Post-COVID Conditions

What causes post-COVID conditions?

Researchers are still learning more about why some people have these symptoms, and what causes them. COVID-19 can affect many organs, including the lungs, heart, digestive tract, kidneys, and brain. Experts are tracking data to learn what this means, and how long these effects may last.

Some symptoms like post-COVID conditions are also found in people who have spent time in the hospital for any serious injury or illness. This is known as post-intensive care syndrome (PICS). It includes problems such as weakness, fatigue, and trouble thinking and focusing. It can cause symptoms of posttraumatic stress disorder (PTSD). These can include anxiety, depression, and insomnia. Researchers are still learning how PICS may connect with post-COVID conditions.

In rare cases, a child or adult may have an autoimmune condition called MIS after having COVID-19. This is multisystem inflammatory syndrome (MIS). It’s a condition where the body attacks itself and causes inflammation in parts of the body. MIS may lead to post-COVID conditions in some cases.

Who is at risk for post-COVID conditions?

Anyone who has been infected with SARS-CoV-2 is at risk for these. You are at risk even if your symptoms of COVID-19 were mild, or if you didn’t have COVID-19 symptoms. You may be at higher risk if you spent time in the hospital.

What are the symptoms of post-COVID conditions?

With post-COVID conditions:

• Your symptoms of COVID-19 may last 4 or more weeks after you were infected.
• You may have new symptoms that start 4 or more weeks after you were infected.
• These can happen even if your COVID-19 symptoms were mild or you had no symptoms.
• The post-COVID symptoms may last for weeks or months.

The most common symptoms of post-COVID conditions are below. You may have one or more of these:

• Anxiety
• Chest pain
• Cough
• Depression
• Diarrhea
• Feeling dizzy when you stand up (orthostatic problems)
• Feeling short of breath when you do little activity
• Feeling that your heart is beating fast (heart palpitations)
• Fever
• Finding it hard to breathe
• General tiredness (fatigue)
• Hair loss
• Headaches
• Irregular menstrual cycles
• Joint or muscle aches
• Loss of smell or taste
• Memory problems
• Muscle weakness
• Rash
• Stomach pain
• Tingling or numbness in parts of your body
• Tiredness that gets worse after any of kind activity (post-exertional malaise)
• Trouble sleeping (insomnia)
• Trouble thinking or focusing (a feeling of brain fog)

How are post-COVID conditions diagnosed?

There is no one test that can diagnose post-COVID conditions. You may have a blood test to look for antibodies to the virus that causes COVID-19. This can show if you had a recent infection with the virus.

You may have other tests to check for health conditions that can cause similar symptoms. There are many kinds of tests that your provider can talk with you about. The type of tests you may need depend on the symptoms you have. These tests may include:

• Blood tests. These can check for many kinds of health problems that can cause symptoms. These include anemia, liver problems, thyroid problems, less kidney function, low iron or potassium, and blood clotting problems. They can look for signs of inflammation in your body. They can check for heart damage.
• Physical tests. You may be asked to do activities to check your ability to exercise. You may have a breathing test. You may have tests to check your balance and risk of falling. You may have tilt table testing to check for orthostatic problems. Your heart’s electrical activity may be tested with an ECG. Your heart’s pumping may be checked with an ultrasound or MRI. You may have a chest X-ray or CT scan. These look for lung injury if you are coughing or short of breath.
• Questions and checklists. Your healthcare provider may ask you questions to see how you score on different kinds of tests that check health. Some tests look for problems with thinking or focusing. Some tests check for anxiety or depression. You may be tested for PTSD. You may be asked about how tired you feel, or how well you are able to sleep. You may be asked when or how often you feel short of breath.

How are post-COVID conditions treated?

Treatment is done by helping you manage your symptoms and daily life until you feel better.

Your treatment may include:

• Managing your activity. This is called pacing. It means not doing too much in a short space of time. You spread your activity out across the day. Your healthcare provider can tell you more about pacing. They may refer you to a physiatrist to help you manage your exercise limits. If you are athletic, you will need close checking of your heart health as you slowly return to exercise or sports.
• Doing specific exercises as advised. You may need to go to physical or occupational therapy to regain strength, especially if you spent time in the hospital. You may be given breathing exercises to help lessen symptoms.
• Taking medicines. Your healthcare provider may have you take medicines to ease headaches, pain, cough, shortness of breath, diarrhea, or other problems. They may prescribe medicine for anxiety or depression. A pharmacist can go over all of your medicines with you. Some medicines to treat Covid may have their own side effects.
• Taking supplements as advised. You may be told to take vitamin or mineral supplements if you have low levels of these. Don’t take any supplements, herbs, or other remedies without talking with your provider.
• Keeping follow-up visits. You may need to see your healthcare provider every 2 to 3 months until you recover. You may need to see other providers to help with nutrition, sleep, or other problems. If you are referred to a post-COVID clinic, you may be able to join a clinical trial. These look at how new treatments work for people. You may be asked to track your oxygen level and blood pressure at home.
• Getting mental health support. Mental health is a vital part of recovery. Your provider may advise ways for you to get support. This may include a counselor, support groups, or social worker. Ask your provider about ways to help support your family, if they are caregivers for you.
• Tracking your progress. Keep a daily written diary of your symptoms. This can help your providers treat you.

Talk with your healthcare provider if you want to be part of a research study on treatments for post-COVID conditions. The National Institutes of Health (NIH) has a program called Researching COVID to Enhance Recovery (RECOVER). You can learn more about the RECOVER program at recovercovid.org.

In some cases, post-COVID conditions may be considered a disability under the Americans with Disabilities Act (ADA). This means you have certain rights that apply to your needs at school, work, or other life situations. These rights are meant to give you reasonable aid in ways you need it. Talk with your healthcare provider or go to the ADA website at www.ada.gov to learn more.

Can post-COVID conditions be prevented?

Researchers don’t yet know exactly how to prevent post-COVID conditions. The best way to prevent COVID-19 illness is to get a COVID-19 vaccine. COVID-19 vaccines are advised for people ages 5 and older. The vaccines are advised even if you already had COVID-19, or if you have post-COVID conditions.

When should I call my healthcare provider?

Call your healthcare provider if you have:

• Chest pain
• Irregular heartbeat
• Shortness of breath
• Symptoms that don’t get better, or get worse
• Other new symptoms

Key points about post-COVID conditions

• Post-COVID conditions are symptoms that last or start weeks or months after a person was infected with the SARS-CoV-2 virus. This can happen even if you didn’t know you had the virus.
• You may hear these conditions called long COVID, post-acute COVID, chronic COVID, or other terms.
• The symptoms can include tiredness, headaches, loss of taste and smell, trouble breathing, and dizziness.
• Anyone who has been infected with SARS-CoV-2 is at risk for these.
• In rare cases, a child or adult may have an autoimmune condition called MIS after having COVID-19.
• Treatment is done by helping you manage your symptoms and daily life until you feel better.
• Researchers are still learning more about why some people have these symptoms, and what causes them.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Hurd, Robert, MD

Medical Reviewer: L Renee Watson MSN RN

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