Vitali Voskoboinik, 79, performs strength-building exercises in his bedroom while recovering from Covid-19. (Photo/Courtesy Voskoboinik)
Vitali Voskoboinik, 79, performs strength-building exercises in his bedroom while recovering from Covid-19. (Photo/Courtesy Voskoboinik)

How worried should I be about developing long Covid?

Every couple of months, there seems to be another surge of Covid. While the majority of those infected develop mild symptoms, especially when fully vaccinated, it’s the risk of getting long Covid that is of the greatest concern to most people.

Post-Covid disorders are common. According to a May 27, 2022 report from the Centers of Disease Control and Prevention, one in five Covid survivors ages 18-64 and one in four survivors 65 and older have experienced at least one condition that might be attributed to a previous Covid-19 infection. An analysis of more than 4,000 publications revealed that women were slightly more likely than men to develop post-Covid symptoms.

First, let’s clear up some definitions. According to the CDC, acute Covid is defined by symptoms up to four weeks from the onset of illness. Post-acute conditions — long Covid — include a range of both physical and mental symptoms that are present for four or more weeks after infection and lack alternative explanations.

The medical name for long Covid illness is “post-acute sequelae of SARS-CoV-2 infection,” or PASC. It may have a long, scientific name, but that does not mean that doctors understand it any better. The possible cause (or causes) remains unknown, though many theories exist, including damage from the initial virus infection, prolonged inflammation, bits of virus persisting in gut tissue and alterations of the gut microbiome.

Fatigue is the most common long Covid symptom, followed by dyspnea (trouble breathing), joint pain, chest pain, cough and anosmia (loss of sense of smell). Some long Covid patients describe having “brain fog.” They have trouble concentrating, their thinking is sluggish, and short-term memory may be poor. An analogy would be a constant state of jet lag.

On a positive note, the latest Covid variants tend to result in lower risk of long Covid. In an observational U.K. study of more than 97,000 vaccinated individuals, infection with the omicron variant resulted in about half the risk of developing long Covid symptoms compared with infection with the delta variant.

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Another observational study, published in JAMA on July 1, 2022, looked at 2,560 patients with mild Covid to determine the effect of vaccination on the risk of getting long Covid. The prevalence of long Covid decreased in line with the number of vaccinations received: Approximately 42% of unvaccinated patients, 30% of patients with one vaccine dose, 17% with two vaccine doses and 16% with three vaccine doses reported post-Covid conditions.

It is uncertain if long Covid can develop after an asymptomatic infection, though a report from the University of California employing data mining from electronic health records suggests it is possible.

Patients with Covid often ask, “When will I recover?” The answer depends on many factors: underlying health problems, the severity of the acute illness and the symptoms the patient may be experiencing. In general, a short recovery (two weeks) can be expected with a mild illness and a longer recovery (two to three months or more) with a severe illness. In a telephone survey of 292 outpatients with Covid, one-third had not returned to baseline by three weeks. Younger patients (ages 18-34) were less likely to have residual symptoms compared with patients older than 50: 26% vs. 47%.

The duration of Covid illnesses is highly dependent on specific symptoms. For example, patients who have experienced a disruption of smell and/or taste usually recover in a few weeks, and a cough should resolve within three months. Those with fatigue or psychological or memory issues can experience these symptoms for up to a year.

For any patient with acute Covid, I advise rest, plenty of sleep and healthy eating. Unfortunately, there is no specific diet or nutritional supplement that has been shown to prevent long Covid. Nor is there yet evidence that the antiviral medication Paxlovid helps to prevent it. The most effective way to avoid long Covid is to keep from getting Covid in the first place by vaccination, masking and social distancing.

In summary, physical and psychological problems are common following infection with Covid-19. Vaccination substantially lowers the risk of developing long Covid, but there are no proven therapies to treat it. Fortunately, most people will fully recover, even if it takes months.

Dr. Jerry Saliman

Jerry Saliman, MD, retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.