The Long and Short of Long COVID: What do we know? What have we learned?

By Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDP, Greenwich Health Dept Promotion Specialist

While most people recover from COVID-19 within days or weeks of becoming ill, some unfortunate folks find that their symptoms linger for months or years beyond their initial diagnosis. Our look-back period is just three years at this time since the virus only emerged in 2019. SARS-CoV-2 (COVID-19) is still considered to be a new (novel) virus in all its mutated forms, and new variations keep emerging.

Other COVID patients have recovered but as time went on symptoms emerged or re-emerged without a new bout of confirmed illness. Even those without symptoms during their infectious period are presenting with symptoms of Long-COVID months to years after having been infected and having recovered.

As a contact tracer since COVID-19 emerged, I’ve had many patients who got tested for a variety of reasons but never had a single perceptible symptom throughout their illness. They had tested in advance of travel, return to school, family visits, or because of a known exposure. Many were shocked to learn they had COVID. They felt fine and were asymptomatic, yet here they were, positive for this serious and highly contagious disease that has already killed 11,863 people in Connecticut alone as of 1/12/23. Just in the last 7 days Connecticut has suffered the loss of 60 more people to COVID-19 (CT-DPH).

So, what do we know about Long COVID? We currently have no test for it. Because it involves so many different body organs and systems, it is difficult to diagnose. Making an accurate diagnosis often requires the input of numerous medical specialists and diagnostic tests. We have people who’ve had multiple episodes of COVID-19 confirmed by PCR testing plus many more who home test and do not show up in our data. There are numerous different strains of COVID-19 circulating simultaneously as a result viral mutations, and as a result we can become contaminated more than once.

The best protection against getting Long-COVID is to avoid getting infected with COVID-19 in the first place. This is best achieved through vaccination and booster shots, and good infection control practices (using masks and social separation when warranted, using good respiratory etiquette, handwashing and routine surface cleaning).

Getting re-infected is a different phenomenon from Long-COVID; when you get re-infected your COVID test will again be positive. On the other hand, many whose symptoms have resolved and who are well past their tenth day remain positive on tests for several months.

We’ve learned from studies and autopsy reports that having had a mild case of COVID-19 or a case with no symptoms at all, is not an assurance or a defense against getting diagnosed with Long-COVID and all its disturbing ramifications.

The National Institutes of Health (NIH) reported that 90% of people who developed Long-COVID had only mild symptoms when they were ill with their acute COVID-19 episode. The American Medical Association stated that the cognitive health symptoms of Long-COVID have as great an impact on people’s health and quality of life as do those who suffer the long-term effects of traumatic brain injury (Hanson, et al, 2022). The most recent CDC information (NIH, 2022) tells us that one in 13 adults had symptoms exceeding three months or longer after becoming ill, and that 20-25% of adult survivors, depending on their age, developed a health condition that appears related to their prior bout with COVID-19 (Levine, 2022).

Various studies and reports have linked over 200 symptoms post-COVID-19 (Levine, 2022). Most common are severe shortness of breath and reduced stamina, headaches, and heart palpitations, as well as depression and anxiety. The range of symptoms have included overwhelming fatigue, sleep disturbances, eye inflammations, gastrointestinal symptoms, muscle and joint pains, dizziness, and cognitive functioning problems that collectively are referred to as “brain fog.”

Others have reported, “pins and needles,” a persistent loss of taste and/or smell, ringing in the ears, and balance problems, as well as other neurological symptoms. Research findings indicate that those who suffered a particularly severe case of COVID-19 may be at higher risk of developing other health complications such as Type 2 diabetes, kidney failure, pulmonary blood clots, and

heart inflammation. It is still unclear, however, if these conditions were caused by COVID, or were merely linked to having had a COVID-19 infection. Levine referenced a study from The Lancet Diabetes & Endocrinology Journal that noted that participants who recovered from COVID-19 had a 40% higher risk of being diagnosed with type 2 diabetes in the year after their COVID-19 diagnosis. Based on this finding, if you have had COVID-19 in the last year, be alert to the common early signs of diabetes such as increased thirst and a frequent need to urinate (which are your body’s attempt to flush the excess sugar out of your body), increased hunger, fatigue and blurred vision. If you or a loved one experience that, get checked out.

The scientific and medical communities have learned a lot from autopsies of those died from their COVID illnesses. Regrettably for the victims and families, that group has provided a large study population. One comprehensive analysis of those who succumbed revealed that the SARS-CoV-2 virus was “widely detected across the body and brain,” infecting 84 distinct locations and body fluid sources (O’Mary, 2023). The virus replicated most heavily in the respiratory system of its victims, but also in many other of their body organs and tissues. This finding was validated in early, mid, and late stage cases.

A huge Veterans’ Administration study of over 86,000 hospitalized and non-hospitalized Long-COVID patients found that for those whose symptoms went beyond the 1 st 30-days of their illness, survivors suffered a “substantial burden of health-loss involving nearly every organ and regulatory system in their body”. This negative health impact involved their respiratory, cardio-vascular, and gastrointestinal systems, as well as impacting nervous system disorders and mental health. The researchers noted that the non-hospitalized COVID-19 survivors had a nearly 60% increased risk for death. Non-hospitalized
would equate to people who seemed less ill while they had active COVID (Al-Aly in O’Mary, 2023).

We continue to learn more about SARS-CoV-2 virus (COVID-19) in all its mutant forms, and we are learning more about Long-COVID and how to treat people suffering from it as time goes on. Post-COVID conditions are not one isolated illness so there are many potential symptomatic treatments that your healthcare provider or providers may suggest for you. Some may be medicinal in nature while others may be life-style modifications. Respiratory, physical and occupational therapy approaches may be ordered. Integrative medicine approaches are in use. It is important to know if you or a loved one is showing any of the signs of Long-COVID, and to follow-up with your healthcare provider if those are observed.


Downey, K. (2023). Neurological effects of long COVID: It is ‘not only a respiratory disease’. Helio/Neurology.

Ellis, R. (2023). Most Long COVID Cases Started With Mild Symptoms: Study. WebMD. What Is Long COVID?

Hanson, S., Abafati, C., Aertz, J., et al. (2022). Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021. JAMA; Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021

Levine, H. (2022). Do I have Long COVID? Here’s how to tell. WebMD. Levine, H. (2022). Do I have Long COVID? Here’s how to tell. WebMD.

NIH. (2022). What Is Long COVID? National Institutes of Health/COVID-19 Research. Retrieved from Most Long COVID Cases Started With Mild Symptoms: Study

O’Mary, L. (2023). Autopsies Show COVID Virus Invades Entire Body. WebMD. Retrieved from Autopsies Show COVID Virus Invades Entire Body

Rapaport, L. (2023). Long COVID Clinical Trials May Offer Shortcut to New Treatments. WebMD. Retrieved from Long COVID Clinical Trials May Offer Shortcut to New Treatments

Stein, S.R., Ramelli, S. C., Grazioli, A. et al, (2022). SARS-CoV-2 infection and persistence in the human body and brain at autopsy. Nature 612, 758–763 (2022). Retrieved from SARS-CoV-2 infection and persistence in the human body and brain at autopsy

Stulpin, C. (2021). Long COVID: A ‘mysterious’ syndrome with ‘no clear pattern’ of symptoms. Helio/Neurology. Retrieved from Long COVID: A ‘mysterious’ syndrome with ‘no clear pattern’ of symptoms