Updated 11 January 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. It’s important to note that a positive COVID-19 test should not be seen as a pre-requisite for Long COVID as many people were not able to get tested and there are false negatives2.
What is the prevalence?
Globally, around one in ten people who have tested positive for COVID-19 report a range of health symptoms more than three weeks after their first symptom3.
What are the symptoms?
Symptoms are highly varied and 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 and muscle weakness2, and hair loss2,4 Many organ systems may be involved and symptoms vary from mild (e.g. loss of smell) to severe (e.g. stroke, psychosis)4.
There is no specific time course: symptoms can improve one week only for relapse to occur the following week, and this pattern can last from three weeks to more than three months3,5,6.
Who is at risk?
To date (11 January 2021), no conclusions are able to be made about risk of Long COVID based on age, sex, or ethnicity, or other underlying health issues. Studies that have followed patients who were hospitalized with COVID-19 have demonstrated differences in symptoms depending on the severity of their infection in Italy7,8, the Netherlands9, the U.K.10,11, the USA12, and China13. However, many reports of Long COVID are from patients who had a mild case of COVID-19 and were not hospitalised3,5,14.
How to support patients with Long COVID?
Reports from patients indicates high levels of frustration with symptoms and the lack of care and empathy from others10. Many patients with Long COVID have reported feeling dismissed by health professionals. Although health professionals can be in a difficult position to support their patients, due to the lack of information, clinical definitions or treatments, it is vital that health professionals still listen to their patients concerns and validate their experiences15. Unlike many places overseas where health systems are overwhelmed, and lockdowns are limiting access to health services here in New Zealand patients with Long COVID can present to clinicians for support and treatment. Health professionals should recommend medical or self-management based on symptoms and comorbidities2, and referrals to specialist services made as needed. It is recommended that primary care professionals also promote peer support and information platforms where appropriate2.
Research into Long COVID and how to best manage or treat it is 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
References *publicly available
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. The many strange long-term symptoms of Covid-19 explained. [press release]. Vox Vox Media, LLC, 15 December 2020 2020.*
5. Bougakov D, Podell K, Goldberg E. Multiple Neuroinvasive Pathways in COVID-19. Mol Neurobiol. 2020:1-12.*
6. 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.*
7. 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.*
8. 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.*
9. 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.*
10. 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.*
11. 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.*
12. 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.*
13. 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.*
14. 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.*
15. “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.*
16. 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.*
17. The Lancet. Facing up to long COVID. The Lancet. 2020;396(10266):1861.*
The information on this page was prepared by multi-disciplinary health professionals at the
National Institute for Health Innovation and affiliates on 9 December 2020.