What We Know About 5 Common Long COVID Symptoms, According to Experts

Lisa Sass, a 31-year-old woman living in Phoenix, tested positive for COVID-19 in February 2021. For a week, she hunkered down in bed, enduring what felt like a severe case of strep throat with a hacking cough. She was able to ride out the infection at home and the worst of her symptoms dissipated—but then, a new set of symptoms slowly appeared.

First, Sass was hit with overwhelming fatigue, and shortness of breath that made simple tasks like walking to her car a challenge. Her brain felt clouded in a haze, and due to all these new-found health issues, her mood tanked. She felt frustrated and ashamed. Sass was eventually diagnosed with long COVID, which is characterized by the development of “new, returning, or ongoing health problems” that people experience at least four weeks after their initial bout of COVID, according to the Centers for Disease Control and Prevention (CDC). She’s now one of the estimated 65 million people in the world who are dealing with the often-debilitating symptoms tied to the condition.¹

For certain folks, long COVID amplified underlying health issues (like asthma or hypertension^2,3), but many people were in good health before they were infected by the virus; now, out of the blue, they’re struggling to breathe or think clearly. It’s a mysterious syndrome that scientists are just starting to unravel, but one fact is apparent: There is no single set of symptoms that defines long COVID. Research has shown it can affect many different body systems—the heart, lungs, brain, and even the gut, among others—and has been associated with more than 200 symptoms.¹

Even though long COVID manifests in seemingly endless ways, certain symptoms are more common than others, based on what experts know so far.⁴ That said, the type of health problems people experience, as well as how long they last, vary widely from person to person. “Many [people with long COVID] may have one, more than one, or a combination” of these symptoms, Sritha Rajupet, MD, MPH, the director of the Stony Brook Medicine Post-COVID Clinic in Commack, New York, tells SELF.

Here are five of the most common long COVID symptoms to be aware of, and what experts have learned about them so far.

Fatigue

Early on, fatigue quickly became one of the tell-tale signs of long COVID. In 2021, some larger studies evaluating post-COVID health issues ranked fatigue at the top of the list, and recent reports have found the same to be true.^5,6,7 Now, up to a third of people with long COVID report fatigue as a symptom.⁸

Surendra Barshikar, MD, the director of UT Southwestern Medical Center’s COVID Recover program, tells SELF he sees a ton of patients come into his clinic with persistent fatigue. For some, it’s mild, he says; they’re not able to run like they used to, for example, but they can generally keep up with their day-to-day lives. On the other end of the spectrum, the fatigue can be so intense that some people can’t do everyday activities—such as grocery shopping, yard work, or washing the dishes—and spend hours if not days trying to recover after exerting themselves. “They almost have to will themselves off the couch to do basic tasks,” says Dr. Rajupet, who also often treats fatigue in her long-COVID clinic.

A lot more research is needed to better understand why long COVID is associated with such intense fatigue. One theory: It’s believed that the virus, SARS-CoV-2, can affect the immune system and cause long-lasting inflammation. This puts multiple body systems on high alert, and chronically makes them work harder to try to keep you healthy, which can make everything feel exhausting.^9,10

Sass was first hit with fatigue when she was diagnosed with COVID, but it never went away—and it progressively got worse. She isn’t simply sleepy; she’s deeply wiped out, all the time. She has trouble waking up. Putting on makeup depletes her. Doing her hair is a chore. Walking to the kitchen to grab a snack feels like a journey. Getting back up after sitting down for a bit has become a hefty to-do. “I feel lazy and gross sometimes,” Sass says, “but I’m drained by the time I have to exert any extra ounce of energy.”

Breathing issues

Dr. Barshikar says he regularly sees respiratory problems, like shortness of breath or chest discomfort, in people who have been hospitalized for COVID pneumonia, but also in those who have “mild” infections. In clinical testing, their oxygen levels will be healthy and their breathing will appear normal at rest, he says, but any slight activity may throw their airways into a tailspin. It can feel like they just can’t get enough air, for example, says Dr. Rajupet.

Some studies suggest people who had COVID are twice as likely to have long-term respiratory symptoms, like a persistent cough, compared to people who never got sick with the virus.¹ This may be due to inflammation, as well as the cell and blood vessel damage SARS-CoV-2 may cause in the lungs specifically, research shows.¹¹

Sass, for example, has asthma, but the breathing difficulties associated with it didn’t have a major impact on her quality of life until she got COVID. Like the fatigue, the breathlessness struck immediately and in full force. In the past, her inhaler would do the trick whenever she’d gasp for air, but now the shortness of breath is constant and brutal.

She lives on the third floor of an apartment complex, and by the time she gets to the second flight of steps, she’s winded and almost always has to use her inhaler when she gets home (which, again, is no longer a guarantee to relief). An avid hiker before she got COVID, Sass now sticks to short, easy hikes at a leisurely pace—it’s the only way she can continue to do her favorite hobby. “I’ve learned to just take things really slow,” she says.

Brain fog

Dr. Barshikar says brain fog, a term used to describe a range of neurological symptoms like impaired concentration and forgetfulness, is one of the most frequent long-COVID symptoms he sees. “People will find that they aren’t as [mentally] sharp as they used to be,” he says. This, once again, may be due to lingering inflammation, specifically in the brain, potential damage to nearby organs that support brain health, and problems with the immune system that can take root after COVID, per the National Institutes of Health.

Estimates suggest nearly 40% of people with long-COVID experience brain fog⁷, and while some people experience milder fogginess that comes and goes, others find the mental haze to be relentless and debilitating, Dr. Barshikar says. Writing a quick email can take a half hour, say, or juggling your family’s packed schedules suddenly feels daunting or even impossible. Because brain fog can reduce a person’s ability to concentrate and be efficient, it can be a huge problem for those trying to get back to work or school, says Dr. Rajupet.¹²

Sass can relate all too well. What she describes as brain fog came on gradually, and she didn’t fully recognize how problematic it had become until she started working in an office again. Soon, she temporarily couldn’t remember people’s names and had trouble recalling conversations she just had—an issue she never dealt with prior to getting sick with COVID. It feels like words are always right on the tip of her tongue, yet they seem to escape her. “I have many ‘brain farts’ and can’t get those words out or remember what I was talking about,” Sass says. As someone whose job relies on networking, she fears she comes off as unprofessional—when, in actuality, long COVID is to blame.

Irregular heart rate

After an initial COVID infection, it can take time for some people to regain certain aspects of their regular cardiac function, even if they had a mild infection. That’s because COVID may damage parts of the heart, leave inflammation in its wake, and starve the cardiovascular system of optimal oxygen, research shows.^13,14 This means the heart may need to work harder than usual to pump blood throughout the body, often leading to prolonged heart palpitations, or an irregular heart rate, for many people with long COVID, says Dr. Barshikar.

Some people will experience an irregular heartbeat after doing a type of physical activity, even if it’s just taking a shower or having a long convo with a friend. For a few seconds or minutes, their heart may flutter or pound, for example.

For others, their heart rate may randomly go haywire when they’re not even doing anything. “They’re not particularly excited but when they look at their smartwatch, they’ll see that their heart rate is high—and that can be really scary,” Dr. Rajupet says.

A smaller group of people with long COVID—between an estimated 2% to 14%—may develop postural orthostatic tachycardia syndrome (POTS), a condition in which a person’s heart rate spikes and blood pressure drops after standing up, sitting down, or even shifting positions, Dr. Barshikar. This can be extremely unsettling, and make a person feel dizzy or faint. Researchers don’t fully understand the link between the two conditions yet.¹⁵

Mental health problems

Estimates suggest at least a third of people who get COVID develop mental health problems such as depression and anxiety, or they aren’t satisfied with their lives overall.¹⁶ Sleep troubles, like insomnia or night terrors, have also become increasingly common symptoms. In fact, a recent report found that 41% of people with long COVID have moderate-to-severe sleep issues.¹⁷ Dr. Rajupet has noticed that many people with long COVID become highly (and understandably) emotional too.

Experts suspect these issues are a combination of the health effects directly caused by the infection—such as inflammation and immune system dysregulation—and a secondary response to all the other problems COVID can trigger for people, says Dr. Barshikar. Living with constant pain and feeling anxious about your health can be draining and stressful, so it’s only natural to feel mentally weighed down.

Long COVID can bring on a lot of changes in your life and prevent you from doing things you previously could do. For Sass, giving up hobbies and worrying about coming off as “lazy” as she grapples with chronic fatigue has grated on her mental health. “Not being able to do daily tasks like you used to can really impact how you feel about yourself,” she says.

Despite all the mystery that clouds this condition, there is hope.

For many people, the symptoms of long COVID clear up with time—within a year for those who had mild infections initially.¹⁸ Scientists are finally getting closer to understanding how long COVID develops, the various measures that may be needed to treat it, and what may help prevent it from taking hold. (For example, research shows that being fully vaccinated against the virus can reduce your chances of developing long-term symptoms.¹⁹)

Specialized long COVID clinics continue to pop up nationwide, and many people looking for answers can now get the care they need directly from primary care physicians, says Dr. Rajupet. If your COVID symptoms persist and start to affect your quality of life, talk to your PCP first. Be honest about everything you’re experiencing, says Dr. Rajupet. That way, your doctor can get a clear idea of what you’re going through so you can hopefully put together a plan of action. That could include testing, prescription medications, or a referral to a specialist like a pulmonologist, cardiologist, or neurologist, depending on your symptoms. It may take some time to nail down an accurate diagnosis, but identifying the issue and getting treatment as soon as possible will hopefully help you feel like yourself again.

Related:

Sources: