As the Omicron variants of COVID-19 have almost completely replaced the more dangerous Delta variant that drove the harrowing days of the COVID pandemic, most Americans are moving on. But it’s not over for everyone: Up to 23 million Americans are dealing with long COVID.

For most people, a COVID infection lasts about two weeks, but some people continue to have COVID symptoms long after the acute infection. Some patients with long COVID had very mild COVID symptoms when they were first infected. (There are even people who never tested positive for COVID.) In some cases, the symptoms of long COVID are worse than the symptoms of the initial infection.


The World Health Organization (WHO) defined long-COVID symptoms as fatigue, shortness of breath, cognitive dysfunction (difficulty thinking clearly), or any other symptoms that have an impact on everyday functioning. People also often report dizziness, tightness in the chest, pain, nausea, vomiting, recurrent fevers, chills, joint pain, and cough.

To meet the WHO definition of long COVID, a person much have symptoms three months after the onset of COVID that last for at least two months and cannot be explained by any other cause. But they can last much longer than that. A study published in the Annals of Clinical and Translational Neurology in May reported that most people with long COVID continue to experience symptoms an average of 15 months after disease onset. (The study looked only at people who had mild initial COVID-19 symptoms and did not need hospitalization.)

“We were surprised by the persistence of most of the debilitating neurological symptoms of our patients, and by the late appearance of symptoms that suggest dysfunction of the autonomic nervous system,” says Igor Koralnik, MD, chief of Neuro-infectious Diseases and Global Neurology at Northwestern Medicine, Chicago.

Risk factors

Today, most experts believe that 10 to 15 percent of people with COVID go on to develop long COVID. Some research suggests that older age may increase the risk. One study found that the risk increased by between 3 to 4 percent for every decade of age. Other risk factors cited have been type 2 diabetes, smoking, and high blood pressure.

The one risk factor that seems to be a constant in the clinic population at Beth Israel Deaconess Medical Center’s long-COVID clinic is obesity. And of course, not being vaccinated increases your risk of COVID substantially, so that is the biggest risk factor for long COVID.


As of now, there is no test that can diagnose long COVID. Diagnosis depends solely on history and symptoms. This situation can be frustrating for both doctors and patients. A disease without diagnostic tests that causes symptoms that are felt but can’t be seen or measured may be dismissed as more psychological than physical, even by some doctors. However, most doctors who deal with long-COVID patients do not doubt that it is a real condition.


Treatments that have been tested in clinical trials and have been found effective are called evidence-based treatments, and treatment guidelines can be built around these findings. Unfortunately, there are no evidence-based guidelines for long COVID yet. Treatment is mainly supportive.

  • Patients benefit from learning about the condition and how to manage the symptoms that they have. Most patients see improvement over three, six, or nine months.
  • Some of the most successful treatments are mind-body therapies like yoga and meditation.
  • Physical therapy, exercise, sleep, and a healthy diet are all part of the treatment.
  • People who suffer from anxiety or depression due to long COVID may benefit from working with a mental health-care provider.
  • Ongoing studies suggest that patients with fatigue and weakness may benefit from balance and gait training, upper and lower body strengthening exercises, and aerobic exercise and reconditioning for improved pulmonary health.
  • The virus disrupts autonomic function, which can result in orthostatic intolerance, or difficulty maintaining blood pressure and pulse, says Jacob Teitelbaum, MD, an internist and author of several studies on the treatment of fibromyalgia and chronic fatigue syndrome. Increasing salt and water intake and using medium-pressure compression stockings can help treat orthostatic intolerance.
  • Dr. Teitelbaum also turns to dietary supplements and suggests that his patients take curcumin to reduce inflammation and low-dose naltrexone to decrease brain fog by addressing a condition called microglial activation.

New variants and risk

According to the U.S. Centers for Disease Control and Prevention, the Omicron variants of COVID-19 have almost completely replaced the Delta variant, but we don’t have a good sense yet on how the shift from the Delta to Omicron and other variants will affect the number of people with long COVID. Anecdotally, the Beth Israel Deaconess Medical Center’s long-COVID clinic continues to be extremely busy with appointments booked months in advance of available openings.

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