Updated 1 April 2021
What is Long COVID?
Long COVID (also known as post-acute COVID, chronic COVID, long-haul- COVID) is the name given to the symptoms people experience after two-weeks, which is how long COVID-19 symptoms are expected to last1.
A positive COVID-19 test should not be seen as a pre-requisite for Long COVID as many people were not able or did not meet the criteria to get tested in the early stages of the pandemic, and false negatives are not uncommon2.
What is the prevalence?
Globally, around one in five people who have tested positive for COVID-19 report a range of health symptoms more than five weeks after their first symptom3,4, and one in ten after more than 12 weeks4.
What are the symptoms?
Symptoms are highly variable. They can differ from the typical COVID-19 symptoms. For example, patients have reported fatigue, headaches, cough, anosmia, sore throat, chest pain and delirium, but they have also reported gastro-intestinal disturbances, skin rashes, metabolic disruption, muscle pain, fatigue, muscle weakness, and hair loss,2,5-9.
Many organ systems may be involved and symptoms vary from mild (e.g. loss of smell) to severe (e.g. stroke, psychosis)10.
There is no specific time course: symptoms can improve one week only for relapse to occur the following week, and this pattern can last for more than three months3,4,11,12.
Who is at risk?
To date (1 April 2021), no conclusions can be made about the risk of developing Long COVID based on age, sex, ethnicity, or underlying health conditions. Studies that have followed patients who were hospitalized with acute COVID-19 disease in Italy13-15, the Netherlands16, the U.K.17,18, the USA19, the Mediterranean20, and China6,21 have demonstrated differences in symptoms depending on the severity of their infection. However, many reports of Long COVID are from patients who had a mild case of COVID-19 and were not hospitalised3,11,22.
How to support patients with Long COVID?
As awareness of Long COVID increases among the public, patients are less concerned about the lack of care and empathy from others17,23, and more concerned about the intensity, duration and unpredictability of their symptoms9,24,25. Health professionals are in a difficult position to support their patients because of the lack of information on clinical definitions or treatments. Therefore, it is vital listen to patients’ about their concerns and validate their experiences26.
Health professionals should recommend medical or self-management based on symptoms and comorbidities2, and, if required, refer patients to specialist services for multidisciplinary assessment and rehabilitation27. It is recommended that primary care professionals also promote peer support and the use of reliable information sources, where appropriate2.
NZ HealthPathways local guidelines for the management of Long COVID are now live.
There are emerging anecdotal reports about Long COVID symptoms improving within a few days after patients receive their second vaccine shot27-29. However, only one non-peer-reviewed prospective study has been conducted so far30.
NZ HealthPathways are currently developing local guidelines for the management of Long COVID.
New research findings about Long COVID and how to best manage or treat it are being published frequently. This page will be updated as new peer-reviewed evidence and guidance becomes available.
Resources for GPs
Management of Long COVID
Support Groups for Patients
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References all references are publicly available unless otherwise stated.
1. World Health Organization. Coronavirus disease (COVID-19). Coronavirus 2020; https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19. Accessed 9 Dec 2020, 2020.
2. Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. 2020;370:m3026.
3. King's College London. COVID Symptom Study. COVID: UK Data 2020; https://covid.joinzoe.com/. Accessed 9 Dec 2020, 2020.
4. Office for National Statistics. The prevalence of long COVID symptoms and COVID-19 complications. Office for National Statistics; 16 Dec 2021 2020.
5. The many strange long-term symptoms of Covid-19 explained. [press release]. Vox Vox Media, LLC, 15 December 2020 2020.
6. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet. 2021;397(10270):220-232.
7. Gorna R, MacDermott N, Rayner C, et al. Long COVID guidelines need to reflect lived experience. The Lancet. 2021;397(10273):455-457.
8. Stefano GB, Ptacek R, Ptackova H, Martin A, Kream RM. Selective Neuronal Mitochondrial Targeting in SARS-CoV-2 Infection Affects Cognitive Processes to Induce 'Brain Fog' and Results in Behavioral Changes that Favor Viral Survival. Medical science monitor : international medical journal of experimental and clinical research. 2021;27:e930886.
9. Bougakov D, Podell K, Goldberg E. Multiple Neuroinvasive Pathways in COVID-19. Mol Neurobiol. 2020:1-12.
10. Centers for Disease Control and Prevention. Late Sequelae of COVID-19. Coronavirus Disease 2020; https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/late-sequelae.html#:~:text=Though%20there%20is%20limited%20information,16%2C%2018%2C%2028). Accessed 8 Dec 2020, 2020.
11. Broughton E. What are the long-term health impacts of coronavirus? [Features]. 2020; https://patient.info/news-and-features/what-are-the-long-term-health-impacts-of-coronavirus. Accessed 9 Dec 2020, 2020.
12. Paneroni M, Simonelli C, Saleri M, et al. Muscle strength and physical performance in patients without previous disabilities recovering from COVID-19 pneumonia. American Journal of Physical Medicine & Rehabilitation. 2020;Publish Ahead of Print.
13. Curci C, Pisano F, Bonacci E, et al. Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol. European journal of physical and rehabilitation medicine. 2020;56(5):633-641.
14. Bellan M, Soddu D, Balbo PE, et al. Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge. JAMA Network Open. 2021;4(1):e2036142-e2036142.
15. Goërtz YMJ, Van Herck M, Delbressine JM, et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res. 2020;6(4):00542-02020.
16. Kingstone T, Taylor AK, O'Donnell CA, Atherton H, Blane DN, Chew-Graham CA. Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID. 2020:bjgpopen20X101143.
17. Arnold DT, Hamilton FW, Milne A, et al. Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. 2020:thoraxjnl-2020-216086.
18. Tenforde MW KS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep. 2020;69:993-998.
19. Moreno-Pérez O, Merino E, Leon-Ramirez J-M, et al. Post-acute COVID-19 Syndrome. Incidence and risk factors: a Mediterranean cohort study. Journal of Infection. 2021.
20. Xiong Q, Xu M, Li J, et al. Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clin Microbiol Infect. 2020:S1198-1743X(1120)30575-30579.
21. “We have been totally abandoned” people left struggling for weeks as they recover from COVID at home [press release]. U.K.: British Lung Foundation, 26 June 2020 2020.
22. Ladds E, Rushforth A, Wieringa S, et al. Persistent symptoms after Covid-19: qualitative study of 114 “long Covid” patients and draft quality principles for services. BMC Health Services Research. 2020;20(1):1144.
23. Theunissen M. COVID 19 coronavirus: ‘Long haulers’ speak of long-term virus effects. . NZ Herald2021.
24. Sher L. Post-COVID syndrome and suicide risk. QJM: An International Journal of Medicine. 2021.* Not Publically Available
25. The Lancet. Facing up to long COVID. The Lancet. 2020;396(10266):1861.
26. Dani M, Dirksen A, Taraborrelli P, et al. Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clinical medicine (London, England). 2021;21(1):e63-e67.
27. Belluck P. Some Long COVID patients feel much better after getting the vaccine. The New York Times. 17 March 2021, 2021.
28. Bernstein L, Guarino B. Some long-haul covid-19 patients say their symptoms are subsiding after getting vaccines. The Washington Post. 17 March 2021, 2021.
29. Satherley D. Coronavirus: Vaccines unexpectedly appear to fix 'Long COVID'. Newshub. 18 March 2021, 2021.
30. Arnold D, Milne A, Samms E, Stadon L, Maskell N, Hamilton F. Are vaccines safe in patients with Long COVID? A prospective observational study. 2021:2021.2003.2011.21253225.
The information on this page was prepared by multi-disciplinary health professionals at the National Institute for Health Innovation and affiliates and was originally created on 9 December 2020.