Long Covid Appears to Impact about 1 Out of 5 Covid-19 survivors

By Dr. Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDP Public Health Education Specialist/Greenwich Department of Health

Long-COVID is now a phenomenon that appears to be impacting about one out of five COVID-19 survivors (CDC). It goes by many other names including Post COVID-19 Condition, Long-Haul COVID, Post-Acute COVID-19, Long-Term Effects of COVID, and Post-Acute Sequelae of SARS-CoV-2, (PASC). Because a COVID-19 infection in any of its variations can infect many different body organs; the symptoms of Long-haul COVID can be diverse and have a long lasting impact on many different body organs and functions. These chronic symptoms can persist for weeks, months and years (CDC, 2022). With many suffering these long-term COVID effects, many questions are being been posed to health care providers and to Contact Tracers and Monitors of the Greenwich Department of Health.

Here is a synopsis of the frequently asked questions and science-based responses to them:

Question: Can someone who never had COVID get Long-haul (Chronic) COVID?
Answer: Yes. Many COVID-infected people never know they have or had COVID if they are or were asymptomatic (without symptoms) and never tested. The USA has under-tested people for COVID since it reached our shores. When only symptomatic people are tested, we are merely confirming COVID in those most likely to be infected based on their symptoms. From the start, we needed to know who had COVID even if they were without symptoms so we could help contain the spread of the disease. Now both adults and children who thought they had been COVID-free are presenting with Long-haul COVID symptoms (AMA).

Question: Are the symptoms of Long-COVID the same as original COVID Symptoms?
Answer: They can be, but they can also be a much wider range of symptoms impacting the many different body systems that COVID -19 can infect. Chronic or long haul COVID symptoms can occur from about 4-weeks after one’s recovery from their initial COVID-19 infection. The symptoms can last from around a month to over a year or more after the initial infection. COVID-19 is a new (novel) virus, so we only have a short history of learning about it, its full impact on the body, and how long symptoms can last. Symptoms have been seen to also come and go (Berg/CDC/AMA/MMWR).

Question: What symptoms can a person experience with Long-COVID?
Answer: The symptoms of Long-COVID can be physical, emotional, and cognitive, or a combination of any or all. Different people are affected differently (CDC):

Long COVID or Post-COVID Conditions

The most common symptoms include:

General Symptoms: A fatigue that becomes worse after physical or mental exertion, and which is often accompanied by fever
Heart & Lung Symptoms: Difficulty breathing, being short of breath, coughing, having palpitations/a rapid heartbeat, and chest pains
Neurological (nerve) symptoms: “Brain fog” exhibited through difficulty concentrating or thinking, headaches, trouble sleeping, getting light-headed or dizzy upon standing, feelings of “pins & needles”, an altered sense of smell or taste that persists, feelings of depression and/or anxiety.
Digestive Symptoms: Diarrhea and/or stomach pains
Additional Symptoms: A rash, joint or muscle pains, and in girls and women altered menstrual cycles. Some people who had severe COVID infections have developed multiple organ involvement that has impacted their kidneys, heart, lung, brain and skin as well as autoimmune conditions. Others have gone on to develop diabetes (pancreas), heart and neurological diseases (CDC/AMA).

Question: How is Chronic (Long-haul, Long-COVID, Post-Acute) COVID diagnosed?
Answer: Long-COVID can be difficult to diagnose because of its multi-organ/multi-system involvement (CDC/AMA). Like many other chronic diseases, it takes time to pinpoint the diagnosis accurately, so what you share with your primary care provider and the specialists you see is very important diagnostically. Diagnosis can involve blood tests, urinalysis, x-rays and scans, and a variety of cardiac, neurological, and respiratory tests as well as tests for cognitive functioning, and anxiety and depression screenings. Download and use this CDC Patient Tips form to prepare in advance of your visit with a healthcare provider for a Post-COVID evaluation appointment:

Patient Tips: Healthcare Provider Appointments for Post-COVID Conditions

Question: Can children get Long-haul/Chronic COVID?
Answer: The American Medical Association has noted that they can, and that their symptoms are similar to adults with that diagnosis, but they are impacted in lower numbers (Dr. Devang Sanghavi, Medical Director, the Mayo Clinic’s Medical Intensive Care Unit). The American Association of Pediatrics lists many possible organ and system involvement that they refer to as “ongoing or residual symptoms known to occur after a SARS-CoV-2 infection” which is not unlike what adults can experience.

Post-COVID-19 Conditions in Children and Adolescents

Question: Is there anything that can help Long-haul COVID sufferers feel better?
Answer: The American Medical Association’s paper on patients’ questions about Long-haul COVID responded to this topic by noting that there have been anecdotal reports (not research studies) of people who were initially without symptoms but tested positive, and that after receiving a COVID vaccine, their symptoms went away (Dr. Sanghavi in Berg, 2022). Right now treatment seems to be largely symptomatic.

Question: Given the wide range of long term symptoms possible with Long-COVID, is it considered a bonafide disability?
Answer: Yes; According to the Department of Health and Human Services and the Civil Rights Divisionof the Department of Justice, long COVID CAN BE a disability under Titles II (state and local government) and III (public accommodations) of the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act of 1973 (Section 504), and Section 1557 of the Patient Protection and Affordable Care Act (Section 1557). Each of these federal laws protects people with disabilities from discrimination. An individual who is seeking a disability status is required to have an individual assessment performed to determine whether their long-COVID condition or any of its symptoms substantially poses a limitation on a major life activity (HHS, 2021). See HHS point #4 in the references for your rights as a disabled person under this determination.

Question: Are you more likely to develop Long-Haul COVID if you are not vaccinated?
Answer: The CDC has noted that unvaccinated people who subsequently develop a COVID-19 infection may be at higher risk for developing Chronic COVID symptoms when compared to those who
were either vaccinated or who had breakthrough infections after being vaccinated.

Question: Can Paxlovid or monoclonal antibody therapy help people with Long-COVID?
Answer: There is not a definitive answer yet to that question. Large group studies have not yet been done. Single patients have identified feeling improved, but that is not sufficient to qualify as a science-based study outcome. In MedPage Today (Walker, 2022) Dr. Michael Peluso of the University of California, San Francisco is quoted as saying that Paxlovid may benefit patients with Long-COVID, but that right now the drug cannot be accessed for that (untested) purpose. The American Society for Microbiology points to a lack of reliable current data since what we have now in regards to this question was collected when we were working with the original strains of COVID and not with the current Omicron B variants that are now dominant (ASM, 2022).

Resources On Long-COVID

AAP (n. a.) (2022). Post-COVID-19 Conditions in Children and Adolescents. America Pediatric Association. Retrieved from: Post-COVID-19 Conditions in Children and Adolescents

ASM (n. a.) (2022). Long COVID: The next chapter in the COVID-19 Pandemic. American Society for Microbiology. Retrieved from: Long COVID: The Next Chapter in the COVID-19 Pandemic

Berg, S. (2022). Covid Long Haulers: Questions patients have about symptoms. American Medical Association; Public Health. Retrieved from: COVID long-haulers: Questions patients have about symptoms

CDC. (n. a.) (2022). Long COVID or Post-COVID Conditions. CDC; Updated 7-11-22. Retrieved from: Long COVID or Post-COVID Conditions

CDC. (n. a.) (2022). Post-COVID Conditions: CDC Science. Updated 6-17-22. Retrieved from:
Post-COVID Conditions: CDC Science

CDC. (n. a.) (2022). CDC Scientific Publications on COVID-19

CDC. (n. a.) (2022). Long COVID or Post-COVID Conditions. CDC; Updated 7-11-22. Retrieved from: Long COVID or Post-COVID Conditions

CDC. (n. a.) (2022). Post-COVID Conditions: CDC Science. Updated 6-17-22. Retrieved from: Post-COVID Conditions: CDC Science

HHS. (n. a.) (2021). Guidance on “Long COVID” as a Disability Under the ADA, Section 504, and Section

  1. HHS.org.; Office for Civil Rights (OCR). Updated 7-26-21. Retrieved from: Guidance on “Long COVID” as a Disability Under the ADA, Section 504, and Section 1557

MMWR. (n. a.) (2022). Post COVID Conditions Among Adult COVID-19 Survivors Aged 18-64 and >
65 Years. CDC; Early Release. Retrieved from: Post–COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years — United States, March 2020–November 2021

Walker, M. (2022). Case Series Hints at Possible Paxlovid Role in Long Covid. MedPage Today. Retrieved From: Case Series Hints at Possible Paxlovid Role in Long COVID