Because the SARS-CoV-2 virus, commonly referred to as COVID-19, has only been circulating for a few years, the lasting implications of the disease are not yet known. Many studies of what we call long COVID-19 are underway around the world as scientific and medical communities work to understand more about the virus and its long-term effects. More is being learned every day. 

For an update, we spoke to internal medicine doctor Andrew Vasey, MD, who sees a variety of post-COVID-19 patients. 

How to know when you have long COVID

The National Institutes of Health defines long COVID-19 as "the prolonged symptoms or new or returning symptoms that people may develop after recovery from initial SARS-CoV-2 infection. These symptoms can persist for months and range from mild to incapacitating." 

Long COVID-19 symptoms may include, but are not limited to: 

• Fatigue
• Shortness of breath 
• Brain fog
• Sleep disorders
• Heart issues
• Gastrointestinal issues
• Chronic cough
• Anxiety and depression 

"If your symptoms resolve within 30 days, it's just related to your initial COVID infection," says Dr. Vasey. "However, if you have persistent symptoms after 30 days, or they start up after 30 days, that's considered long COVID, or post-acute COVID."

The duration of symptoms for long COVID-19 patients is extremely variable from person to person. 

Some people can have issues for weeks, months or longer. Some people will have persistent symptoms, others will have symptoms that wax and wane. Most people with long COVID-19 symptoms do get better with time.

Is long COVID contagious?

The exact reason why post-COVID-19 issues happen isn't clear, but they don't appear to be true active infections, which means they're probably not contagious. 

There's some thought that people still have the virus in their system, similar to the chickenpox virus, which can reemerge later on as shingles.

As for post-COVID-19 rashes or other types of skin issues, these don't appear to be an infectious type rash like cellulitis. It is just the way the body system is reacting to having had COVID-19.

The same with a lingering cough that someone may have after a COVID-19 infection. Other types of viral infections, such as pneumonia, can cause a post-viral cough for a while but they're not infectious. 

How long COVID impacts your body

Research is ongoing, but there is some evidence that a COVID-19 infection can sometimes cause what is referred to as in-organ damage, such as scarring in the lungs or heart. But again, a lot of people with COVID-19 don't show evidence of that. 

It's thought that COVID-19 also affects your autonomic nervous system, which is involved in pretty much every process that your body undergoes. 

For example, a non-COVID-19 patient who has been in the ICU for months and months, not moving around, will have extreme fatigue and limits to how much they can exert themselves after they're discharged. The thinking is that COVID-19 mimics that. So, even when a person with COVID-19 hasn't been confined to a bed for months, their body has deconditioned a lot more than what we'd expect from the level of illness they've had.

Who is most likely to get long COVID?

In his presentation on Post-COVID-19 Conditions and Prevention via Vaccination, infectious diseases expert, Mark Rupp, MD, cited a recent MMRW report stating that patients under the age of 65 had a 1 in 5 chance of developing a post-COVID-19 condition in the 30 days to one year after a COVID-19 diagnosis. This increased to a 1 in 4 chance in patients over the age of 65.

"At least from what I've seen in clinic, long COVID occurs more often in middle-age to older individuals," says Dr. Vasey. "That's not to say that people in their 20s can't have post-COVID-19 issues, because we do see people of that age here. It's also not just an issue that affects people in their seventh or eighth decade of life, but adults of any age."

The severity of illness doesn't really predict whether or not you're going to develop long COVID-19. A lot of people who have post-COVID-19 symptoms have only been mildly to moderately ill and were not admitted to the hospital. 

"With omicron, we're seeing people who were infected in January or February who are now experiencing post-COVID-19 issues," says Dr. Vasey. "Again, these people weren't necessarily hospitalized or severely ill. That's the issue with COVID-19. It's not just the flu. You aren't just sick for a week and go back to normal. There's somewhat of a large chance that you may have continued issues with this."

Will long COVID go away?

"We don't really know yet if long COVID symptoms are permanent," says Dr. Vasey. "There are some people in our clinic who had COVID-19 at the onset of the pandemic who are still having issues. But, the vast majority of people we see do get better over a period of time."

How to get help for long COVID

In most cases, you'll want to start by seeing your primary care doctor. (If you don't have a primary care doctor, it's a good idea to establish a relationship with a doctor who can get to know you long-term.)

If you're experiencing post-COVID-19 symptoms, your provider will want to make sure there's nothing else going on that might be contributing. 

"A small subset of people may have some in-organ damage, including issues with their lungs or heart," says Dr. Vasey. "Your doctor will want to make sure you don't have a condition like pulmonary fibrosis that is causing your symptoms, because the treatment for that might be different."

Once some of the more serious issues are ruled out, your doctor can begin to treat the symptoms. 

"Right now, many of the treatments that we use for post-COVID issues act on the central nervous system, and these treatments can add their own set of side effects," says Dr. Vasey.

Being vaccinated against COVID-19 helps 

There still isn't enough data to say definitively whether vaccination prevents post-COVID-19 symptoms. However, it does decrease your risk of getting infected with COVID-19 in the first place. There's still a chance that people who are vaccinated can be infected and have post-COVID-19 issues, but it's less than those who aren't vaccinated. 

In fact, being fully vaccinated can decrease the occurrence of post-COVID-19 symptoms anywhere from 13% to 50% according to several studies cited by Dr. Rupp. "Long COVID is alive and well, and has real implications on our health care system and our ability to care for these patients," he says. "COVID-19 is going to continue to affect our population for years to come, as some people continue to have these conditions probably for the rest of their lives."