In the summer of 2022, the Social Security Administration asked the National Academies of Sciences, Engineering, and Medicine (NAS) to convene a committee to understand the state of knowledge about long COVID given the number of people dealing with lingering effects of infection. Experts in epidemiology, diagnosis and clinical care of long COVID were brought together from across the country to carry out the work. Some of these individuals were, themselves, affected by long COVID. To gather evidence, the committee conducted a global literature search and held three information-gathering workshops open to the public. They heard from many people, including invited speakers and individuals with long COVID. The result was a 265-page report published in 2024.
The committee came to nine conclusions. While each is informative, this article will focus on four that can provide an understanding of what the research into this condition has shown to date. Importantly, as the authors highlighted, no definition of long COVID has been agreed upon at this point, and more remains to be learned.
Diagnosis
Diagnosis of long COVID is complicated by several factors:
- Affected individuals can experience a range of symptoms. More than 200 symptoms have been reported, and this long list can affect almost any organ system.
- Because of the array of symptoms, the effects across individuals can vary widely, so no clear set of diagnostic criteria have evolved.
- A history of a positive COVID-19 test is not required for someone to be diagnosed with long COVID because over the course of the pandemic, testing was variably available and employed.
In 2022, about 34 of 1,000 adults and 5 of 1,000 children were estimated to have experienced lingering effects of a COVID-19 infection. However, the authors indicated the numbers may be higher given that a standard approach to diagnosis has not been defined and awareness may be lacking among both healthcare providers and the public.
Risk
While anyone can get long COVID, some groups are more prone to experience the lingering effects of this infection. According to the analysis, the following are supported by research:
- Long COVID is found twice as often in women compared with men.
- Although people with a mild infection, including children, can get long COVID, people with more severe disease are at higher risk. For example, those who were hospitalized for COVID-19 infection are two or three times more likely to experience long COVID. Similarly, those who required life support or who were in intensive care are twice as likely to have long COVID than others who were hospitalized for COVID-19.
- People with certain preexisting conditions can experience more severe disease and are, therefore, more likely to experience linger effects. Some of these conditions include diabetes, heart failure, chronic obstructive pulmonary disease (COPD) and dementia.
- People who were vaccinated are less likely to experience long COVID. The data suggest that taking antiviral or steroid treatments during infection also decreases the likelihood of experiencing long COVID.
Importantly, the number of people with long COVID who had mild disease surpasses the number with long COVID who had severe disease. Because people with severe disease are more likely to develop long COVID, this statement may seem counterintuitive. However, most people experience mild infection, so the percent of total long COVID diagnoses is greater in this group.
Effects
Because of the range of symptoms and the wide array of affected organs and systems, the health effects among affected individuals can be variable. Regardless of one’s individual symptoms, however, about 1 in 5 affected adults described “significant activity limitations” as of January 2024 (p. 56). Importantly, these limitations are reported as fluctuating over time. For example, some people report increased severity after exercise or other activities, known as post-exertional malaise.
Long-term effects can include development or worsening of preexisting conditions, including:
- Acute coronary disease, heart failure, or irregular heartbeat
- Coughing, shortness of breath, or low blood oxygen
- Kidney injury or disease
- Joint pain or muscle weakness
- Tiredness or lack of energy
- Anxiety, depression, sleep disorders, or substance abuse
- Stroke, headaches, memory issues or issues with sense of smell
- Obesity, diabetes, or high cholesterol
- Constipation, diarrhea, or acid reflux
- Hair loss or skin rash
- Blood clots
This is not a complete list; however, the report includes several tables with more information. The authors also included more detailed discussions about chronic fatigue and post-exertional malaise, cognitive impairment, and nervous system dysfunction. These more detailed discussions were included because of their potential to affect an individual’s ability to work and participate in normal daily activities — something particularly relevant to the Social Security Administration.
Treatment
While no cures for long COVID have been found to date, some efforts to treat symptoms and improve functional ability have been helpful, such as:
- Pacing, meaning balancing periods of activity and rest
- Mobility support
- Social support
- Diet modulation
- Medications
- Cognitive-behavioral therapy
- Rehabilitation
For more information
As noted, the committee came to additional conclusions based on the current literature, and the entire report can be downloaded for free. So, if you are interested in more details, we recommend checking the NAS website.
If you or someone you know is suffering from long COVID, you can stay abreast of news and developments by checking out “The Sick Times,” a website developed by science journalists to “chronicle the long COVID crisis.”
To see how long COVID can affect families, check this article by a single parent in Canada whose daughter developed long COVID following a COVID-19 infection.
In the summer of 2022, the Social Security Administration asked the National Academies of Sciences, Engineering, and Medicine (NAS) to convene a committee to understand the state of knowledge about long COVID given the number of people dealing with lingering effects of infection. Experts in epidemiology, diagnosis and clinical care of long COVID were brought together from across the country to carry out the work. Some of these individuals were, themselves, affected by long COVID. To gather evidence, the committee conducted a global literature search and held three information-gathering workshops open to the public. They heard from many people, including invited speakers and individuals with long COVID. The result was a 265-page report published in 2024.
The committee came to nine conclusions. While each is informative, this article will focus on four that can provide an understanding of what the research into this condition has shown to date. Importantly, as the authors highlighted, no definition of long COVID has been agreed upon at this point, and more remains to be learned.
Diagnosis
Diagnosis of long COVID is complicated by several factors:
- Affected individuals can experience a range of symptoms. More than 200 symptoms have been reported, and this long list can affect almost any organ system.
- Because of the array of symptoms, the effects across individuals can vary widely, so no clear set of diagnostic criteria have evolved.
- A history of a positive COVID-19 test is not required for someone to be diagnosed with long COVID because over the course of the pandemic, testing was variably available and employed.
In 2022, about 34 of 1,000 adults and 5 of 1,000 children were estimated to have experienced lingering effects of a COVID-19 infection. However, the authors indicated the numbers may be higher given that a standard approach to diagnosis has not been defined and awareness may be lacking among both healthcare providers and the public.
Risk
While anyone can get long COVID, some groups are more prone to experience the lingering effects of this infection. According to the analysis, the following are supported by research:
- Long COVID is found twice as often in women compared with men.
- Although people with a mild infection, including children, can get long COVID, people with more severe disease are at higher risk. For example, those who were hospitalized for COVID-19 infection are two or three times more likely to experience long COVID. Similarly, those who required life support or who were in intensive care are twice as likely to have long COVID than others who were hospitalized for COVID-19.
- People with certain preexisting conditions can experience more severe disease and are, therefore, more likely to experience linger effects. Some of these conditions include diabetes, heart failure, chronic obstructive pulmonary disease (COPD) and dementia.
- People who were vaccinated are less likely to experience long COVID. The data suggest that taking antiviral or steroid treatments during infection also decreases the likelihood of experiencing long COVID.
Importantly, the number of people with long COVID who had mild disease surpasses the number with long COVID who had severe disease. Because people with severe disease are more likely to develop long COVID, this statement may seem counterintuitive. However, most people experience mild infection, so the percent of total long COVID diagnoses is greater in this group.
Effects
Because of the range of symptoms and the wide array of affected organs and systems, the health effects among affected individuals can be variable. Regardless of one’s individual symptoms, however, about 1 in 5 affected adults described “significant activity limitations” as of January 2024 (p. 56). Importantly, these limitations are reported as fluctuating over time. For example, some people report increased severity after exercise or other activities, known as post-exertional malaise.
Long-term effects can include development or worsening of preexisting conditions, including:
- Acute coronary disease, heart failure, or irregular heartbeat
- Coughing, shortness of breath, or low blood oxygen
- Kidney injury or disease
- Joint pain or muscle weakness
- Tiredness or lack of energy
- Anxiety, depression, sleep disorders, or substance abuse
- Stroke, headaches, memory issues or issues with sense of smell
- Obesity, diabetes, or high cholesterol
- Constipation, diarrhea, or acid reflux
- Hair loss or skin rash
- Blood clots
This is not a complete list; however, the report includes several tables with more information. The authors also included more detailed discussions about chronic fatigue and post-exertional malaise, cognitive impairment, and nervous system dysfunction. These more detailed discussions were included because of their potential to affect an individual’s ability to work and participate in normal daily activities — something particularly relevant to the Social Security Administration.
Treatment
While no cures for long COVID have been found to date, some efforts to treat symptoms and improve functional ability have been helpful, such as:
- Pacing, meaning balancing periods of activity and rest
- Mobility support
- Social support
- Diet modulation
- Medications
- Cognitive-behavioral therapy
- Rehabilitation
For more information
As noted, the committee came to additional conclusions based on the current literature, and the entire report can be downloaded for free. So, if you are interested in more details, we recommend checking the NAS website.
If you or someone you know is suffering from long COVID, you can stay abreast of news and developments by checking out “The Sick Times,” a website developed by science journalists to “chronicle the long COVID crisis.”
To see how long COVID can affect families, check this article by a single parent in Canada whose daughter developed long COVID following a COVID-19 infection.