COVID-19. Find a RECOVER study site near you.

• NIH’s Longitudinal Study of COVID-19 Sequelae and Immunity (RECON_19) investigates long-term medical problems people experience after they have recovered from COVID-19. Close contacts of people with COVID-19 are also invited to participate, to find out whether they became infected but did not have symptoms. The study is taking place in Bethesda, Maryland.

• The Cardiac Magnetic Resonance Tissue Characterization in COVID-19 Survivors study will look for COVID-19's long-term effects on the hearts of people who had the disease. Up to 500 people can participate in this 3-year study, which is based in New York City.

Participate in a Pediatric Long COVID Observational Study

• As part of RECOVER, the Pediatric COVID Outcomes Study (PECOS) is monitoring up to 5,000 children and young adults who previously tested positive for COVID-19. The study, which evaluates how COVID-19 affects participants’ physical and mental health for a total of 3 years, is taking place in Washington, D.C., and Bethesda, Maryland.

• Newborns, children, teens, and young adults up to age 25 may take part in the Understanding the Long-term Impact of COVID on Children and Families study, which is taking place at 65 locations in the United States. If you or your child has COVID-19, Long COVID, or MIS-C or may have been exposed to COVID-19, you may be eligible for the study. The study is open to pregnant people and to people who never had COVID-19.

• CDC is inviting people age 6 months and older in New Orleans, Louisiana, to take part in the Collection of SARS-CoV-2 (COVID-19) Virus Secretions and Serum for Countermeasure Development study. Scientists are collecting samples of blood, urine, saliva, stool, and tears from about 2,000 people who have COVID-19 or Long COVID or who have recovered from the disease. The results may lead to new ideas for treating and preventing COVID-19.