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    For most people, mild or moderate cases of COVID-19 last for approximately 2 weeks. However, some patients experience continued symptoms that persist after recovering from their initial illness- this is referred to as ‘long COVID-19.’ Dr. Stephen Hall, Pullman Regional Hospital Chief Medical Officer and Family Medicine provider at Palouse Medical shares what we know so far about this evolving illness. 


    What is long COVID-19?


    Long COVID-19 refers to COVID-19 symptoms that last for 2 or more months after the initial illness. The symptoms may develop during or within weeks after the acute COVID-19 illness and cannot be explained by an alternative diagnosis.


    Dr. Hall notes that “patients with long COVID-19 typically test negative for COVID-19 (upon repeat testing 2 months after the initial positive test) despite experiencing continued and sometimes severe symptoms.” There are currently limited studies exploring this condition, and it is not yet known what causes some patients to develop long COVID-19.


    What are the symptoms of long COVID-19?


    Severe cases of acute COVID-19 may cause inflammation and scarring of the lungs, heart, pancreas, and kidneys as well as neurological problems including impaired taste or smell and postural orthostatic tachycardia syndrome (POTS). Since long COVID-19 is also seen in otherwise healthy patients who experienced mild cases of COVID-19, the relationship between organ or tissue damage during the acute illness and the development of long COVID-19 has not been clearly established.


    Common physical symptoms that persist following an acute COVID-19 illness include fatigue, dyspnea (labored breathing), chest pain, and cough. Less common symptoms include headache, joint pain, myalgias (aches and pains), fever, and diarrhea. Prolonged psychological and neurocognitive symptoms are also commonly reported, including poor concentration, memory problems, insomnia, anxiety, and depression.


    Who is getting long COVID-19? 


    Patients can develop long COVID-19 regardless of symptom severity and pre-existing risk factors. 


    Large proportions of patients with moderate to severe cases of COVID-19 who required hospitalization have experienced symptoms for greater than 2 months. Several observational studies have reported persistent symptoms following discharge in over half of patients, at times ranging from 2-12 months after discharge. 


    Significant proportions of patients with mild COVID-19 cases (not requiring hospitalization) are also reporting persistent symptoms. One prospective study of 161 COVID-19 outpatients reported 19% of patients with 1-2 symptoms, 14% with 3 or more symptoms, and 29% with a decreased quality of life at 6 months.


    Are children getting long COVID-19?


    In general, younger patients tend to have lower rates of severe illness and tend to recover sooner from acute COVID-19. One survey compared patients ages 18-34, 35-49, and >50 years and reported rates of residual symptoms to be 26%, 32% and 47% at a median time of 16 days since testing positive.


    “Long COVID-19 has been observed in children and younger adults, and the limited long-term data on these populations makes the relationship between age and symptom duration an area for further study,” says Dr. Hall.


    What are the risk factors for developing long COVID-19?


    Risk factors including hypertension, smoking history, pre-existing lung disease, type 2 diabetes, and obesity have been associated with more severe cases of acute COVID-19. Dr. Hall notes that “while observational studies have associated moderate to severe cases of COVID-19 to higher rates of developing long COVID-19, the relationship between long COVID-19 and these risk factors remains unclear.”


    Do we know how long it lasts?


    “Unfortunately, as of right now, we do not know exactly how long it can last,” says Dr. Hall.  Most patients have reported prolonged symptoms lasting from 2 to 12 months following the initial COVID-19 illness. 


    Due to the recent nature of COVID-19, there is minimal long-term data and reports analyzing patient outcomes at greater than 12 months. Symptoms may last longer than 12 months, and additional time is needed to determine whether resolution or improvement of long COVID-19 occurs in all cases. It is unknown if different variants affect the duration of long COVID-19. 


    Pullman Regional Hospital continues to monitor long COVID-19 and the COVID-19 pandemic as a whole. If you believe you are experiencing long COVID-19, talk to your primary care provider. If you are experiencing COVID-19 symptoms and need immediate medical treatment, call 9-1-1 or visit the Pullman Regional Hospital Emergency Department.


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