Long-COVID – long-term effects of COVID-19

As can happen with other infectious diseases, people who contract COVID-19 sometimes experience health problems for weeks or even months after recovering from the initial SARS-CoV-2 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 following a coronavirus infection.

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. Many people experience several symptoms at the same time.

The most common symptoms are tiredness and rapid exhaustion – also known as fatigue.

People with long-COVID often also complain of a lack of stamina and being short of breath. Many also have a limited ability to concentrate and impaired memory – this is commonly known as brain fog.

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
• persistent cough
• sleep disorders and non-restful sleep
• psychological stress, such as depression and anxiety
• increased hair loss
• chest pain and perceived heart palpitations or skipped heartbeats
• cardiovascular disorders such as high blood pressure
• gastrointestinal problems

Some people find that their lung function deteriorates or that their liver, kidney or heart functions are impaired. For example, they may develop myocarditis (inflammation of the heart muscle), diabetes or thromboembolism – where blood clots cut off the blood supply.

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 factors play a role. These can work individually or in conjunction.

Firstly, it is assumed that inflammatory processes that primarily affect the blood vessels and thus various organ systems continue to occur in the body after a coronavirus infection.

Autoimmune reactions – where the immune system attacks the body’s own cells – can also influence the development of long-COVID.

Secondly, 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, known as microthromboembolisms, can play a role in the condition’s development.

The information available on the prevalence of long-COVID differs greatly.

It differs depending on the type and size of the sample group, the length of the observation period and the symptoms and health limitations recorded.

It is estimated that up to 20% of adults still have one or more symptoms long after they have recovered from the acute SARS-CoV-2 infection.

Based on what is currently known, women appear to be more likely than men to develop long-COVID. Overall, children and adolescents seem to be less likely than adults to suffer from long-COVID.

However, it is not yet entirely clear just how many people are affected.

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

People who suffer an acute initial infection with COVID-19 are likely to suffer more long-term consequences.
 
The likelihood of suffering long-term effects of COVID-19 also appears to be higher for people who have pre-existing physical conditions, such as:

• asthma
• high blood pressure (hypertension)
• diabetes mellitus
• obesity (severe overweight)

Factors that increase the risk of developing long-COVID include:

• increasing age
• the number and type of symptoms that developed in the first week of the acute infection
• the viral load at the start of the infection
• a low level of SARS-CoV-2 antibodies in the blood
• the presence of autoantibodies – these are produced by a faulty immune response and target the body’s own tissue
• reactivation of the Epstein-Barr virus – this virus remains in the body following an infection and can be reactivated when the immune system is weakened

It is impossible to say precisely how quickly people will recover from an acute COVID-19 infection.

For most people, the symptoms disappear within a period of 4 weeks after the acute infection.

The severity of the infection does not necessarily dictate whether symptoms will persist after the acute infection has subsided. However, findings to date suggest that people who suffer a severe case of COVID-19 are more likely to develop long-COVID.

According to studies, around 76% of adults with COVID-19 who were treated in hospital were still experiencing various health problems after 6 months. This figure is around 10% among those who initially have a mild infection.

New health problems may also develop. It is not yet possible to say how often this happens.

There is still a lack of long-term data on the outlook of long-COVID, especially with regard to the extent to which the symptoms recede or can persist. It is also not yet possible to specify the extent to which serious organ complications occur.

The only form of protection against long-COVID is to avoid becoming infected with the SARS-CoV-2 coronavirus.

In addition to observing the public health guidance on “hands, face, space and fresh air” (i.e., wash hands, wear a mask, observe social distance and keep indoor areas well ventilated), vaccination against COVID-19 is an important preventive measure.

People who have been vaccinated have a reduced risk of contracting a COVID-19 infection and of becoming seriously ill with the virus. This also reduces the likelihood of developing long-term effects.

To diagnose long-COVID, it is essential to determine if and when an acute infection with the coronavirus SARS-CoV-2 occurred.

In the case of a known prior 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 work are negatively affected
• whether the person feels socially isolated
• whether the person has any psychological symptoms such as anxiety or 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 in the case of unclear problems, a specialist medical examination may be required.

At present, there are no special treatment options to specifically treat long-COVID. Teams of doctors and researchers are working hard to further develop the treatment concepts.

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.

These are tailored to the patient’s individual clinical picture and life situation. The aim is also to prevent the symptoms from becoming chronic.

Depending on the type and strength of the physical or mental impairments, various measures help to improve patients’ health. These include:

• pain therapy
• physical and mental (cognitive) training
• guidance on sleep hygiene
• stress reduction techniques
• psychotherapeutic care

Depending on which organ systems are affected, specialist medical treatment may also be necessary.

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”).

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 and their loved ones 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).