How common is LONG COVID?

As the COVID-19 pandemic continues, we are just beginning to understand how common it is to have persistent symptoms long after the COVID infection itself, called ‘Long COVID’. A recent review summarizes what we have learned so far.

The authors identified 143 articles that published data on symptoms that persisted 1 month after infection with the coronavirus. Some studies followed people for up to a 1 year after infection. Shockingly, health consequences after COVID are present in 33% to 98% of people who have been infected.

Here are just some of the Long COVID issues that the paper describes, organized by organ system. (I encourage interested readers to check out the article for further details – it’s a free download)

Lung complications:

Shortness of breath is experienced by up to 88% of survivors, and can take 3 months or longer to resolve.
At 3 months after hospital discharge from COVID-19 infection, evidence of fibrosis (lung scarring) is seen in 25-65% of people.

Heart complications:

Chest pain is reported amongst up to 43% of COVID survivors. Up to 11% report palpitations. Many patients are still reporting these symptoms 6 months after infection.
Many patients have a cardiac event (eg heart attack) during acute illness, which can cause permanent heart dysfunction and heart failure.
Inflammatory injury to the heart muscle (myocarditis) can persist for at least 2 months after COVID-19 diagnosis.
People who have had myocarditis during COVID may be at higher risk of heart injury upon return to strenuous physical activity.
POTS (postural orthostatic tachycardia) has been linked with prior COVID infection – this can be a debilitating condition where, with standing up, a person develops a high heart rate, palpitations, lightheadedness, and difficulty thinking clearly.

Neurological complications:

5% of patients infected with COVID have a stroke.
Anywhere from 17-91% of people report headaches ongoing more than 4 weeks after infection, with up to 25% experiencing migraine-like severe pain. There is no correlation between severity of COVID infection and the development (or severity) of headaches afterwards.
Persistent cognitive impairment (‘brain fog’) is reported by up to 21% of people age 40 or older, six months after COVID infection.
Up to 53% of people report disturbed taste/smell beyond 1 month after infection with COVID.
13% report change in hearing, and/or tinnitus (ringing in ears) two months after hospital discharge.

Mental health complications:

35-56% report: PTSD, anxiety, depression, insomnia, and/or OCD symptoms after COVID infection

Gastrointestinal complications:

Three months after hospital discharge, up to 44% report ongoing GI symptoms. These include loss of appetite, nausea, heartburn, diarrhea, bloating, belching, vomiting, and abdominal pain.

Kidney complications:

Over 1/3 of hospitalized COVID patients have acute injury to the kidneys.
14% of people hospitalized for COVID need dialysis. Of these who are still alive at 2 months after hospital discharge, over half remain on dialysis.

Endocrine (hormonal) complications:

COVID can cause new onset diabetes that requires insulin for treatment long term.
COVID survivors may have detrimental effects on bone and muscle health.
The coronavirus can cause thyroid dysfunction which can be temporary or long term.

Other:

Chronic fatigue is the most common long COVID symptom, reported by up to 98% of people who have had COVID. This frequently lasts 60 days or longer. The risk of having chronic fatigue is unrelated to how severe the COVID infection was.
Most people reporting fatigue also report joint pain, chest pain, and/or shortness of breath.
Hair loss in up to 25% of COVID survivors.
COVID toes/fingers are reported in up to 7%, with some cases lasting beyond 6 months.

Children: While children are less likely to have long COVID, the most common long term symptoms include:

insomnia in 19% of kids infected
fatigue in 11%
muscle pain in 11%
headache in 10%
lack of concentration in 10%

These long COVID symptoms are reported in kids who were either asymptomatic or symptomatic with COVID originally.

PIMS (pediatric inflammatory multisystem syndrome) is a severe inflammatory condition affecting about 2% of kids infected with COVID.

It is important to understand that anyone is at risk of long COVID. People especially at risk are people in rural communities, racial and ethnic minorities, older people, and those with preexisting medical conditions.

BOTTOM LINE: Long COVID symptoms are extremely common, and can affect anyone. These symptoms may be present right after infection, but can also develop weeks to months later. People who have had mild infection are at as high a risk of many long COVID features as people who have had severe infection. It is disturbing to think that we are just beginning to understand the consequences that long COVID will have on our individual health, productivity, quality of life, and our health care system. People who have had COVID infection should be aware of the features of long COVID, and seek attention from health care providers for any concerns that persist, or are new, after a COVID infection. Health care providers should be aware of the long and complex list of possible health issues that can arise in people who have had a COVID-19 infection.

Vaccination is the best way to avoid both acute COVID, and Long COVID complications.

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