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Scientists are slowly gathering information about long COVID. Dan Kitwood/Getty Images
  • There have been numerous reports of people who survived COVID-19 developing various long-term health issues.
  • Symptoms are wide-ranging, can affect all people, and can develop months after the infection.
  • Individuals with long COVID require interdisciplinary care and support.

In a new literature review, researchers provide a thorough overview of post-acute COVID-19 syndrome, otherwise known as long COVID.

The review, which appears in the journal Nature Medicine, highlights the importance of patient advocacy groups and the need for interdisciplinary care and support over a more extended period.

COVID-19 has had a devastating effect on global health, with nearly 3 million deaths recorded worldwide.

While the disease typically affects a person’s respiratory health, scientists now generally recognize it as a multi-organ disease, with symptoms ranging from nonexistent to life threatening. However, as the pandemic has progressed, experts are becoming more aware of the longer-term effects of COVID-19.

Dubbed “long COVID,” survey reports have suggested that people are continuing to experience symptoms long after they first contracted acute COVID-19.

A team of over 30 experts from various fields has now analyzed the current literature on long COVID, offering a thorough overview of the disease and suggesting ways to support people who develop it.

According to the first author of the study Dr. Ani Nalbandian, a cardiology fellow at Columbia University Vagelos College of Physicians and Surgeons in New York, “over the course of the summer, we started getting a sense of what issues these people were having. We felt that a review of all these possible issues would be important not only for healthcare providers but also for patients.”

“It’s important for patients to know that what they’re experiencing may be a consequence of [contracting SARS-CoV-2] and that they are not alone in experiencing lingering effects of COVID-19.”

The researchers note that various cardiovascular issues have associations with long COVID, including chest pain, blood clots, stroke, pulmonary embolisms, and heart arrhythmias.

Dr. Elaine Y. Wan, the Esther Aboodi Assistant Professor of Medicine in Cardiology and Cardiac Electrophysiology at Columbia University and the review’s senior author, said, “arrhythmias can lead to stroke, heart failure, and long-lasting damage to the heart, and that’s something that patients may not be aware of.”

The review also highlighted the importance of ongoing respiratory symptoms, such as breathlessness, in around 1 in 5 people with COVID-19. Breathlessness could have a respiratory or cardiac origin. At least 1 in 6 patients experienced a persistent cough.

The review also highlighted the characteristic “brain fog” and indicated that between 1 in 2 or 1 in 3 people with long COVID have persistent headaches. More than half of patients describe mental health problems, such as chronic fatigue, PTSD, anxiety, or depression.

Less well-known features of post-acute COVID included hair loss in 20% of people and, in a small proportion, previously undiagnosed diabetes. People discharged from the hospital were more likely to have signs of some impairment of kidney function.

The authors also note that symptoms can affect multiple organs throughout a person’s body. For Dr. Nalbandian, “if you go to a cardiologist, the cardiologist may just focus on the heart. But we need to think of the whole person since COVID-19 is potentially affecting many organs, especially in those who have been hospitalized.”

For the authors, although having pre-existing health conditions or a severe case of COVID-19 appears to increase the chance of developing longer-term issues, long Covid has also affected otherwise healthy people.

According to Dr. Wan, “any of these issues can happen to any patient who had COVID-19.

“For example, we’ve seen young patients without prior medical illness who developed autonomic dysfunction and fast heart rates after COVID-19. It’s not just the most vulnerable who have issues after COVID-19.”

The review noted the predominance of people from Black and Minority Ethnic backgrounds in study populations of people with post-acute COVID-19. They reported that in one study in the United Kingdom, 52% of people were Black compared with 19–21% BAME in the general population.

“There really is a post-COVID syndrome, and it doesn’t always correlate with the severity of the acute [SARS-CoV-2] infection itself,” added Dr. Nalbandian.

For some people, the symptoms of COVID-19 appear to stretch out in the weeks after their initial infection. Others recover and only later start experiencing long COVID symptoms.

For Dr. Wan, “I have seen young patients, weeks or even months after [contracting SARS-CoV-2], and they’ve suddenly developed new onset of heart racing, palpitations, and chronic fatigue.”

“When we think of COVID-19, we think of mostly a respiratory illness. But even after [someone has] recovered from their respiratory illness, they may still have other clinical symptoms due to issues with other organ systems.”

The authors highlight that because long COVID can affect so many aspects of a person’s physiology and mental health, teams from all disciplines must work together to offer complete care and support.

For Dr. Wan, “COVID-19 is the first infectious disease that I’ve come across that has such an effect on a wide variety of organs. It’s changed my clinical practice. No matter what the patient comes in for, I now ask if they ever had COVID-19 […]. It changes the possible range of diagnoses.”

“Based on this review, all of us recognized that there needs to be interdisciplinary care to treat patients longitudinally,” added Dr. Nalbandian. “Care for patients with COVID-19 should not conclude at the time of hospital discharge.”

The authors also point out that there is great value in people speaking out about their experiences and joining advocacy groups. This is because not all doctors recognize long COVID.

According to Dr. Nalbandian, “here in New York, we’re seeing patients who have been struggling for weeks and months looking for doctors who are knowledgeable. [Doctors] should be attentive, legitimize patient concerns, and thoroughly document the symptoms.”

Dr. Nalbandian suggests that people should be proactive at reaching out to clinicians: “get in touch with your doctors even if you’re not sure if your symptoms are lingering from your [SARS-CoV-2] infection. The situation is still fluid, and we’re learning more every month.”

People with the symptoms of long COVID can also put themselves forward to join clinical trials, which further helps develop a clinical understanding of the disease, the authors suggest.

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