Long COVID

Last updated: 28 April 2022

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Long-term health impacts of COVID-19

SARS-CoV-2 is still a relatively new virus and we still have a lot to learn about the long-term health impacts of COVID-19. The long-term physiological and psychological effects of COVID-19 are not yet fully known. New evidence on long COVID continues to emerge from around the world.

Most people with COVID-19 recover completely and return to normal health. People usually recover from COVID-19 after 2–6 weeks and many make a full recovery within 12 weeks.

For some people signs and symptoms can carry on for longer than 12 weeks, may change over time, and new symptoms may develop. In addition, some patients develop medical complications that may have lasting health effects. Patients that are admitted to intensive care units may also experience ‘post-intensive care syndrome’ (PICS) which are health problems that remain after critical illness.

The World Health Organization (WHO) has called the persistent state of ill health after COVID-19 ‘post COVID condition’, but it is also commonly known as ‘long COVID’.

Many other terms for the illness are also used globally, such as: post-acute sequalae of SARS-CoV-2 infection (PASC); post COVID syndrome; post-acute COVID-19; long-term COVID-19; post-COVID-19 syndrome, and chronic COVID syndrome.

Read more:

Long COVID definitions

Ongoing symptoms are common following many viral and bacterial infections, including other coronaviruses.

The presence of lingering symptoms may have a significant impact on the daily lives of those who are affected, and their family and whānau. Given the numbers of people who have been or will be infected with SARS-CoV-2 worldwide, the public health impact of long COVID could be significant.

The term ‘long COVID’ is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 (four weeks from the initial infection). Symptoms may last for weeks or months after the acute illness.

There is no internationally agreed definition of the long COVID condition yet. However, the WHO published the following definition in October 2021:

“Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.

Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others which generally have an impact on everyday functioning.

Symptoms may be new onset, following initial recovery from an acute COVID-19 episode, or persist from the initial illness. Symptoms may also fluctuate or relapse over time. A separate definition may be applicable for children.”

The Centers for Disease Control (CDC) in the US uses the term ‘post-COVID conditions’ to describe long COVID, defined as a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19.

The National Institute for Health and Care Excellence (NICE) in the UK uses the following definitions to classify the long-term effects of COVID-19:

Ongoing symptomatic COVID-19: Signs and symptoms of COVID‑19 from 4 weeks up to 12 weeks.

Post-COVID-19 syndrome: Signs and symptoms that develop during or after an infection consistent with COVID‑19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body.

The term ‘long COVID’ is commonly used to describe signs and symptoms that continue or develop after acute COVID‑19. It includes both ongoing symptomatic COVID‑19 (from 4 to 12 weeks) and post‑COVID‑19 syndrome (12 weeks or more).

Symptoms of long COVID

To better understand how long COVID could be diagnosed, it is important to understand how symptoms, signs and tests are used to make a diagnosis for any condition. Symptoms are what a patient feels, such as a sore throat or headache. Signs are changes which a healthcare practitioner notices when they examine a person, such as a fast heart rate, or fast breathing.

Unfortunately, for long COVID there are often very few signs, and there is no test for long COVID. Therefore, the diagnosis is made on the basis of persistent symptoms occurring after a person has had COVID-19. There are a wide range of symptoms for acute COVID-19 and for long COVID, but these symptoms are also common in many other conditions. Ongoing symptoms can vary widely and affect people differently.

There are many different conditions that share these symptoms, so it is important to check with your doctor before assuming something is due to a COVID-19 infection. Importantly, long COVID symptoms may be less commonly reported in children or young adults, and it has been noted that a separate definition for children may be needed.

Commonly reported symptoms include (but are not limited to) the following:

Respiratory symptoms

  • Breathlessness
  • Cough

Cardiovascular symptoms

  • Chest tightness
  • Chest pain
  • Palpitations

Neurological symptoms

  • Cognitive impairment (‘brain fog’, loss of concentration or memory issues)
  • Headache
  • Sleep disturbance
  • Pins and needles and numbness
  • Dizziness
  • Delirium (in older populations)
  • Mobility impairment
  • Visual disturbance
  • Musculoskeletal symptoms
  • Joint pain
  • Muscle pain

Generalised symptoms

  • Fatigue
  • Fever
  • Pain
  • Gastrointestinal symptoms
  • Abdominal pain
  • Nausea and vomiting
  • Diarrhoea
  • Weight loss and reduced appetite

Ear, nose and throat symptoms

  • Tinnitus
  • Earache
  • Sore throat
  • Dizziness
  • Loss of taste and/or smell
  • Nasal congestion

Luke's long COVID journey

After having COVID-19 in 2020, Luke still suffers from the effects of long COVID. In this video he describes his experience and the importance of getting boosted to avoid infection. While Luke was infected with an earlier variant of the virus that causes COVID-19, the features of long COVID after infection with the Omicron variant are still being investigated.

Kia orana, my name is Luke Maclean-McMahon. I was born and raised in Porirua. I'm Cook Island and I'm also Irish and Scottish.

I'm grappling with what specialists have diagnosed as long COVID, so I have ongoing symptoms even today. The main things for me are heart related; I black out often and also there's the chronic fatigue aspects. Today’s a good day, but some days you have no energy to get out of bed and literally do anything.

I've struggled with depression since and I think a large part of that has probably been losing the life of the health that I used to have. I can't play the sports that I love, I can't play basketball, I can't play tennis.

COVID-19 took me out of work quite a lot. You feel like you're unmotivated, like you're not contributing but also you've got to try and pay the bills and put food on the table. I don't want any of my family or friends or anyone in New Zealand to go through what I have.

In the COVID-19 ward next to me on the ward was Dr Papa Joe Williams. A former Cook Islands Prime Minister, but also a doctor who helped many. When he passed away I think it put in the minds of a lot of Pacific Islanders, actually this thing is real.

What I would say to people is don't ever assume because you're young or fit or healthy or eat well or exercise a lot that you'll get through it fine, we just don't know what your immune response will be.

You know Pacific Islanders are more vulnerable, Maori are more vulnerable and so if you're sitting in one of those groups and there's a booster that's available for you free, you know just down the road or around the corner, get there get to that vaccination centre and get boosted as soon as you can, don't wait!

Who gets long COVID

Long COVID appears to be more common among people who had severe COVID-19 symptoms when they first got sick but can also affect those who initially had mild or moderate COVID-19. Even people who initially had no symptoms may go on to develop long COVID. Long COVID is seen in all age groups. However, it appears to be less common in children and adolescents than in adults.

Some factors that may be associated with increased chance of having long COVID symptoms have been identified, including:

  • older age
  • having more than one underlying chronic medical condition
  • a higher body mass index (obesity)
  • being female
  • being admitted to hospital during acute phase of having COVID 19

The best way to prevent long COVID is to be up-to-date with your COVID-19 vaccinations.

Read more from the CDC: Post-COVID Conditions

Burden of long COVID

There are many reports from people worldwide who feel they do not recover to their previous level of health after having COVID-19, and there are increasing studies showing that a significant proportion of people may experience some ongoing health impacts.

Most of the long COVID studies have been carried out for previous variants of the virus, but more information about long COVID in people infected with Omicron will soon be available.

Estimates of the number of people who develop long COVID range quite widely as shown in the following international reports:

Although it is difficult to precisely predict the likely burden of long COVID in New Zealand, given the large number of people who have now had COVID-19 in New Zealand (particularly recently with the Omicron variant), this may result in significant impacts on individuals, families and whānau, and the healthcare system over time.

Possible causes of long COVID

Long COVID is complex and there is likely to be more than one cause. There are several types of ongoing health issues that come under the umbrella term of long COVID. The CDC describes post-COVID conditions as: new or ongoing symptoms, multiorgan effects of COVID-19, and effects of COVID-19 illness and hospitalisation.

Researchers are working to learn more about the cause/s of long COVID, which will help inform advice for management and treatment. A range of factors have been suggested to contribute to long COVID, including: effects of the virus on the body (particularly on the nervous system and vascular system); the possibility of virus fragments lingering in the body triggering ongoing symptoms; or the immune system becoming overactive in response to COVID-19. More research is needed to better understand the potential causes of long COVID.

It appears that some people with long COVID are experiencing similar symptoms to myalgic encephalomyelitis / chronic fatigue syndrome. There is research underway to investigate how long COVID may be related to conditions like chronic fatigue.

Treatment, management and support options

The long-term physiological and psychological effects of COVID-19 are not yet fully known. However, recovery from viral infections often requires rehabilitation for extended periods of time.

Managing and recovering from long COVID will be different for each person. The severity of symptoms can vary from mild to debilitating and fluctuate over time. In some cases, people begin to feel better before experiencing a return of symptoms such as fatigue.

For support with management and treatment of long COVID symptoms, people should seek the help of their GP or healthcare team, particularly if new symptoms arise or symptoms worsen.

Treatment options will need to take a holistic approach, as each person will present with a range of symptoms. Allied health professionals including occupational therapists, physiotherapists, speech and language therapists, dieticians, social workers, psychologists and exercise physiologists will be able to offer supports to individuals based on their unique circumstances.

Supports could include energy conservation and fatigue management, confidence building, muscle strengthening, anxiety management, nutritional advice, speech and swallowing advice, breathing re-education, assessment for aids and adaptations and activities to support individuals to regain function. Other multidisciplinary team members will also be involved including relevant medical specialties.

People can also free call or text 1737 anytime of the day or night to speak with a trained counsellor.

Tracking symptoms

Some people find it useful to keep track of their symptoms. Keeping a log of symptoms can help identify which symptoms are of most concern and to identify patterns and changes in symptoms. This information is also useful to take to appointments with healthcare professionals. There are several apps that can be downloaded for this purpose. An example of a paper version for tracking symptoms is available from the National Institute for Health Innovation.

Impact of vaccination on long COVID

The best way to prevent long COVID is to prevent infection with COVID-19. Vaccines reduce the risk of long COVID by lowering the chances of getting COVID-19 in the first place. There is also some evidence that vaccination reduces the risk of people who do get COVID-19 going on to develop long COVID.

A new review by UK Health Security Agency shows that people who have had one or more doses of a coronavirus (COVID-19) vaccine are less likely to develop long COVID than those who remain unvaccinated. Further investigation is needed, and we will continue to monitor this research.

UKHSA review shows vaccinated less likely to have long COVID than unvaccinated

Vaccination against COVID-19 continues to be available to all New Zealand adults and children over the age of 5 years old. Find out the latest on our vaccine programme:

What the Ministry of Health is doing to manage the long-term effects of COVID

The Ministry of Health has established a long COVID programme with the goal of disseminating emerging models of care, clinical practice, patient self-management and digital enablement to support patients with long COVID-19 in a New Zealand context.  

The programme is based on the following principles:

  • giving effect to our obligations under Te Tiriti o Waitangi, including considering the interests and needs of Māori
  • ensuring equity, which involves inclusiveness for all communities, particularly those most affected by COVID outbreaks i.e Māori and Pacific
  • ensuring equity of access to services and outcomes,
  • ensuring services are effective, timely and reflects best-practice as the evidence emerges
  • ensuring services are patient centred, including patient self-management and digital enablement to support patients with Long COVID
  • long COVID symptoms are investigated, treated, and funded in the same way as other long-term conditions.

Within the work programme, four workstreams are underway to support the development of the long COVID rehabilitation and service delivery guidance within an Aotearoa New Zealand context:

  • Development of a service development toolkit (also known as a change package), including monitoring DHB’s with existing specific services for long COVID
  • Establishing an expert advisory group to provide guidance and input into the long COVID rehabilitation guideline, with broad representation from Māori, Pacific peoples, researchers, clinicians, service providers and people with lived experience.
  • Monitoring emerging evidence to inform clinical pathways to identify and manage long COVID
  • Ongoing research to identify gaps that are particular to Aotearoa New Zealand and how options for how they might be addressed.

Read more:

The Ministry has previously published guidelines for the rehabilitation for people with or recovering from COVID-19. This guidance is in the process of being updated and will include additional focus on long COVID. 

The Ministry is currently establishing the Expert Advisory Group for long COVID to assess the evidence on long COVID and apply it to the Aotearoa New Zealand context, to help inform recommendations for clinical practice and guidelines.  The group will provide oversight, with broad representation from Māori, Pacifica, researchers consumers, clinicians, and service providers. The group will meet in May 2022.

The Ministry is also funding research on the Impacts of COVID-19 in Aotearoa study, run by Victoria University of Wellington. This study aims to understand the experiences of people in Aotearoa New Zealand who have had COVID-19 and to learn about the short- and longer-term impacts of COVID-19 on the health and well-being of individuals, whānau and families. There is a particular focus on key subgroups including Māori, Pacific people, people with disabilities (including long COVID), and people who developed COVID-19 through their employment. The outcomes of the study will be used to advise health officials. 

For those who had COVID-19 prior to December 2021, there is an opportunity to take part in the Impacts of COVID-19 in Aotearoa study run by Victoria University of Wellington looking at the importance of appropriate health services for people with COVID.

To take part, go to covidaotearoa.com or call 0800 800 581.

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