Long Covid: What is it and what are the symptoms?

By Rachel Schraer
Health reporter

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Most people who catch Covid-19 won't become severely ill and get better relatively quickly.

But significant numbers have had long-term problems after recovering from the original infection - even if they weren't very ill in the first place.

As society reopens, there are fears long Covid could disproportionately affect those not yet fully vaccinated.

What are long Covid symptoms?

Guidance for UK health workers describes long Covid as symptoms continuing for more than 12 weeks after an infection - severe or mild - and can't be explained by another cause.

According to the NHS, symptoms include:

  • extreme tiredness
  • shortness of breath, heart palpitations, chest pain or tightness
  • problems with memory and concentration ("brain fog")
  • changes to taste and smell
  • joint pain

Surveys have identified tens and even hundreds of other complaints. Probably the largest study so far, by University College London (UCL), identified 200 symptoms affecting 10 organ systems in people with long Covid, at higher levels than in people who were fully recovered.

They include hallucinations, insomnia, hearing and vision changes, short-term memory loss and speech and language issues. Others have reported gastro-intestinal and bladder problems, changes to periods and skin conditions.

How severe these symptoms are varies, but many have been left unable to perform tasks like showering, grocery shopping and remembering words.

What causes long Covid?

We don't yet know for sure.

One possibility is the infection makes some people's immune systems go into overdrive, attacking not just the virus but their own tissues. That can happen in people who have very strong immune responses.

The virus itself getting into and damaging our cells might explain some symptoms like brain fog and a loss of smell and taste, while damage to blood vessels in particular could lead to heart, lung and brain problems.

media captionBBC reporter Lucy Adams explored long Covid in a film with Panorama

Another theory is that fragments of the virus could remain in the body, possibly lying dormant and then becoming reactivated.

This happens with some other viruses, like herpes and the Epstein Barr virus which causes glandular fever. However, there isn't much evidence for this happening with Covid at the moment.

It's likely there are several different things going on in different people, to cause such a wide range of problems.

Who gets long Covid and how common is it?

This is really difficult to pin down at the moment, because doctors have only just started recording long Covid as an official diagnosis.

However, there is a substantial body of research suggesting the condition becomes increasingly likely with age, and is twice as common among women.

Some, but not all, long Covid symptoms are more common in people who were very ill or ended up in hospital.

Analysis of several studies and health record databases by King's College London suggested 1-2% of people in their 20s who had the virus would develop long Covid, compared with 5% of people in their 60s.

"But 1-2% of 100,000 cases a day is a lot of people," Dr Claire Steves, one of the study's authors, pointed out.

And Dr David Strain at the University of Exeter Medical School, who works with patients with long Covid, said most people being referred to his clinic were in their 20s, 30s and 40s. That might be because these symptoms, though slightly less common in younger people, have a bigger impact on them.

This may also change as older people are more likely to be fully vaccinated. Senior author on the UCL paper Dr Athena Akrami said: "We're going to deal with a big wave of seemingly mild infections where maybe one in seven is going to develop long Covid, and that will be among young people".

How will I know I have long Covid?

There is currently no test - instead it is currently a "diagnosis of exclusion", Dr Strain explained, with doctors first ruling out other possible causes.

They will make sure tests for other issues like diabetes, thyroid function and iron deficiency are all clear, before giving a diagnosis.

According to researchers, a blood test for long Covid could become available in the future. And in research settings more sophisticated tools are already being used to identify organ damage - but you won't be able to get these at a standard GP appointment.

Can the vaccine help?

Roughly half of people with long Covid reported an improvement in their symptoms after being jabbed - possibly by resetting their immune response or helping the body attack any remaining fragments of the virus, say experts.

Vaccination can also help prevent people contracting the virus and developing long Covid in the first place.

What treatments are available?

In England, 89 specialist long Covid assessment centres have been set up.

Similar clinics are expected to open in Northern Ireland in the coming months, while in Scotland and Wales patients will be referred to different services by their GPs, depending on their symptoms.

At the moment there are no proven drug treatments and the main focus is on managing symptoms and gradually increasing activity.

A formal clinical trial into drug treatments is expected to launch soon.

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