Updated 20 June 2022

Long COVID is the name used to describe symptoms that continue or develop after someone has COVID-19 (4 weeks from the initial infection). The most common Long COVID symptoms are fatigue, shortness of breath, loss of smell, impairment of functional mobility, changes in mental health (depression, anxiety), sleep disturbances, and concentration difficulties), which can impact daily functioning. Long COVID symptoms in children (<18 years) are typically resolved within 1–5 months, although it is important to contact your child’s GP if your child has an ongoing fever. For more information visit KidsHealth.

Information for Patients

Information for GPs and other health professionals

Summary

Researchers have identified over 50 Long COVID symptoms. The most common symptoms are fatigue, shortness of breath, muscle and joint pain, headache, cough, chest pain, modified sense of smell and taste, and changes in mental health (depression, anxiety). All can adversely impact daily functioning.

Long COVID symptoms in children (<18 years) are typically resolved within 1–5 months. Contact your child’s GP if your child has an ongoing fever. To learn more, follow KidsHealth. Young people, physically fit before the infection, have also reported symptoms lasting for months after an acute illness.

Vaccinated people are mostly asymptomatic or experience mild symptoms while infected and report fewer symptoms of long COVID.

Severe infection with the SARS-CoV-2 is not a prerequisite for developing Long COVID; many studies suggest that even a mild or asymptomatic infection of SARS-CoV-2 can cause Long COVID.

Several studies into the cardiovascular effects of Long COVID have confirmed effects on microcirculation and endothelium. A study involving the national databases of the US Department of Veterans Affairs (n = 12,095,836) showed increased risks of major adverse cardiovascular events (MACEs) in the 12 months after acute COVID-19 infection, irrespective of age, race, sex and other cardiovascular risk factors, previous history of CVD, and severity of acute phase of COVID-19. Another recent publication with the same database showed people with COVID-19 exhibited an increased risk (HR 1·40, 95% CI 1·36–1·44) and excess burden (13·46, 95% CI 12·11–14·84, per 1000 people at 12 months) of incident diabetes. Researchers suggest that these cases area new type of cardiovascular disease (so-called ‘COVID heart’).

Based on the US study, it is predicted that if one million New Zealanders caught Omicron, there would be an additional 300-900 heart attacks and 400-1200 extra strokes experienced by New Zealanders in the following year.

Researchers have confirmed the persistence or re-appearance of neurological symptoms after COVID-19 (termed ‘Neuro COVID’), and depression symptom severity was found to be significantly associated with cognitive impairment severity.  

Further to the health impacts, Long COVID has a severe economic impact. In the USA, 9.6 million people have developed Long COVID, and 1 million are currently (as of May 5, 2022) out of work , an annual economic cost to the US economy of $50 million. The UK also faces a surge of longer-term absence from work and economic threats.

Long COVID Management

Researcher at the University of Zurich have developed a prediction model, the PACS score, to predict the risk of a person developing Long COVID and help in early detection and treatment. A patient’s age, history of asthma, number of symptoms during the primary infection, and IgG3 and IgM antibody levels are required to calculate the prediction  model. It is suggested to do this assessment in order to offer early rehabilitation for highly susceptible patients.

Kidney function should be monitored in Long COVID care. Multiple studies, including a large cohort (n = 1,726,683) study in the USA, found an increased risk of kidney issues.

Blood results should be regularly monitored, and individuals’ thrombotic risk should be regularly evaluated up to 12 months based on their comorbidities and coagulation profile, as some patients have reported late-onset thrombocytopenia related to immune system dysregulation.

Glucocorticoids may be an alternative treatment option for patients who are not responding or intolerant to conventional therapy. However, avascular necrosis (AVN) of bone due to steroid treatment is a concern. Orthopaedic departments worldwide are reporting a higher number of cases of AVN among those who received steroid treatment during acute infection.  

Several novel treatment options have been proposed, including stellate ganglion block and non-invasive brain stimulation (NIBS) to treat cognitive and visual impairments, and montelukast in cases with respiratory problems.

The persistent symptoms of COVID-19 infection among frontline health workers are still under investigation. It has been suggested that they might experience complex PTSD symptoms.  

Announcements

International:

• The US National Institutes of Health (NIH) has launched a $1.15-billion research investigation over four years into long COVID.
• NIH awarded $470 million to support diverse research on the long-term effects of COVID-19 at 30 institutes. The NIH REsearching COVID to Enhance Recovery (RECOVER) Initiative has started recruiting children and young adults who previously tested positive for COVID-19 to track the impact on their physical and mental health over three years. Details of the study are accessed here.
• The FDA approved antiviral medication (molnupiravir) for the treatment of mild-to-moderate COVID-19 infection in vulnerable adults on 23 March 2022. Details of the letter are accessed here.  
• President Biden has announced disability protection rights for the COVID ‘long haulers’.
• Finland’s Minister of Family Affairs and Social Services Krista Kiuru said around 20% of its population are experiencing cognitive impairment due to Long COVID.
• The University of Helsinki is conducting an extensive multinational online survey (international COVID sleep study (ICOSS)) on sleep and circadian rhythm pattern with COVID survivors. The study collected data across four continents: Europe, North America, South America, and Asia.
• The UK Government's Office of National Statistics (ONS) report published in June 2022 indicated that around 3.1% of the UK  population had self-reported Long COVID and had the symptoms for one year. The vaccinated population had lower risks of Long COVID.

Aotearoa New Zealand:

• The Ministry of Health's chief science adviser, Dr Ian Town, announced (15 March 2022) the publication of a "rehabilitation framework" developed by an expert advisory group. More than 8000 COVID survivors had already been recruited for this research to develop guidelines for the health professionals.
• Victoria University of Wellington has been granted $1.2 million to establish a longitudinal study in New Zealand to understand the short- and long-term impacts of COVID-19 and highlight equity issues anticipated by the cohort.
• University of Otago's Emeritus Professor Warren Tate and colleagues have received funding from Brain Research New Zealand to study the relationship between Long COVID and myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS). Dr Anna Brooks from the University of Auckland is part of this team and will be investigating the immunological aspects of Long COVID.

The information on this page was prepared by multi-disciplinary health professionals at the National Institute for Health Innovation and affiliates and was originally created on 9 December 2020.