General
There isn’t a single test or blood work to tell you have long covid. Many of the symptoms from long covid overlap with several other conditions, but if your symptoms became worse or started after you had a covid 19 infection or had a covid 19 vaccine or booster, it is most likely from long covid. Taste and smell abnormalities are somewhat specific to long covid. More info here.
12 points or
higher and you have long covid according to this one study
| Symptom | Points |
| Anosmia/Parosmia | 8 |
| Postexertional malaise | 7 |
| Chronic cough | 4 |
| Brain fog | 3 |
| Thirst | 3 |
| Chest pain | 2 |
| Palpitations | 2 |
| Fatigue | 1 |
| Changes in sexual desire or capacity | 1 |
| Dizziness | 1 |
| Gastrointestinal symptoms | 1 |
| Abnormal movements | 1 |
Thaweethai T, Jolley SE,
Karlson EW, et al. Development of a definition of postacute sequelae of SARS-CoV-2
infection. JAMA. Published
online May 25, 2023. doi:10.1001/jama.2023.8823.
Subtypes of Long Covid
| Incidence | Subtype | Group Specifics |
|---|---|---|
| 34% | Kidney, heart, circulation; Anemia Heart failure Cardiac dysrhythmias/tachycardia, palpitations, Abnormalities on heartbeat, acute renal failure; fluid and electrolyte disorders; Nausea/vomiting | Median 65 years 1:1 male:female Covid hospitalization 61% More preexisting conditions |
| 33% | Respiratory & sleep, anxiety, fear related, headache, nonspecific chest pain , breathing abnormalities (shortness of breath, cough) and throat/chest pain | Female 63% Median age 51 years From later waves of covid COPD/asthma |
| 23% | Musculoskeletal and nervous system, arthritis/joint pain, digestive; headaches, malaise, fatigue, cognitive problems/brain fog, smell and taste problems, neuropathies, sleep problems, skin rashes | Female > 60% |
| 10% | Digestive and respiratory; GERD, gastritis, nausea/vomiting, diarrhea, abdominal or pelvic pain; lower respiratory disease, throat pain, chest pain; | Female >60% |
These symptoms affect several different organ systems, but what do they have in common? The autonomic nervous system. These symptoms overlap in situations where there is a high sympathetic tone and a parasympathetic low tone.
General symptoms
- Tiredness or fatigue that interferes with daily life activities
- Symptoms that get worse after physical or mental effort (also known as “post-exertional malaise”)
Aging
- Accelerated aging can occur due to long covid. For more info click here.
Respiratory and heart symptoms
- Difficulty breathing or shortness of breath – while the sympathetic nervous system does dilate the airways, it can make it harder to breath due to extra work it puts on the breathing muscles.
- Cough and chest pain
- Fast-beating or pounding heart (also known as heart palpitations)
Digestive symptoms
- Nausea
- Upset stomach
- Diarrhea
Other symptoms
- Joint or muscle pain
- Rash
- Changes in menstrual cycles
Neurological symptoms
- Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
- Headache
- Sleep problems
- Dizziness when you stand up (lightheadedness)
- Pins-and-needles Sensation
- Change in smell or taste
- Depression or anxiety
There are several hypotheses on what causes it. We still don’t know if it is one or more causes. Some believe its direct damage from the covid-19 virus; others believe it’s from the cytokine storm that covid-19 virus creates. There is some new evidence suggesting chronic inflammation around the olfactory nerve epithelium. One possible mechanism is the dysautonomia or autonomic nervous system dysfunction that maintains the chronic inflammation. This one explains most if not all of the symptoms exhibited. While it goes by many different names: Long Covid or long hauler’s or post-acute covid syndrome (PACS), they all refer to the same constellation of symptoms.
| General symptoms | Tiredness/exhaustionPost exertional malaise (PEM) – feeling tired after any physical or mental effortFeverFeeling cold or hot, poor temperature control |
| Cardiovascular/Pulmonary (lung)/respiratory | Palpitations/pounding heartHigh heart rateShortness of breathCoughDysphagia (trouble swallowing/painful swallowing)Chest painDizziness, lightheadedness |
| Neurological | Brain fog – difficulty in concentrating and thinkingInsomnia/trouble falling asleep or staying asleepAnosmia/hyposmia/parosmiaAgeusia/DysgeusiaVibration sensations throughout bodyBlurry visionNeuropathies/tingling/pins and needlesTinnitusVertigo |
| Psychiatric | DepressionAnxietyPTSD |
| Digestive | Abdominal painDiarrhea |
| Other | Abnormal sweat smell like onions or cheeseJoint or muscle painsSkin rashes |
Certain symptoms appear to occur from a low vagus nerve/parasympathetic tone, while other are more related to the high sympathetic nervous system tone.
Long COVID (also called post-COVID-19 condition or post-acute sequelae of SARS-CoV-2 infection) is a complex, multisystem disorder that occurs after SARS-CoV-2 infection and is present for at least three months. It can be continuous, relapsing and remitting, or progressive, affecting one or more organ systems. The medical term for this is an infection-associated chronic condition (IACC).
Why are some people more likely to get Long COVID / who is at most risk of getting long covid?
Scientists are uncovering risk factors for Long COVID and learning why symptoms vary from person to person. While 203 long covid symptoms have been documented, not everyone will have the same set of symptoms.
Some groups have a higher risk, including:
- People who did not get a COVID-19 vaccine (2 doses were reported to reduce risk by 40%)
- Number of covid-19 infections (each one increases risk by 5%)
- Female sex (2x risk over male)
- Older age (>70 years of age)
- The specific SARS-CoV-2 variant that caused the initial infection alpha & delta >> omnicron
- Higher viral loads during covid
- Having 5 or more symptoms during the 1 week of covid-19 infection
- Preexisting autoimmunity such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis, lupus/SLE, Sjogren’s disease
- Preexisting herpes family virus infection such as CMV or EBV
- Preexisting Lyme disease
- Ehlers-Danlos syndrome (EDS)
- Gut dysbiosis
- Poor mental health – preexisting anxiety or depression
- Preexisting asthma
- Obesity; BMI > 30
- Smokers
- Diabetes mellitus
- Immunosuppressed
- Ischemic heart disease