Long COVID – long-term effects of COVID-19

As with other infectious diseases, people who contract COVID-19 sometimes experience health problems for weeks or even months after recovering from the initial coronavirus infection.

If the symptoms persist for more than 4 weeks after the acute infection or if new symptoms develop that cannot be explained in any other way, this is known as long COVID. If symptoms last for more than 12 weeks, this is known as post COVID-19 condition or post COVID for short.

Anyone who suffers from a severe case of COVID-19 is at a higher risk of developing long COVID. However, long-term consequences are also possible following mild cases and infections without symptoms.

Long COVID can affect both adults and children.

People with long COVID report a wide range of physical and psychological symptoms. These can be so severe that they reduce people’s quality of life, make their everyday life difficult and impair their working and social life.

To alleviate the symptoms as far as possible and improve the quality of life and physical capacity of people with long-term effects of COVID-19, early and targeted advice and treatment are essential.

The symptoms described by people with long COVID differ greatly. They can occur individually or in combination, last for differing periods of time and vary widely.

The most common symptoms include:

• fatigue and a loss of stamina
• a limited ability to concentrate and impaired memory, commonly known as brain fog
• persistent respiratory problems such as coughing and a shortness of breath

Furthermore, the following symptoms may occur after the acute SARS-CoV-2 infection has passed:

• muscle weakness and muscle pain
• lost or changed sense of smell and taste
• sleep disorders and non-restful sleep
• psychological symptoms such as depression and anxiety

Some people’s lung and kidney functions deteriorate as a result of COVID-19. Complications are also possible, such as:

• cardiovascular diseases: for example myocarditis (inflammation of the heart muscle), heart attack, stroke, the blockage of blood vessels by blood clots (thromboembolisms)
• diabetes mellitus
• auto-immune diseases
• neuro-COVID: neurological restrictions due to brain or nerve disorders and problems

Long COVID occurs as a result of infection with the coronavirus SARS-CoV-2, the COVID-19 pathogen.

What exactly causes long COVID is not yet fully known. Experts assume that various disease mechanisms play a role. These can work in combination or in isolation.

The assumed mechanisms include:

• virus persistence: coronavirus remains in the body following an acute infection. This can potentially lead to inflammatory processes, primarily affecting the blood vessels and thus various organ systems.
• autoimmune reactions: an excessive immune response occurs, resulting in the immune system attacking the body’s own cells. This could affect the development of long COVID.
• reactivation of the Epstein Barr virus (EBV): the virus remains in the body following an EVB infection and could be reactivated due to a weakened immune system.
• There are indications that changes to the blood cells, functional disorders of the vascular, nervous and immune systems and the blockage of usually tiny blood vessels by blood clots (microthromboembolisms) can play a role in the condition’s development.

At present, there is no reliable information on how many people develop long COVID. The data provided by studies on prevalence differs greatly.

It depends, for example, on:

• the size of the group of people involved in the study
• the type of people involved in the study, for example with regard to their age and the severity of their illness
• the length of the observation period
• the number and type of symptoms and health impairments recorded
• the involvement of a control group

Based on what is currently known, women appear to be more likely than men to develop long COVID. Children and adolescents seem to be less likely than adults to suffer from long COVID. However, this has yet to be conclusively clarified.

Initial indications have also shown that the prevalence of long COVID could differ depending on the virus variant.

Research has yet to conclusively determine exactly which factors increase the risk of developing long COVID.

The latest findings indicate that people who suffer a severe initial infection with COVID-19 are more likely to suffer long-term consequences.

In addition, the likelihood of suffering long-term consequences of COVID-19 appears to be higher among people with certain pre-existing conditions and health risks such as diabetes or obesity.

Factors such as age and gender also seem to influence the development of long COVID.

To date, long-term studies of patients with long COVID have been limited.

It is therefore not yet possible to clearly say whether and how quickly long COVID symptoms go away again.

According to studies, many people who were not hospitalized due to COVID-19 find that their long COVID symptoms disappear within a few months.

This process generally takes longer for people who were hospitalized.

Some patients still experience symptoms a year after the infection.

The best form of prevention against long COVID is to avoid infection with the SARS-CoV-2 coronavirus.

Several studies have also indicated that full coronavirus immunization can reduce the prevalence and severity of long COVID symptoms.

Vaccination may also have a positive effect in people who have already recovered from a SARS-CoV-2 infection and are showing symptoms of long COVID. However, this has not yet been proven.

Experts have developed initial recommendations for diagnosing long COVID. These recommendations will be developed on an ongoing basis to improve medical care.

The challenge with diagnosis

It is currently difficult to diagnose long COVID as:

• there is no standardized clinical picture
• it is not yet always possible to clearly differentiate long COVID from other conditions

In addition, it is not always possible to establish a definite link with a prior SARS-CoV-2 infection – for example, because people may have an infection without experiencing any symptoms or because an infection was not established by means of a test.

Diagnosis in the case of a known coronavirus infection

If it is known that the person has previously had a COVID-19 infection, doctors will ask which symptoms occurred during the acute phase of the illness and which are currently persisting.

They will also ask whether and what new health issues have developed and whether any symptoms that were already present prior to the infection have worsened as a result of the illness.

The aim is to record all physical and psychological symptoms, as well as any limitations these have caused.

The doctor may ask the following during the consultation:

• whether and to what extent everyday life and, where applicable, work are negatively affected
• whether the person has any psychological symptoms, such as anxiety, or is showing signs of depression
• whether and to what extent the person’s mental and physical capabilities are limited

Depending on the type and severity of the symptoms or if the person is experiencing non-specific problems, a specialist may need to perform technical procedures or blood tests, for example.

At present, there is no specific treatment for long COVID. As such, the treatment currently focuses on alleviating the symptoms.

To optimally alleviate the symptoms and improve the quality of life and physical capacity of people with long COVID, early and targeted medical advice and treatment options are important.

Treatment measures

Depending on the symptoms and the organ systems affected, targeted treatment by a medical specialist can be required.

Other possible measures include:

• pain therapy
• targeted physiotherapy
• physical and mental (cognitive) training
• guidance on sleep hygiene
• techniques to reduce stress
• psychotherapy
• energy and activity management (pacing) in the case of chronic fatigue syndrome: this is about learning to make careful use of the body’s energy reserves so as not to overdo things.

Treatment aim

Depending on the type and severity of the physical or mental impairments, various measures can help to improve patients’ health.

These are tailored to the patient’s individual clinical picture and personal circumstances.

A key aim is to prevent the symptoms from becoming chronic. Teams of doctors and researchers are working hard to develop special treatment concepts.

It is also essential for people with long COVID to learn to deal with their illness better during their daily lives. Personalized guidance from trained personnel can help them do this.

Rehabilitation by a trained, interdisciplinary team can help people with long COVID regain their physical and mental strength and resilience.

Rehab can occur in an inpatient or outpatient capacity. Depending on the severity of the limitations, it is also possible to obtain aftercare and services that help people with their working life.

Further information about rehabilitation for long COVID can be found on the websites of the German pension insurance organization (“Deutsche Rentenversicherung”) and the Federal Ministry for Labor and Social Affairs (“Bundesministerium für Arbeit und Soziales”).

COVID-19 as an occupational disease

In some situations, statutory accident insurance providers will recognize COVID-19 as an occupational disease or work accident.

People for whom that applies can contact their insurance provider if they want to receive rehabilitation services due to long COVID.

Self-help groups offer people with long COVID or post-COVID and their relatives a way of obtaining information and advice, and of sharing personal experiences.

Further information about COVID-19 self-help groups can be found on the website of the National Contact and Information Point for Encouraging and Supporting Self-Help Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen – NAKOS).

In addition, clinics and hospitals offer long COVID consultations or run long COVID outpatient clinics, which people can attend to obtain advice.

An overview of post COVID-19 clinics in Germany is provided on the website of the Long COVID Initiative Germany (“Initiative Long COVID Deutschland”).

For more information about the long-term effects of a coronavirus infection, see the websites of the Federal Center for Health Education (“Bundeszentrale für gesundheitliche Aufklärung”, BZgA) and the Robert Koch Institute (RKI).

The website of the German national association for self-help for people with a disability or chronic illness and their relatives (BAG SELBSTHILFE e.V.) provides information about self-help groups, long COVID and care providers.