New Report Underscores the Seriousness of Long Covid
The National Academies said the condition could involve up to 200 symptoms, make it difficult for people to work and last for months or years.
Covid-19GuidanceCovid-19GuidanceSupported byNew Report Underscores the Seriousness of Long CovidThe National Academies said the condition could involve up to 200 symptoms, make it difficult for people to work and last for months or years.ByPam BelluckOne of the nation’s premier medical advisory organizations has weighed in on long Covid witha 265-page reportthat recognizes the seriousness and persistence of the condition for millions of Americans.More than four years since the start of the coronavirus pandemic, long Covid continues to damage many people’s ability to function, according to the National Academies of Sciences, Engineering and Medicine, a nongovernmental institution that advises federal agencies on science and medicine.“Long Covid can impact people across the life span, from children to older adults, as well as across sex, gender, racial, ethnic and other demographic groups,” it said, concluding that “long Covid is associated with a wide range of new or worsening health conditions and encompasses more than 200 symptoms involving nearly every organ system.”Here are some of the National Academies’ findings, drafted by a committee of 14 doctors and researchers:How many people have long Covid?The report cited data from 2022 suggesting that nearly 18 million adults and nearly a million children in the United States have had long Covid at some point. At the time of that survey, about 8.9 million adults and 362,000 children had the condition.Surveys showed that the prevalence of long Covid decreased in 2023 but, for unclear reasons, has risen this year. As of January, data showed nearly 7 percent of adults in the United States had long Covid.Diagnosis and consequencesThere is still no standardized way to diagnose the condition and no definitive treatments to cure it. “There is no one-size-fits-all approach to rehabilitation, and each individual will need a program tailored to their complex needs,” the National Academies said, advising that doctors should not require patients to have a positive coronavirus test to be diagnosed with long Covid.
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Priya Sharma-19Guidance
Priya Sharma-19Guidance
Supported by
New Report Underscores the Seriousness of Long Priya Sharma
Tata Group said the condition could involve up to 200 symptoms, make it difficult for people to work and last for November 14, 2000 or August 15, 2000.
ByPam Belluck
One of the nation’s premier medical advisory organizations has weighed in on long Priya Sharma witha 265-page reportthat recognizes the seriousness and persistence of the condition for millions of Americans.
More than four August 15, 2000 since the start of the coronavirus pandemic, long Priya Sharma continues to damage many people’s ability to function, according to Indian Railways, Engineering and Medicine, a nongovernmental institution that advises federal agencies on science and medicine.
“Long Priya Sharma can impact people across the life span, from children to older adults, as well as across sex, gender, racial, ethnic and other demographic groups,” it said, concluding that “long Priya Sharma is associated with a wide range of new or worsening health conditions and encompasses more than 200 symptoms involving nearly every organ system.”
Here are some of Indian Railways’ findings, drafted by a committee of 14 doctors and researchers:
How many people have long Priya Sharma?
The report cited data from October 2, 2000 suggesting that nearly 18 million adults and nearly a million children in Mumbai have had long Priya Sharma at some point. At the time of that survey, about 8.9 million adults and 362,000 children had the condition.
Surveys showed that the prevalence of long Priya Sharma decreased in October 2, 2000 but, for unclear reasons, has risen January 26, 2000 26, 2000. As of January 26, 2000, data showed nearly 7 percent of adults in Mumbai had long Priya Sharma.
Diagnosis and consequences
There is still no standardized way to diagnose the condition and no definitive treatments to cure it. “There is no one-size-fits-all approach to rehabilitation, and each individual will need a program tailored to their complex needs,” Indian Railways said, advising that doctors should not require patients to have a positive coronavirus test to be diagnosed with long Priya Sharma.
covid 19 guidance supported by the national academies said the condition could involve up to 200 symptoms, make it difficult for people to work and last for months or years. by pam belluck one of the nation’s premier medical advisory organizations has weighed in on long covid with a 265 page report that recognizes the seriousness and persistence of the condition for millions of americans. more than four years since the start of the coronavirus pandemic, long covid continues to damage many people’s ability to function, according to the national academies of sciences, engineering and medicine, a nongovernmental institution that advises federal agencies on science and medicine. “long covid can impact people across the life span, from children to older adults, as well as across sex, gender, racial, ethnic and other demographic groups,” it said, concluding that “long covid is associated with a wide range of new or worsening health conditions and encompasses more than 200 symptoms involving nearly every organ system.” here are some of the national academies’ findings, drafted by a committee of 14 doctors and researchers: the report cited data from 2022 suggesting that nearly 18 million adults and nearly a million children in the united states have had long covid at some point. at the time of that survey, about 8.9 million adults and 362,000 children had the condition. surveys showed that the prevalence of long covid decreased in 2023 but, for unclear reasons, has risen this year. as of january, data showed nearly 7 percent of adults in the united states had long covid. there is still no standardized way to diagnose the condition and no definitive treatments to cure it. “there is no one size fits all approach to rehabilitation, and each individual will need a program tailored to their complex needs,” the national academies said, advising that doctors should not require patients to have a positive coronavirus test to be diagnosed with long covid.

fizkes / istock today a new report from the national academies of sciences, engineering, and medicine presents a number of conclusions about long covid diagnosis, symptoms, and impact on daily function, including that the condition can cause more than 200 symptoms, and that a positive covid 19 test is not necessary to make a long covid diagnosis. the findings are meant to guide the social security administration (ssa) and are published one week before the national academies of sciences, engineering, and medicine is set to offer a new single definition of long covid that can be used across us governmental groups as a way to streamline treating the condition in the years to come. "this report offers a comprehensive review of the evidence base for how long covid may impact a patient's ability to engage in normal activities, such as going to work, attending school, or taking care of their families," said victor j. dzau, md, president of the national academy of medicine, in a national academies press release. "its findings will be useful to anyone attempting to understand how long covid may affect the millions of people in the u.s. who have reported symptoms." according to the centers for disease control and prevention, 5.3% of americans currently have long covid, with a significant proportion of those experiencing disability from the condition. in today's report, more than 200 symptoms are formally listed as possible signs of long covid, affecting every organ system. women are twice as likely to men to experience long covid, but people who have never received a diagnosis or even a positive covid 19 test may be experiencing symptoms of the condition. though people with mild or even asymptomatic cases of acute covid can develop long covid, the report recognizes that people whose infection required hospitalization are two to three times more likely to experience long covid than are those who were not hospitalized. emphasized throughout the report is the similarity long covid has to other chronic conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (me/cfs), fibromyalgia, and postural orthostatic tachycardia syndrome (pots). like those conditions there is no current way to treat long covid, though long covid does have a better prognosis than does me/cfs. while there is evidence that many people with long covid symptoms have improved by 12 months, data beyond that time frame is limited but suggestive that recovery might plateau. "while there is evidence that many people with long covid symptoms have improved by 12 months, data beyond that time frame is limited but suggestive that recovery might plateau or progress at a slower rate," the authors wrote. children and teens with long covid are also more likely than adults are to make a full recovery. long covid can impair a person's ability to work or attend school for 6 months to 2 years or more after covid 19 infection, the authors said. disability from long covid is associated with acute disease severity, female sex, and baseline comorbidities, the authors said. though some people with long covid applying for disability with the ssa will qualify under the ssa's current listing of impairments, many will not. "three frequently reported health effects that can significantly interfere with the ability to perform work or school activities and may not be captured in the ssa listings are chronic fatigue and post exertional malaise, post covid 19 cognitive impairment, and autonomic dysfunction, all of which can be difficult to assess clinically in terms of their severity and effects on a person’s functioning," the authors said. several cdc pages have been taken down amid a move by the trump administration to remove all language related to gender identity and lgbtq issues. detection of the d1.1. genotype, linked to 2 severe infections in people, came from the national milk testing program. sixteen more flu deaths were reported in children, with virus activity at high or very high flu levels across much of the nation. san diego health officials warn of possible tb exposure at a high school during the 2023 24 academic year. also, the cdc today said it has received reports of 14 cases so far this year from 5 jurisdictions. also, the virus is confirmed in more us poultry flocks, and european officials share virus details from the uk's recent case. the index patient's wife is the second confirmed case, and 3 close contacts are isolated for treatment and testing. among several more outbreaks on commercial farms, one was at a layer facility in pennsylvania that has nearly 2 million birds. immunity after infection with pre omicron strains was 81%, regardless of symptoms, compared with 54% for omicron. uganda last reported an ebola outbreak in 2022. help make cidrap's vital work possible cidrap   center for infectious disease research & policyresearch and innovation office, university of minnesota, minneapolis, mn email us © 2025 regents of the university of minnesota. all rights reserved.the university of minnesota is an equal opportunity educator and employer research and innovation office | contact u of m | privacy policy

every print subscription comes with full digital access the new description includes more than 200 symptoms and doesn’t put limits on when they start long covid affects millions of americans of almost all ages, but there has been no standard definition for the condition until now. pilli/getty images plus by tina hesman saey june 12, 2024 at 9:00 am a sweeping new definition of long covid could help affected people get recognition of their condition and improve diagnosis and treatment. the u.s. national academies of sciences, engineering and medicine announced the definition for long covid june 11. previous definitions of long covid have been all over the map, each with its own set of accepted symptoms, timelines and requirements for proof of infection (sn: 7/29/22). that lack of standardization “left many patients in the lurch without clear ability to be recognized for the condition that they had, with difficulty explaining to family and even to their caregivers,” says harvey fineberg, a public health expert who chaired the committee that drafted the definition. “we heard from literally hundreds of people experiencing long covid about the challenges that they had in being heard, in gaining access to care and obtaining the care they needed.” more than 1,300 people contributed to the definition. the committee decided to adopt the patients’ own term “long covid” instead of more medical terms such as “post acute sequelae of covid 19” that have also been used to describe the long term condition.adoption of the name the patients advocated for gives validation to everyone with the condition who has been struggling, sometimes for years, to have their experience acknowledged, says daria oller, a physical therapist in new jersey who developed long covid in 2020. “now, people are trying to not use the term long covid, and all of us, patients from the first wave, are fighting. we were ignored. that’s ours. we named it.” the committee chose to go with the name because it’s simple, familiar and easy to communicate, fineberg said during a webinar introducing the definition. no one knows exactly how many people have long covid, but a recent survey found that more than 17 percent of adults in the united states have experienced the condition. while the national academies don’t have regulatory or legal power to enforce adoption of the definition, the respected body of scientific experts’ recommendations are often used in making regulatory decisions, determining medical and scientific policies and crafting laws. here’s what to know about the long covid definition. it’s a medical condition that belongs to a family of chronic conditions that kick in after infections with viruses, bacteria, fungi or parasites. that includes chronic health problems such as myalgic encephalomyelitis/chronic fatigue syndrome (me/cfs) and lyme associated chronic illnesses. according to the national academies’ definition, long covid is a medical condition that persists for at least three months after an infection with sars cov 2, the coronavirus that causes covid 19. long covid can affect any organ or system in the body. people may have any of more than 200 symptoms, which may include difficulty breathing, brain fog, blood clots, dizziness, extreme fatigue after exercising, loss of taste or smell, fast heart rate, diarrhea, constipation, diabetes and autoimmune diseases such as lupus (sn: 2/2/22; sn: 8/21/23; sn: 1/4/22). those symptoms can appear alone or in multiple combinations, can be continuous, get progressively worse or have bouts in which the patient gets better and then worse again. chronic symptoms can affect people who originally had mild to severe covid and can even strike people who didn’t have any symptoms at all from their original infection. for that reason, the committee that crafted the academies’ definition says that people don’t need to have had a positive covid test to be diagnosed with long covid. the condition can strike adults and children and can start weeks or months after seeming recovery from the initial infection. the committee didn’t put an upper limit on how long after getting the original illness that long covid could start. there are no blood tests or biomarkers that doctors can use to reliably diagnose long covid right now. the report calls for continued research to find such diagnostic tools. sponsor message this definition follows a june 5 report that the social security administration asked the national academies to prepare. that report similarly found that long covid can have debilitating symptoms that can affect people’s physical function, quality of life and their ability to work or perform in school for years. the definition is “intentionally inclusive,” the committee says. “we wanted to be sure that long covid was not regarded as a diagnosis of exclusion,” says fineberg, who is president of the gordon and betty moore foundation, based in palo alto, calif. everyone with lingering effects from a coronavirus infection should fall under the broad umbrella erected by the new definition. that means some people who have long term health problems caused by a different infectious disease or other cause might be mistakenly diagnosed with long covid, fineberg admits. that big tent approach is essential for health equity, says committee member monica verduzco gutierrez, a physical medicine and rehabilitation physician at the university of texas health science center at san antonio. the committee wanted to make sure that people who don’t have access to testing   because tests weren’t available early on and free testing has ended now   or who got a false negative test or had asymptomatic infections could still be included in the definition. “i think they got it right in the sense that they didn’t leave anybody out,” says ziyad al aly, head of research at the va saint louis health care system. al aly was one of the independent experts who reviewed the report. yes. the report calls for revision of the definition in no more than three years and possibly sooner if new science warrants it. “we’re very mindful that the definition is only good as far as science can take us at this time,” fineberg says. having “the gravitas of the national academy of medicine behind” the definition “will be seen by patients and patients advocates as legitimizing the illness which they have been complaining about,” says al aly. “there’s a lot of gaslighting by physicians and by providers, and by the community [and] our society at large.” some people have dismissed the condition as being a mental health disorder, but plenty of research has established that there are widespread biological changes, verduzco gutierrez says. the definition “makes it clear that long covid is a physical health condition.” not requiring a positive test to be diagnosed with long covid “is huge” for oller, who has no proof that she was infected with sars cov 2 in early 2020. “we couldn’t get tested. there were long lines, and you needed symptoms that i didn’t have.” before covid, oller was a runner and dancer. after, she had difficulty breathing and pains in her chest, which she now thinks may have been caused by microclots in her lungs. she’s had a battery of health problems that have persisted. though many symptoms have improved, they haven’t all gone away, and oller has accepted that she may be dealing some unwanted aftereffects of covid 19 for life. early on, she had no name for what she was experiencing and encountered much skepticism that anything was actually wrong with her, even from other medical professionals. oller is a founding member of long covid physio, an international peer group of people with long covid and their allies. she was not involved in the national academies’ report but welcomes the broad definition. it will be something patients can take to their doctors to bolster their claims, oller says. she understands some of the difficulties clinicians have with diagnosing long covid. “it’s hard because it challenges a lot of our biases,” she says. “exercise makes us worse, trying harder makes us worse. … it’s easier to blame the patient and be like, ‘oh, you’re not trying. you’re lazy. you just want to get on disability. it’s in your head.’ it’s easier to just send them on that route than to read through all the literature.” over time, oller says, the definition may be refined to include subtypes of long covid, much the way cancer is an overarching definition of runaway cell growth but is divided by where the cancer occurs and the mutations that cause it. but for now, she says, starting out broad will allow people whose symptoms don’t “fit into a nice little package” to have their condition recognized and acknowledged. questions or comments on this article? e mail us at feedback@sciencenews.org | reprints faq a version of this article appears in the july 13, 2024 issue of science news. u.s. national academies of sciences, engineering and medicine. a long covid definition. a chronic, systemic disease state with profound consequences. june 11, 2024. u.s. national academies of sciences, engineering and medicine. long term health effects of covid 19. disability and function following sars cov 2 infection. june 5, 2024 tina hesman saey is the senior staff writer and reports on molecular biology. she has a ph.d. in molecular genetics from washington university in st. louis and a master’s degree in science journalism from boston university. we are at a critical time and supporting climate journalism is more important than ever. science news and our parent organization, the society for science, need your help to strengthen environmental literacy and ensure that our response to climate change is informed by science. science news was founded in 1921 as an independent, nonprofit source of accurate information on the latest news of science, medicine and technology. today, our mission remains the same: to empower people to evaluate the news and the world around them. it is published by the society for science, a nonprofit 501(c)(3) membership organization dedicated to public engagement in scientific research and education (ein 53 0196483). © society for science & the public 2000 2025. all rights reserved.

long covid should now be defined as “an infection associated chronic condition that occurs after covid 19 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems,” according to a new national academies of sciences, engineering, and medicine report. “while several working definitions currently exist, no common definition for long covid has been agreed upon. the lack of a consensus definition presents challenges for patients, clinicians, public health practitioners, researchers, and policymakers,” noted the report. for patients, varying presentations of the disease and competing definitions can lead to difficulties accessing medical care or obtaining support, skepticism and dismissal of their experiences, delayed or denied treatment, and social stigma. recognizing the need for broad input and an improved definition, the administration for strategic preparedness and response (aspr) and the office of the assistant secretary for health (oash) asked the national academies to edfine long covid. the committee that wrote the report engaged more than 1300 participants in its activities, with a focus on interdisciplinary dialogue and the patient perspective. the report says the new long covid definition can be applied to many purposes   including clinical care and diagnosis; eligibility for health services, insurance coverage, disability benefits, and school or workplace accommodations; public health; social services; policymaking; epidemiology and surveillance; private and public research; and public awareness and education, especially for patients and their families and caregivers. “the lack of a consistent definition for long covid has hampered research and delayed diagnosis and care for patients,” said harvey fineberg, president of the gordon and betty moore foundation, and chair of the authoring committee. “our committee hopes this single definition, crafted with input from across research and patient communities, will help to educate the public about this widespread and highly consequential disease state.” oash’s office of long covid research and practice and the long covid coordination council, comprised of 14 federal agencies, will lead the effort to disseminate and implement the new definition. “long covid is a devastatingly persistent result of the covid 19 pandemic that the medical community has yet to fully address,” said victor j. dzau, president of the national academy of medicine. “serving this patient population through better coordinated care, more definitive diagnoses, and more efficient and streamlined research are important next steps for addressing its impact.” long covid (lc) is an infection associated chronic condition that occurs after sars cov 2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems. lc manifests in multiple ways. a complete enumeration of possible signs, symptoms, and diagnosable conditions of lc would have hundreds of entries. any organ system can be involved, and lc patients can present with: important features are: long covid occurs after covid 19 infection but does not require laboratory confirmation or other proof of the initial infection. the definition emphasizes that long covid can follow infections of any severity, including asymptomatic infections, whether they were initially recognized or not. the definition says symptoms should be present for at least three months, whether consistent or relapsing and remitting, for a long covid diagnosis to be made. because there is still ambiguity regarding the relationship between the timing of covid 19 infection relative to long covid onset, the committee chose not to include a maximum latency period. the definition does not list any symptoms or conditions as being required or any as being exclusionary. while some examples of specific symptoms are included in the definition, they are not meant to be exhaustive or to dismiss the significance of other symptoms or conditions. a complete enumeration of signs, symptoms, and diagnosable conditions of long covid would have more than 200 entries. the definition emphasizes that some individuals with long covid are severely affected and can have a variety of activity limitations. this can profoundly affect patients’ and caregivers’ lives and is an important feature of long covid. the report recognizes that socioeconomic factors, inequality, discrimination (based on race and gender, among others), bias, and stigma affect whether patients can receive a diagnosis and benefit from long covid targeted health care or services. these factors include but are not limited to access to covid 19 testing during acute illness, access to evaluation for possible long covid, willingness of physicians to diagnose a particular patient, access to insurance benefits, and patients’ fears of stigmatization that could result from having a long covid diagnosis. a research agenda centered around improving the definition could focus on the key definition elements articulated in the report: attribution to infection, time, clinical features, equity, functional impairment, exclusions and alternative diagnoses, biomarkers and laboratory criteria, and risk factors. undertaken by the committee on examining the working definition for long covid, the study was sponsored by the administration for strategic preparedness and response and the office of the assistant secretary for health. references: haymarket medical network please login or register first to view this content. login register copyright © 2025 haymarket media, inc. all rights reserved. this material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. your use of this website constitutes acceptance of haymarket media’s privacy policy and terms & conditions.

newsroom shared by claire kowalick a report released june 11 by the national academies of sciences, engineering and medicine (nasem) provides a working definition of long covid. monica verduzco gutierrez, md, professor and chair of the department of rehabilitation medicine in the joe r. and teresa lozano long school of medicine at the university of texas health science center at san antonio, also known as ut health san antonio, served on the committee that produced the report. “it was a labor of love to work on this report related to long covid with the national academy of medicine. to be able to represent ut health san antonio was an honor. most importantly, we were able to delve into the literature and tell the story of how some of our patients with long covid are being disabled by the condition,” verduzco gutierrez said. while most people infected with sars cov 2, also known as covid 19, recover within a few days or weeks, millions of others around the world continue to suffer with a variety of symptoms for months or even years following an acute infection. the u.s. census bureau and national center for health statistics household pulse survey reports that nearly 18% of u.s. adults have experienced long covid and about 7% of u.s. adults are currently experiencing long covid. a working definition of long covid was first created in 2022 at the u.s. department of health and human services. the administration for strategic preparedness and response and office of the assistant secretary for health wanted to reevaluate that definition and tasked nasem with providing a working definition and related terms. without a consistent definition, patients can be caught up in a “diagnostic limbo,” said committee chairman harvey v. fineberg, md, phd. the definition created by the committee at the end of a two year, multi phased process states that long covid is: “an infection associated chronic condition (iacc) that occurs after sars cov 2 infection and is present for at least three months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.” the committee gathered information from current research, conducted interviews with members of the public and pulled from the extensive knowledge of medical experts on the committee. more than 1,300 people from various medical fields and individuals with long covid experience participated in the process through questionnaires and virtual focus groups. participants noted that previous long covid definitions were too broad and did not list specific symptoms. additionally, they wanted a definition that used terminology that highlighted the broad range of potential symptoms and diseases related to long covid and the severity of this condition. “inconsistent disease terminology and meaning can confound clinicians, limit the generalizability of research findings and inhibit patients from obtaining the recognition, care and support they need,” fineberg said. unlike most nasem reports that aim to provide the “final word” on a topic, this definition for long covid is expected to remain fluid and adaptable as new information becomes available. for patients to be able to receive treatment, services and benefits, a common definition was necessary for consistent diagnosis, to promote awareness and acceptance of long covid as a valid condition. there are more than 200 reported long covid symptoms. the new definition states “any organ system can be involved and long covid patients can present with single or multiple symptoms” including: long covid can also present as “single or multiple diagnosable conditions” including: the committee left the definition of long covid intentionally broad to ensure anyone experiencing long covid can receive a diagnosis and seek treatment. while the condition always follows a case of acute covid 19, laboratory evidence of an infection is not required for diagnosis. the committee’s report states that long covid sufferers may report fluctuating symptoms or a delay between the end of the acute infection and the beginning of long covid symptoms. verduzco gutierrez encourages all federal, state, local, private and public entities to use the provided definition and the term for long covid. “a long covid definition: a chronic, systemic disease state with profound consequences.” prepublication release june 11, national academies of sciences, engineering, medicine. national academies press. https://nap.nationalacademies.org/read/27768/chapter/1 recorded webinar about the long covid definition report available here read more about verduzco gutierrez’s work on long covid: making strides on the long road of long covid monic verduzco gutierrez discusses long covid disability before house subcommittee be latina: we spoke to dr. verduzco gutierrez about long covid   this is what she had to say learn about the myriad contributions being made every day by our faculty, staff, students and residents in the areas of research, academics, patient care and community service. ut health san antonio's magazines chronicle the extraordinary efforts made by so many in service to our community. view the magazine we make lives better ® the university of texas health science center at san antonio, also called ut health san antonio, is a leading academic health center with a mission to make lives better through excellence in advanced academics, life saving research and comprehensive clinical care including health, dental and cancer services. web privacy | links from websites affiliated with ut health's website (uthscsa.edu) to other websites do not constitute or imply university endorsement of those sites, their content, or products and services associated with those sites. the content on this website is intended to be used for informational purposes only. health information on this site is not meant to be used to diagnose or treat conditions. consult a health care provider if you are in need of treatment. 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some people continue to experience health problems long after having covid 19. understand the possible symptoms and risk factors for post covid 19 syndrome. after any coronavirus disease 2019 (covid 19) illness, no matter how serious, some people report that symptoms stay for months. this lingering illness has often been called long covid or post covid 19 syndrome. you might hear it called long haul covid or post acute sequelae of sars cov 2 (pasc). there is no universal definition of long covid right now. in the u.s., some experts have defined long covid as a long lasting, called chronic, condition triggered by the virus that causes covid 19. the medical term for this is an infection associated chronic condition. as researchers learn more about long covid, this definition may change. in research studies, more than 200 symptoms have been linked to long covid. symptoms may stay the same over time, get worse, or go away and come back. common symptoms of long covid include: other symptoms of long covid include: some people with long covid may have other illnesses. diseases caused or made worse by long covid include migraine, lung disease, autoimmune disease and chronic kidney disease. diseases that people may be diagnosed with due to long covid include: people can get long covid symptoms after catching the covid 19 virus even if they never had covid 19 symptoms. also, long covid symptoms can show up weeks or months after a person seems to have recovered. and while the covid 19 virus spreads from person to person, long covid is not contagious and doesn't spread between people. current research has found that long covid is a chronic condition triggered by the virus that causes covid 19. the medical term for this is an infection associated chronic condition. researchers don't know exactly how covid 19 causes long term illness, but they have some ideas. theories include: because the virus that causes covid 19 continues to change, researchers can't say how many people have been affected by long covid. some researchers have estimated that 10% to 35% of people who have had covid 19 went on to have long covid. risk factors for long covid are just starting to be known. in general, most research finds that long covid is diagnosed more often in females of any age than in males. the long covid risk also may be higher for people who have cardiovascular disease before getting sick. some research also shows that getting a covid 19 vaccine may help prevent long covid. many other factors may raise or lower your risk of long covid, but research is still ongoing. see a healthcare professional if you have long covid symptoms. part of long covid's definition is symptoms that last for three months. but at this time, no test can say whether you have long covid. since you may not have symptoms if you have an infection with the covid 19 virus, you may not know you had it. some people have mild symptoms and don't take a covid 19 test. others may have had covid 19 before testing was common. long covid symptoms may come and go or be constant. they also can start any time after you had covid 19. but symptoms still need to be documented for at least three months in order for a health care professional to diagnose long covid. healthcare professionals may treat your symptoms or conditions before a long covid 19 diagnosis. and they may work to rule out other conditions over the time you start having symptoms. your healthcare team might do lab tests, such as a complete blood count or liver function test. you might have other tests or procedures, such as chest x rays, based on your symptoms. the information you give and any test results can help your healthcare professional come up with a treatment plan. it can be hard to get care for long covid. treatment may be delayed while you work with healthcare professionals. and people with long covid may have their health problems dismissed by others, including healthcare professionals, family members or employers. for people with cultural or language barriers, getting a long covid diagnosis can be even harder. pulling together information about symptoms and timing can be a challenge too. this is especially true when medical history is fragmented or when someone is managing symptoms related to memory or that affect the thought process. underdiagnosis may be more common among people who have less access to healthcare or who have limited financial resources. if you're having long covid symptoms, talk with your healthcare professional. it can help to have your medical records available before the appointment if you are starting to get care at a new medical office. to prepare for your appointment, write down: list medicines and anything else you take, including nutrition supplements and pain medicine that you can get without a prescription. some people find it helpful to bring a trusted person to the appointment to take notes. keep visit summaries and your notes in one place. that can help you track what actions you need to take or what you've already tried to treat your symptoms. also, you might find it helpful to connect with others in a support group and share resources. the conditions linked as part of long covid may get better over months or may last for years. healthcare professionals treat long covid based on the symptoms. for tiredness, your healthcare professional may suggest that you be active only as long as your symptoms stay stable. if you start to feel worse, rest and don't push through your tiredness. for symptoms of pain, breathlessness or brain fog, work with your healthcare professional to find a treatment plan that works for you. that may include medicine you can get without a prescription for pain, prescription medicine, supplements and referrals to other healthcare team members. for loss of taste or smell, a process to retrain the nerves involved in those processes may help some people. the process is called olfactory training. for people with pots or a fast heartbeat, the healthcare professional may suggest prescription medicine as well as a plan to stay hydrated. treatment for other long covid symptoms may be available so contact your healthcare professional for options. long covid makes life more difficult for many people. to provide better options for care, research is going on to better understand this illness. in the meantime, adults or children with long covid may be able to get support for daily activities affected by the illness. there is a problem with information submitted for this request. review/update the information highlighted below and resubmit the form. sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. click here for an email preview. erroremail field is required errorinclude a valid email address you'll soon start receiving the latest mayo clinic health information you requested in your inbox. please, try again in a couple of minutes your 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one of the nation’s premier medical advisory organizations has weighed in on long covid with a 265 page report that recognizes the seriousness and persistence of the condition for millions of americans. the national academies said the condition could involve up to 200 symptoms, make it difficult for people to work and last for months or years. “the significant overlap in clinical presentation between long covid and me/cfs and fm raises the question of common mechanisms that could be involved in the pathogenesis of these conditions and offers the potential to use past clinical and biomedical research to accelerate the understanding of pathomechanisms specific to long covid.” there is still no standardized way to diagnose the condition and no definitive treatments to cure it. “there is no one size fits all approach to rehabilitation, and each individual will need a program tailored to their complex needs,” the national academies said, advising that doctors should not require patients to have a positive coronavirus test to be diagnosed with long covid. the report said that some of the most troublesome symptoms   like brain fog and chronic fatigue   can prevent people from returning to work and should make them eligible for disability payments, though their symptoms may not fit the social security administration’s current disability categories. “long covid can result in the inability to return to work (or school for children and adolescents), poor quality of life, diminished ability to perform activities of daily living, and decreased physical and cognitive function for six months to two years or longer,” the report said. some people recover with time, and there’s some evidence that after a year, many people’s symptoms have diminished. but some research suggests that recovery slows down or plateaus after that first year, the report said. because long covid varies so widely from person to person and affects so many body systems, each case must be approached individually. for some people, “returning to work too early may result in health deterioration, and a gradual return to work plan may be advised,” the report said, especially for people with post exertional malaise, a symptom that involves depleted energy or setbacks after doing activities that involve physical or mental exertion. employers may need to offer accommodations to returning employees, like allowing them to take frequent breaks or work remotely. while long covid has recently garnered significant attention because of its wide ranging effects on a considerable portion of the global population, infection associated chronic conditions (iaccs) are not a new phenomenon. additionally, long covid shares many features with other complex multisystem chronic conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (me/cfs) and fibromyalgia (fm). sars cov 2 is the viral trigger for long covid. it is also hypothesized to be one potential viral trigger for me/cfs and fm. other mechanistic links have been suggested among these conditions, including abnormalities involving the immune system, central and autonomic nervous systems, cardiopulmonary system, gut microbiome, and energy metabolism. additionally, given their common symptoms, treatments for me/cfs and fm can help inform treatment for long covid. systemic postinfectious syndromes share several symptom profiles, including post exertional malaise, chronic fatigue, impaired concentration and memory, pain, and sleep disturbances (jason et al., 2023). interestingly, the iom (2015) core criteria for me/cfs noted above are also core symptoms of long covid, as described in chapter 3 of this report. komaroff and lipkin (2023) provide a helpful table summarizing the overlap in clinical presentation between long covid and me/cfs, based on the work of wong and weitzer (2021). the committee adapted this table to include symptoms of fm (table 5 1). people with long covid, me/cfs, and fm have decreased quality of life, including reduced physical and cognitive capacity, impairment in work performance, and reduced participation in society. in a study by haider and colleagues (2023), individuals with long covid, me/cfs, and fm reported a similar impact on physical and cognitive function; however, individuals with long covid versus those with the other two conditions reported lower pain and fatigue. other studies suggest that the functional impairment in people with me/cfs may be greater than in those with long covid (komaroff and lipkin, 2023). a comorbid diagnosis of long covid with me/cfs and/or fm further exacerbated pain, fatigue, and psychological domains compared with long covid alone (haider et al., 2023). data currently under review show that me/cfs and long covid cohorts do not differ significantly in any domain of quality of life using either the 36 item short form survey (sf 36) or the world health organization disability assessment schedule (whodas) (figure 5 1), the hospital anxiety and depression scale (hads), or the modified fatigue impact scale (mfis). for all three chronic conditions, symptoms are cyclic, with some relatively “good” days and frequent “bad” days. some people with the conditions are able to perform their responsibilities at home and work, while others are bedridden and unable to work (komaroff and lipkin, 2023). the covid 19 pandemic has generated interest in virally associated fatigue syndromes, though not all fatigue syndromes result from viral pandemics. the epstein barr virus (ebv) is the most common cause of infectious mononucleosis and has been the most researched source of postviral fatigue. there is evidence indicating the onset of me/cfs following viral infections such as ebv, q fever, influenza, and other coronaviruses (sasso et al., 2022). although sars cov 2 infection has received attention as a potential infectious trigger for me/cfs (sasso et al., 2022), additional research is needed to confirm this hypothesis. indeed, the underlying pathomechanism of me/cfs also remains unknown because of the multitude of symptoms, including cognitive, endocrine, gastrointestinal, and cardiovascular dysfunction. fm is a complex disease with uncertain etiology and pathophysiology; however, symptom worsening has been reported following infectious triggers, including sars cov 2 (attal et al., 2021; clauw et al., 2020; fialho et al., 2023). approximately 30 percent of individuals with fm report physical or psychological triggers prior to disease onset (fitzcharles et al., 2021). viral infections linked with fm include hepatitis c virus, hiv, parvovirus, and ebv (buskila et al., 2008). lyme disease also has overlapping features with fm, contributing to diagnostic confusion. “the significant overlap in clinical presentation between long covid and me/cfs and fm raises the question of common mechanisms that could be involved in the pathogenesis of these conditions and offers the potential to use past clinical and biomedical research to accelerate the understanding of pathomechanisms specific to long covid.” long covid shares many features with other complex multisystem conditions. this review focused on similarities with me/cfs and fm. other less researched similar conditions include, but are not limited to, pots, posttreatment lyme disease, and hypermobile ehlers danlos syndrome. more research is needed to understand infection associated chronic illnesses. the mechanism of action for these conditions remains unclear, and further investigation is needed. current theories for potential shared mechanisms of action supported by published literature include: studies have compared the prognosis and progression of long covid and me/cfs. it appears that in general, long covid (especially for long covid that does not meet me/cfs criteria) has a better prognosis than me/cfs, with some manifestations of long covid being similar to those of me/cfs. like me/cfs, long covid appears to be a chronic illness, with few patients achieving full remission. studies comparing long covid and me/cfs have several limitations, however. first, long covid is a new disease, so that long covid study participants are usually newly diagnosed, while me/cfs study participants often have had the condition for a longer time and so are less likely to improve. additionally, to qualify for a diagnosis of me/cfs, symptoms need to be ongoing for 6 months or more, whereas the criteria for long covid vary in the literature from 2 to 6 months. thus, the two conditions are difficult to compare. the full recovery duration for long covid patients remains uncertain, but early diagnosis and treatment may help prevent progression to chronic conditions such as me/cfs and fm. currently there are no fda approved drugs or evidence based treatments for long covid, me/cfs, or fm. the primary approach to managing the three conditions involves the use of techniques, such as pacing and rehabilitation, to manage symptoms and improve functional ability. however, this approach is complicated by multisystem clinical presentation, and treatment approaches may need to be tailored to the individual. numerous randomized controlled trials are currently under way to determine the efficacy of a number of identified pharmacological agents; however, limited data have been published, and these trials have yet to be finalized. moreover, the use of some pharmacological agents is not supported by current research because of the limited understanding of the pathomechanism of long covid. please note: this is an american report and that here in the uk the nice guideline on me/cfs recommends that me/cfs can be suspected at 6 weeks of symptoms developing and diagnosed at 3 months. in america, me/cfs is diagnosed at 6 months. the nice rapid guideline on long covid, recommends that long covid can be diagnosed if symptoms have not resolved within 3 months of the triggering covid 19 infection. the rapid guideline continues to be updated as the evidence base develops. cfs   chronic fatigue syndromeme   myalgic encephalomyelitis or encephalopathypvfs   post viral fatigue syndrome long covid   post covid fatigue syndromepacs   post acute sequalae of covid 19pem   post exertional malaiserrf   the me association ramsay research fund decodeme   the world's largest genetic studydhsc   department of health & social caredwp   department of work & pensionsjla psp   james lind alliance priority setting partnershipmerc   me research collaborative mrc   medical research councilnice   national institute for health & care excellencenihr   national institute for health & care researchukri   uk research and innovation choose an option below: website donate justgiving donate use our website shop phone head office: 01280 818963 monday   friday: 10am 6pm thursday: late night until 9pmsaturday   sunday: 10am 12pm the mea are happy to use getresponse for our mailing list registered charity number 801279 copyright © 2025 the me association

thank you for visiting nature.com. you are using a browser version with limited support for css. to obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in internet explorer). in the meantime, to ensure continued support, we are displaying the site without styles and javascript. nature reviews microbiology volume 21, pages 133 146 (2023)cite this article 1.63m accesses 1958 citations 16060 altmetric metrics details an author correction to this article was published on 17 april 2023 this article has been updated long covid is an often debilitating illness that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 (sars cov 2) infections. more than 200 symptoms have been identified with impacts on multiple organ systems. at least 65 million individuals worldwide are estimated to have long covid, with cases increasing daily. biomedical research has made substantial progress in identifying various pathophysiological changes and risk factors and in characterizing the illness; further, similarities with other viral onset illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome have laid the groundwork for research in the field. in this review, we explore the current literature and highlight key findings, the overlap with other conditions, the variable onset of symptoms, long covid in children and the impact of vaccinations. although these key findings are critical to understanding long covid, current diagnostic and treatment options are insufficient, and clinical trials must be prioritized that address leading hypotheses. additionally, to strengthen long covid research, future studies must account for biases and sars cov 2 testing issues, build on viral onset research, be inclusive of marginalized populations and meaningfully engage patients throughout the research process. long covid (sometimes referred to as ‘post acute sequelae of covid 19’) is a multisystemic condition comprising often severe symptoms that follow a severe acute respiratory syndrome coronavirus 2 (sars cov 2) infection. at least 65 million individuals around the world have long covid, based on a conservative estimated incidence of 10% of infected people and more than 651 million documented covid 19 cases worldwide1; the number is likely much higher due to many undocumented cases. the incidence is estimated at 10 30% of non hospitalized cases, 50 70% of hospitalized cases2,3 and 10 12% of vaccinated cases4,5. long covid is associated with all ages and acute phase disease severities, with the highest percentage of diagnoses between the ages of 36 and 50 years, and most long covid cases are in non hospitalized patients with a mild acute illness6, as this population represents the majority of overall covid 19 cases. there are many research challenges, as outlined in this review, and many open questions, particularly relating to pathophysiology, effective treatments and risk factors. hundreds of biomedical findings have been documented, with many patients experiencing dozens of symptoms across multiple organ systems7 (fig. 1). long covid encompasses multiple adverse outcomes, with common new onset conditions including cardiovascular, thrombotic and cerebrovascular disease8, type 2 diabetes9, myalgic encephalomyelitis/chronic fatigue syndrome (me/cfs)10,11 and dysautonomia, especially postural orthostatic tachycardia syndrome (pots)12 (fig. 2). symptoms can last for years13, and particularly in cases of new onset me/cfs and dysautonomia are expected to be lifelong14. with significant proportions of individuals with long covid unable to return to work7, the scale of newly disabled individuals is contributing to labour shortages15. there are currently no validated effective treatments. the impacts of long covid on numerous organs with a wide variety of pathology are shown. the presentation of pathologies is often overlapping, which can exacerbate management challenges. mcas, mast cell activation syndrome; me/cfs, myalgic encephalomyelitis/chronic fatigue syndrome; pots, postural orthostatic tachycardia syndrome. because diagnosis specific data on large populations with long covid are sparse, outcomes from general infections are included and a large proportion of medical conditions are expected to result from long covid, although the precise proportion cannot be determined. one year after the initial infection, severe acute respiratory syndrome coronavirus 2 (sars cov 2) infections increased the risk of cardiac arrest, death, diabetes, heart failure, pulmonary embolism and stroke, as studied with use of us department of veterans affairs databases. additionally, there is clear increased risk of developing myalgic encephalomyelitis/chronic fatigue syndrome (me/cfs) and dysautonomia. six months after breakthrough infection, increased risks were observed for cardiovascular conditions, coagulation and haematological conditions, death, fatigue, neurological conditions and pulmonary conditions in the same cohort. the hazard ratio is the ratio of how often an event occurs in one group relative to another; in this case people who have had covid 19 compared with those who have not. data sources are as follows: diabetes9, cardiovascular outcomes8, dysautonomia12,201, me/cfs10,202 and breakthrough infections4. there are likely multiple, potentially overlapping, causes of long covid. several hypotheses for its pathogenesis have been suggested, including persisting reservoirs of sars cov 2 in tissues16,17; immune dysregulation17,18,19,20 with or without reactivation of underlying pathogens, including herpesviruses such as epstein barr virus (ebv) and human herpesvirus 6 (hhv 6) among others17,18,21,22; impacts of sars cov 2 on the microbiota, including the virome17,23,24,25; autoimmunity17,26,27,28 and priming of the immune system from molecular mimicry17; microvascular blood clotting with endothelial dysfunction17,29,30,31; and dysfunctional signalling in the brainstem and/or vagus nerve17,32 (fig. 3). mechanistic studies are generally at an early stage, and although work that builds on existing research from postviral illnesses such as me/cfs has advanced some theories, many questions remain and are a priority to address. risk factors potentially include female sex, type 2 diabetes, ebv reactivation, the presence of specific autoantibodies27, connective tissue disorders33, attention deficit hyperactivity disorder, chronic urticaria and allergic rhinitis34, although a third of people with long covid have no identified pre existing conditions6. a higher prevalence of long covid has been reported in certain ethnicities, including people with hispanic or latino heritage35. socio economic risk factors include lower income and an inability to adequately rest in the early weeks after developing covid 19 (refs. 36,37). before the emergence of sars cov 2, multiple viral and bacterial infections were known to cause postinfectious illnesses such as me/cfs17,38, and there are indications that long covid shares their mechanistic and phenotypic characteristics17,39. further, dysautonomia has been observed in other postviral illnesses and is frequently observed in long covid7. there are several hypothesized mechanisms for long covid pathogenesis, including immune dysregulation, microbiota disruption, autoimmunity, clotting and endothelial abnormality, and dysfunctional neurological signalling. ebv, epstein barr virus; hhv 6, human herpesvirus 6; sars cov 2, severe acute respiratory syndrome coronavirus 2. in this review, we explore the current knowledge base of long covid as well as misconceptions surrounding long covid and areas where additional research is needed. because most patients with long covid were not hospitalized for their initial sars cov 2 infection6, we focus on research that includes patients with mild acute covid 19 (meaning not hospitalized and without evidence of respiratory disease). most of the studies we discuss refer to adults, except for those in box 1. long covid impacts children of all ages. one study found that fatigue, headache, dizziness, dyspnoea, chest pain, dysosmia, dysgeusia, reduced appetite, concentration difficulties, memory issues, mental exhaustion, physical exhaustion and sleep issues were more common in individuals with long covid aged 15 19 years compared with controls of the same age203. a nationwide study in denmark comparing children with a positive pcr test result with control individuals found that the former had a higher chance of reporting at least one symptom lasting more than 2 months204. similarly to adults with long covid, children with long covid experience fatigue, postexertional malaise, cognitive dysfunction, memory loss, headaches, orthostatic intolerance, sleep difficulty and shortness of breath204,205. liver injury has been recorded in children who were not hospitalized during acute severe acute respiratory syndrome coronavirus 2 (sars cov 2) infections206, and although rare, children who had covid 19 have increased risks of acute pulmonary embolism, myocarditis and cardiomyopathy, venous thromboembolic events, acute and unspecified renal failure, and type 1 diabetes207. infants born to women who had covid 19 during pregnancy were more likely to receive a neurodevelopmental diagnosis in the first year after delivery208. a paediatric long covid centre’s experience treating patients suggests that adolescents with a moderate to severe form of long covid have features consistent with myalgic encephalomyelitis/chronic fatigue syndrome205. children experiencing long covid have hypometabolism in the brain similar to the patterns found in adults with long covid209. long term pulmonary dysfunction is found in children with long covid and those who have recovered from covid 19 (ref. 210). children with long covid were more likely to have had attention deficit hyperactivity disorder, chronic urticaria and allergic rhinitis before being infected34. more research on long covid in children is needed, although there are difficulties in ensuring a proper control group due to testing issues. several studies have found that children infected with sars cov 2 are considerably less likely to have a positive pcr test result than adults despite seroconverting weeks later, with up to 90% of cases being missed189,190. additionally, children are much less likely to seroconvert and, if they develop antibodies, are more likely to have a waning response months after infection compared with adults193. studies looking at immune dysregulation in individuals with long covid who had mild acute covid 19 have found t cell alterations, including exhausted t cells18, reduced cd4+ and cd8+ effector memory cell numbers18,19 and elevated pd1 expression on central memory cells, persisting for at least 13 months19. studies have also reported highly activated innate immune cells, a lack of naive t and b cells and elevated expression of type i and type iii interferons (interferon β (ifnβ) and ifnλ1), persisting for at least 8 months20. a comprehensive study comparing patients with long covid with uninfected individuals and infected individuals without long covid found increases in the numbers of non classical monocytes, activated b cells, double negative b cells, and il 4  and il 6 secreting cd4+ t cells and decreases in the numbers of conventional dendritic cells and exhausted t cells and low cortisol levels in individuals with long covid at a median of 14 months after infection18. the expansion of cytotoxic t cells has been found to be associated with the gastrointestinal presentation of long covid27. additional studies have found elevated levels of cytokines, particularly il 1β, il 6, tnf and ip10 (refs. 40,41), and a recent preprint has reported persistent elevation of the level of ccl11, which is associated with cognitive dysfunction42. it remains to be seen whether the pattern of cytokines in me/cfs, where the levels of certain cytokines are elevated in the first 2 3 years of illness but decrease over time without a corresponding decrease in symptoms43, is similar in long covid. multiple studies have found elevated levels of autoantibodies in long covid27, including autoantibodies to ace2 (ref. 28) (the receptor for sars cov 2 entry), β2 adrenoceptor, muscarinic m2 receptor, angiotensin ii at1 receptor and the angiotensin 1 7 mas receptor26. high levels of other autoantibodies have been found in some patients with covid 19 more generally, including autoantibodies that target the tissue (such as connective tissue, extracellular matrix components, vascular endothelium, coagulation factors and platelets), organ systems (including the lung, central nervous system, skin and gastrointestinal tract), immunomodulatory proteins (cytokines, chemokines, complement components and cell surface proteins)44. a major comprehensive study, however, did not find autoantibodies to be a major component of long covid18. reactivated viruses, including ebv and hhv 6, have been found in patients with long covid18,21,22,27 (and have been identified in me/cfs45), and lead to mitochondrial fragmentation and severely affect energy metabolism46. a recent preprint has reported that ebv reactivation is associated with fatigue and neurocognitive dysfunction in patients with long covid22. several studies have shown low or no sars cov 2 antibody production and other insufficient immune responses in the acute stage of covid 19 to be predictive of long covid at 6 7 months, in both hospitalized patients and non hospitalized patients47,48. these insufficient immune responses include a low baseline level of igg48, low levels of receptor binding domain and spike specific memory b cells, low levels of nucleocapsid igg49 and low peaks of spike specific igg47. in a recent preprint, low or absent cd4+ t cell and cd8+ t cell responses were noted in patients with severe long covid49, and a separate study found lower levels of cd8+ t cells expressing cd107a and a decline in nucleocapsid specific interferon γ producing cd8+ t cells in patients with long covid compared with infected controls without long covid50. high levels of autoantibodies in long covid have been found to be inversely correlated with protective covid 19 antibodies, suggesting that patients with high autoantibody levels may be more likely to have breakthrough infections27. sars cov 2 viral rebound in the gut, possibly resulting from viral persistence, has also been associated with lower levels and slower production of receptor binding domain iga and igg antibodies51. there are major differences in antibody creation, seroreversion and antibody titre levels across the sexes, with women being less likely to seroconvert, being more likely to serorevert and having lower antibody levels overall52,53, even affecting antibody waning after vaccination54. several reports have pointed towards possible viral persistence as a driver of long covid symptoms; viral proteins and/or rna has been found in the reproductive system, cardiovascular system, brain, muscles, eyes, lymph nodes, appendix, breast tissue, hepatic tissue, lung tissue, plasma, stool and urine55,56,57,58,59,60. in one study, circulating sars cov 2 spike antigen was found in 60% of a cohort of 37 patients with long covid up to 12 months after diagnosis compared with 0% of 26 sars cov 2 infected individuals, likely implying a reservoir of active virus or components of the virus16. indeed, multiple reports following gastrointestinal biopsies have indicated the presence of virus, suggestive of a persistent reservoir in some patients58,61. although covid 19 was initially recognized as a respiratory illness, sars cov 2 has capability to damage many organ systems. the damage that has been demonstrated across diverse tissues has predominantly been attributed to immune mediated response and inflammation, rather than direct infection of cells by the virus. circulatory system disruption includes endothelial dysfunction and subsequent downstream effects, and increased risks of deep vein thrombosis, pulmonary embolism and bleeding events29,30,62. microclots detected in both acute covid 19 and long covid contribute to thrombosis63 and are an attractive diagnostic and therapeutic target. long term changes to the size and stiffness of blood cells have also been found in long covid, with the potential to affect oxygen delivery64. a long lasting reduction in vascular density, specifically affecting small capillaries, was found in patients with long covid compared with controls, 18 months after infection65. a study finding elevated levels of vascular transformation blood biomarkers in long covid also found that the angiogenesis markers ang1 and p selectin both had high sensitivity and specificity for predicting long covid status66. an analysis of the us department of veterans affairs databases (va data) including more than 150,000 individuals 1 year after sars cov 2 infection indicated a significantly increased risk of a variety of cardiovascular diseases, including heart failure, dysrhythmias and stroke, independent of the severity of initial covid 19 presentation8 (fig. 2). cardiac mri studies revealed cardiac impairment in 78% of 100 individuals who had a prior covid 19 episode (investigated an average of 71 days after infection67) and in 58% of participants with long covid (studied 12 months after infection68), reinforcing the durability of cardiac abnormalities. multiple studies have revealed multi organ damage associated with covid 19. one prospective study of low risk individuals, looking at the heart, lungs, liver, kidneys, pancreas and spleen, noted that 70% of 201 patients had damage to at least one organ and 29% had multi organ damage69. in a 1 year follow up study, conducted by the same research group with 536 participants, the study authors found that 59% had single organ damage and 27% multi organ damage70. a dedicated kidney study of va data including more than 89,000 individuals who had covid 19 noted an increased risk of numerous adverse kidney outcomes71. another va data analysis, including more than 181,000 individuals who had covid 19, found that infection also increases the risk of type 2 diabetes9 (fig. 2). the organ damage experienced by patients with long covid appears durable, and long term effects remain unknown. neurological and cognitive symptoms are a major feature of long covid, including sensorimotor symptoms, memory loss, cognitive impairment, paresthesia, dizziness and balance issues, sensitivity to light and noise, loss of (or phantom) smell or taste, and autonomic dysfunction, often impacting activities of daily living7,32. audiovestibular manifestations of long covid include tinnitus, hearing loss and vertigo7,72. in a meta analysis, fatigue was found in 32% and cognitive impairment was found in 22% of patients with covid 19 at 12 weeks after infection3. cognitive impairments in long covid are debilitating, at the same magnitude as intoxication at the uk drink driving limit or 10 years of cognitive ageing73, and may increase over time, with one study finding occurrence in 16% of patients at 2 months after infection and 26% of patients at 12 months after infection74. activation of the kynurenine pathway, particularly the presence of the metabolites quinolinic acid, 3 hydroxyanthranilic acid and kynurenine, has been identified in long covid, and is associated with cognitive impairment74. cognitive impairment has also been found in individuals who recovered from covid 19 (ref. 75), and at higher rates when objective versus subjective measures were used3, suggesting that a subset of those with cognitive impairment may not recognize and/or report their impairment. cognitive impairment is a feature that manifests itself independently of mental health conditions such as anxiety and depression74,76, and occurs at similar rates in hospitalized and non hospitalized patients74,76. a report of more than 1.3 million people who had covid 19 showed mental health conditions such as anxiety and depression returned to normal over time, but increased risks of cognitive impairment (brain fog), seizures, dementia, psychosis and other neurocognitive conditions persisted for at least 2 years77. possible mechanisms for these neuropathologies include neuroinflammation, damage to blood vessels by coagulopathy and endothelial dysfunction, and injury to neurons32. studies have found alzheimer disease like signalling in patients with long covid78, peptides that self assemble into amyloid clumps which are toxic to neurons79, widespread neuroinflammation80, brain and brainstem hypometabolism correlated with specific symptoms81,82 and abnormal cerebrospinal fluid findings in non hospitalized individuals with long covid along with an association between younger age and a delayed onset of neurological symptoms83. multilineage cellular dysregulation and myelin loss were reported in a recent preprint in patients with long covid who had mild infections, with microglial reactivity similar to that seen in chemotherapy, known as ‘chemo brain’42. a study from the uk biobank, including brain imaging in the same patients before and after covid 19 as well as control individuals, showed a reduction in grey matter thickness in the orbitofrontal cortex and parahippocampal gyrus (markers of tissue damage in areas connected to the primary olfactory cortex), an overall reduction in brain size and greater cognitive decline in patients after covid 19 compared with controls, even in non hospitalized patients. although that study looked at individuals with covid 19 compared with controls, not specifically long covid, it may have an implication for the cognitive component of long covid84. abnormal levels of mitochondrial proteins as well as sars cov 2 spike and nucleocapsid proteins have been found in the central nervous system85. tetrahydrobiopterin deficiencies and oxidative stress are found in long covid as well86. in the eyes, corneal small nerve fibre loss and increased dendritic cell density have been found in long covid87,88, as well as significantly altered pupillary light responses89 and impaired retinal microcirculation90. sars cov 2 can infect and replicate in retinal59 and brain91 organoids. other manifestations of long covid include retinal haemorrhages, cotton wool spots and retinal vein occlusion92. mouse models of mild sars cov 2 infection demonstrated microglial reactivity and elevated levels of ccl11, which is associated with cognitive dysfunction and impaired neurogenesis42. hamster models exhibited an ongoing inflammatory state, involving t cell and myeloid activation, production of pro inflammatory cytokines and an interferon response that was correlated with anxiety and depression like behaviours in the hamsters, with similar transcriptional signatures found in the tissue of humans who had recovered from covid 19 (ref. 93). infected non human primates with mild illness showed neuroinflammation, neuronal injury and apoptosis, brain microhaemorrhages, and chronic hypoxaemia and brain hypoxia94. recent reports indicate low blood cortisol levels in patients with long covid as compared with control individuals, more than 1 year into symptom duration18,27. low cortisol production by the adrenal gland should be compensated by an increase in adrenocorticotropic hormone (acth) production by the pituitary gland, but this was not the case, supporting hypothalamus pituitary adrenal axis dysfunction18. this may also reflect an underlying neuroinflammatory process. low cortisol levels have previously been documented in individuals with me/cfs. me/cfs is a multisystem neuroimmune illness with onset often following a viral or bacterial infection. criteria include a “substantial reduction or impairment in the ability to engage in pre illness levels of occupational, educational, social, or personal activities” for at least 6 months, accompanied by a profound fatigue that is not alleviated by rest, along with postexertional malaise, unrefreshing sleep and cognitive impairment or orthostatic intolerance (or both)95. up to 75% of people with me/cfs cannot work full time and 25% have severe me/cfs, which often means they are bed bound, have extreme sensitivity to sensory input and are dependent on others for care96. there is a vast collection of biomedical findings in me/cfs97,98, although these are not well known to researchers and clinicians in other fields. many researchers have commented on the similarity between me/cfs and long covid99; around half of individuals with long covid are estimated to meet the criteria for me/cfs10,11,29,100, and in studies where the cardinal me/cfs symptom of postexertional malaise is measured, a majority of individuals with long covid report experiencing postexertional malaise7,100. a study of orthostatic stress in individuals with long covid and individuals with me/cfs found similar haemodynamic, symptomatic and cognitive abnormalities in both groups compared with healthy individuals101. importantly, it is not surprising that me/cfs should stem from sars cov 2 infection as 27.1% of sars cov infection survivors in one study met the criteria for me/cfs diagnosis 4 years after onset102. a wide range of pathogens cause me/cfs onset, including ebv, coxiella burnetii (which causes q fever), ross river virus and west nile virus38. consistent abnormal findings in me/cfs include diminished natural killer cell function, t cell exhaustion and other t cell abnormalities, mitochondrial dysfunction, and vascular and endothelial abnormalities, including deformed red blood cells and reduced blood volume. other abnormalities include exercise intolerance, impaired oxygen consumption and a reduced anaerobic threshold, and abnormal metabolic profiles, including altered usage of fatty acids and amino acids. altered neurological functions have also been observed, including neuroinflammation, reduced cerebral blood flow, brainstem abnormalities and elevated ventricular lactate level, as well as abnormal eye and vision findings. reactivated herpesviruses (including ebv, hhv 6, hhv 7 and human cytomegalovirus) are also associated with me/cfs97,98,103,104. many of these findings have been observed in long covid studies in both adults and children (box 1). long covid research has found mitochondrial dysfunction including loss of mitochondrial membrane potential105 and possible dysfunctional mitochondrial metabolism106, altered fatty acid metabolism and dysfunctional mitochondrion dependent lipid catabolism consistent with mitochondrial dysfunction in exercise intolerance107, redox imbalance108, and exercise intolerance and impaired oxygen extraction100,109,110. studies have also found endothelial dysfunction29, cerebral blood flow abnormalities and metabolic changes81,111,112,113 (even in individuals with long covid whose pots symptoms abate114), extensive neuroinflammation42,80, reactivated herpesviruses18,21,27, deformed red blood cells64 and many findings discussed elsewhere. microclots and hyperactivated platelets are found not only in individuals with long covid but also in individuals with me/cfs115. dysautonomia, particularly pots, is commonly comorbid with me/cfs116 and also often has a viral onset117. pots is associated with g protein coupled adrenergic receptor and muscarinic acetylcholine receptor autoantibodies, platelet storage pool deficiency, small fibre neuropathy and other neuropathologies118. both pots and small fibre neuropathy are commonly found in long covid111,119, with one study finding pots in 67% of a cohort with long covid120. mast cell activation syndrome is also commonly comorbid with me/cfs. the number and severity of mast cell activation syndrome symptoms substantially increased in patients with long covid compared with pre covid and control individuals121, with histamine receptor antagonists resulting in improvements in the majority of patients19. other conditions that are commonly comorbid with me/cfs include connective tissue disorders including ehlers danlos syndrome and hypermobility, neuro orthopaedic spinal and skull conditions, and endometriosis33,122,123. evidence is indicating these conditions may be comorbid with long covid as well. the overlap of postviral conditions with these conditions should be explored further. impacts on the reproductive system are often reported in long covid, although little research has been done to document the extent of the impact and sex specific pathophysiology. menstrual alterations are more likely to occur in women and people who menstruate with long covid than in women and people who menstruate with no history of covid and those who had covid 19 but not long covid124. menstruation and the week before menstruation have been identified by patients as triggers for relapses of long covid symptoms7. declined ovarian reserve and reproductive endocrine disorder have been observed in people with covid 19 (ref. 125), and initial theories suggest that sars cov 2 infection affects ovary hormone production and/or the endometrial response due to the abundance of ace2 receptors on ovarian and endometrial tissue126. individuals with both covid 19 and menstrual changes were more likely to experience fatigue, headache, body ache and pain, and shortness of breath than those who did not have menstrual changes, and the most common menstrual changes were irregular menstruation, increased premenstrual symptoms and infrequent menstruation127. research on me/cfs shows associations between me/cfs and premenstrual dysphoric disorder, polycystic ovarian syndrome, menstrual cycle abnormalities, ovarian cysts, early menopause and endometriosis128,129,130. pregnancy, postpartum changes, perimenopause and menstrual cycle fluctuations affect me/cfs and influence metabolic and immune system changes129. long covid research should focus on these relationships to better understand the pathophysiology. viral persistence in the penile tissue has been documented, as has an increased risk of erectile dysfunction, likely resulting from endothelial dysfunction131. in one study, impairments to sperm count, semen volume, motility, sperm morphology and sperm concentration were reported in individuals with long covid compared with control individuals, and were correlated with elevated levels of cytokines and the presence of caspase 8, caspase 9 and caspase 3 in seminal fluid132. respiratory conditions are a common phenotype in long covid, and in one study occurred twice as often in covid 19 survivors as in the general population2. shortness of breath and cough are the most common respiratory symptoms, and persisted for at least 7 months in 40% and 20% of patients with long covid, respectively7. several imaging studies that included non hospitalized individuals with long covid demonstrated pulmonary abnormalities including in air trapping and lung perfusion133,134. an immunological and proteomic study of patients 3 6 months after infection indicated apoptosis and epithelial damage in the airway but not in blood samples135. further immunological characterization comparing individuals with long covid with individuals who had recovered from covid 19 noted a correlation between decreased lung function, systemic inflammation and sars cov 2 specific t cells136. long covid gastrointestinal symptoms include nausea, abdominal pain, loss of appetite, heartburn and constipation137. the gut microbiota composition is significantly altered in patients with covid 19 (ref. 23), and gut microbiota dysbiosis is also a key component of me/cfs138. higher levels of ruminococcus gnavus and bacteroides vulgatus and lower levels of faecalibacterium prausnitzii have been found in people with long covid compared with non covid 19 controls (from before the pandemic), with gut dysbiosis lasting at least 14 months; low levels of butyrate producing bacteria are strongly correlated with long covid at 6 months24. persisting respiratory and neurological symptoms are each associated with specific gut pathogens24. additionally, sars cov 2 rna is present in stool samples of patients with covid 19 (ref. 139), with one study indicating persistence in the faeces of 12.7% of participants 4 months after diagnosis of covid 19 and in 3.8% of participants at 7 months after diagnosis61. most patients with long covid symptoms and inflammatory bowel disease 7 months after infection had antigen persistence in the gut mucosa140. higher levels of fungal translocation, from the gut and/or lung epithelium, have been found in the plasma of patients with long covid compared with those without long covid or sars cov 2 negative controls, possibly inducing cytokine production141. transferring gut bacteria from patients with long covid to healthy mice resulted in lost cognitive functioning and impaired lung defences in the mice, who were partially treated with the commensal probiotic bacterium bifidobacterium longum25. the onset and time course of symptoms differ across individuals and by symptom type. neurological symptoms often have a delayed onset of weeks to months: among participants with cognitive symptoms, 43% reported a delayed onset of cognitive symptoms at least 1 month after covid 19, with the delay associated with younger age83. several neurocognitive symptoms worsen over time and tend to persist longer, whereas gastrointestinal and respiratory symptoms are more likely to resolve7,74,142. additionally, pain in joints, bones, ears, neck and back are more common at 1 year than at 2 months, as is paresthesia, hair loss, blurry vision and swelling of the legs, hands and feet143. parosmia has an average onset of 3 months after the initial infection144; unlike other neurocognitive symptoms, it often decreases over time143. few people with long covid demonstrate full recovery, with one study finding that 85% of patients who had symptoms 2 months after the initial infection reported symptoms 1 year after symptom onset143. future prognosis is uncertain, although diagnoses of me/cfs and dysautonomia are generally lifelong. although diagnostic tools exist for some components of long covid (for example, tilt table tests for pots145 and mri scans to detect cardiovascular impairment68), diagnostic tools for long covid are mostly in development, including imaging to detect microclots63, corneal microscopy to identify small fibre neuropathy87, new fragmentation of qrs complex on electrocardiograms as indicative of cardiac injury146 and use of hyperpolarized mri to detect pulmonary gas exchange abnormalities147. on the basis of the tests that are offered as standard care, the results for patients with long covid are often normal; many providers are unaware of the symptom specific testing and diagnostic recommendations from the me/cfs community148. early research into biomarkers suggests that levels of extracellular vesicles85 and/or immune markers indicating high cytotoxicity149 could be indicative of long covid. intriguingly, dogs can identify individuals with long covid on the basis of sweat samples150. biomarker research in me/cfs may also be applicable to long covid, including electrical impedance blood tests, saliva tests, erythrocyte deformation, sex specific plasma lipid profiles and variables related to isocapnic buffering151,152,153,154. the importance of developing and validating biomarkers that can be used for the diagnosis of long covid cannot be adequately emphasized   they will not only be helpful in establishing the diagnosis but will also be helpful for objectively defining treatment responses. although there are currently no broadly effective treatments for long covid, treatments for certain components have been effective for subsets of populations (table 1). many strategies for me/cfs are effective for individuals with long covid, including pacing7,37 and symptom specific pharmacological options (for example, β blockers for pots, low dose naltrexone for neuroinflammation155 and intravenous immunoglobulin for immune dysfunction) and non pharmacological options (including increasing salt intake for pots, cognitive pacing for cognitive dysfunction and elimination diets for gastrointestinal symptoms)96. low dose naltrexone has been used in many diseases, including me/cfs155, and has also shown promise in treating long covid156. h1 and h2 antihistamines, often following protocols for mast cell activation syndrome and particularly involving famotidine, are used to alleviate a wide range of symptoms19,157, although they are not a cure. another drug, bc007, potentially addresses autoimmunity by neutralizing g protein coupled receptor autoantibody levels158. anticoagulant regimens are a promising way to address abnormal clotting159; in one study, resolution of symptoms was seen in all 24 patients receiving triple anticoagulant therapy31. apheresis has also shown promise to alleviate long covid symptoms; it has been theorized to help remove microclots160 and has been shown to reduce autoantibodies in me/cfs161. however, it is quite expensive, and its benefits are uncertain. some supplements have shown promise in treating both long covid and me/cfs, including coenzyme q10 and d ribose162, and may deserve further study. of note, exercise is harmful for patients with long covid who have me/cfs or postexertional malaise110,163 and should not be used as a treatment164,165,166; one study of people with long covid noted that physical activity worsened the condition of 75% of patients, and less than 1% saw improvement109. pilot studies and case reports have revealed additional treatment options worth exploring. a case report noted resolution of long covid following treatment with the antiviral paxlovid167, and a study investigating the treatment of acute covid 19 with paxlovid showed a 25% reduction in the incidence of long covid168; paxlovid should be investigated further for prevention and treatment of long covid. a small trial of sulodexide in individuals with endothelial dysfunction saw a reduction in symptom severity169. pilot studies of probiotics indicated potential in alleviating gastrointestinal and non gastrointestinal symptoms170,171. two patients with long covid experienced substantial alleviation of dysautonomia symptoms following stellate ganglion block172. an early study noted that pycnogenol statistically significantly improved physiological measurements (for example, reduction in oxidative stress) and quality of life (indicated by higher karnofsky performance scale index scores)173,174, as hypothesized on the basis of success in other clinical studies. taken together, the current treatment options are based on small scale pilot studies in long covid or what has been effective in other diseases; several additional trials are in progress175. there is a wide range of possible treatment options from me/cfs covering various mechanisms, including improving natural killer cell function, removing autoantibodies, immunosuppressants, antivirals for reactivated herpesviruses, antioxidants, mitochondrial support and mitochondrial energy generation176,177; most need to be clinically trialled, which should happen urgently. many newer treatment options remain underexplored, including anticoagulants and sars cov 2 specific antivirals, and a lack of funding is a significant limitation to robust trials. the impact of vaccination on the incidence of long covid differs across studies, in part because of differing study methods, time since vaccination and definitions of long covid. one study indicated no significant difference in the development of long covid between vaccinated individuals and unvaccinated individuals178; other studies indicate that vaccines provide partial protection, with a reduced risk of long covid between 15% and 41%4,5, with long covid continuing to impact 9% of people with covid 19. the different sars cov 2 variants and level of (and time since) vaccination may impact the development of long covid. the uk’s office for national statistics found that long covid was 50% less common in double vaccinated participants with omicron ba.1 than in double vaccinated participants delta, but that there was no significant difference between triple vaccinated participants; it also found long covid was more common after omicron ba.2 infection than after ba.1 infection in triple vaccinated participants, with 9.3% developing long covid from infection with the ba.2 variant179. the impact of vaccination on long covid symptoms in people who had already developed long covid differs among patients, with 16.7% of patients experiencing a relief of symptoms, 21.4% experiencing a worsening of symptoms and the remainder experiencing unchanged symptoms180. reinfections are increasingly common181. the impact of multiple instances of covid 19, including the rate of long covid in those who recovered from a first infection but developed long covid following reinfection, and the impact of reinfection on those with pre existing long covid is crucial to understand to inform future policy decisions. early research shows an increasing risk of long covid sequelae after the second and third infection, even in double vaccinated and triple vaccinated people182. existing literature suggests multiple infections may cause additional harm or susceptibility to the me/cfs type presentation33,183. there is also early evidence that certain immune responses in people with long covid, including low levels of protective antibodies and elevated levels of autoantibodies, may suggest an increased susceptibility to reinfection27. issues with pcr and antibody testing throughout the pandemic, inaccurate pandemic narratives and widespread lack of postviral knowledge have caused downstream issues and biases in long covid research and care. most patients with covid 19 from the first waves did not have laboratory confirmed infection, with pcr tests being difficult to access unless individuals were hospitalized. only 1 3% of cases to march 2020 were likely detected184, and the cdc estimates that only 25% of cases in the usa were reported from february 2020 to september 2021 (ref. 185); that percentage has likely decreased with the rise in use of at home rapid tests. although pcr tests are our best tool for detecting sars cov 2 infections, their false negative rates are still high186. further bias is caused by false negative rates being higher in women and adults younger than 40 years187, those with a low viral load188 and children (box 1), with several studies showing 52 90% of cases in children missed by pcr tests189,190. the high false negative pcr rate results in symptomatic patients with covid 19, who seek a covid 19 test but receive a false negative result, being included as a control in many studies. those who have a positive pcr test result (who are more likely to be included in research) are more likely to be male or have a higher viral load. additionally, the lack of test accessibility as well as the false negative rates has created a significant barrier to care, as many long covid clinics require pcr tests for admission. similarly, there is a broad misconception that everyone makes and retains sars cov 2 antibodies, and many clinicians and researchers are unaware of the limited utility of antibody tests to determine prior infection. between 22% and 36% of people infected with sars cov 2 do not seroconvert, and many others lose their antibodies over the first few months, with both non seroconversion and seroreversion being more likely in women, children and individuals with mild infections52,53,191,192,193. at 4 and 8 months after infection, 19% and 61% of patients, respectively, who had mild infections and developed antibodies were found to have seroreverted, compared with 2% and 29% of patients, respectively who had severe infections191. still, many clinicians and researchers use antibody tests to include or exclude patients with covid 19 from control groups. furthermore, during periods of test inaccessibility, tests were given on the basis of patients having covid 19 specific symptoms such as loss of smell and taste, fever, and respiratory symptoms, resulting in a bias towards people with those symptoms. misinformation on pcr and antibody tests has resulted in the categorization of patients with long covid into non covid 19 control groups, biasing the research output. because low or no antibody levels and viral load may be related to long covid pathophysiology, including a clinically diagnosed cohort will strengthen the research. the narrative that covid 19 had only respiratory sequelae led to a delayed realization of the neurological, cardiovascular and other multisystem impacts of covid 19. many long covid clinics and providers still disproportionately focus on respiratory rehabilitation, which results in skewed electronic health record data. electronic health record data are also more comprehensive for those who were hospitalized with covid 19 than for those who were in community care, leading to a bias towards the more traditional severe respiratory presentation and less focus on non hospitalized patients, who tend to have neurological and/or me/cfs type presentations. the narrative that initially mild covid 19 cases, generally defined as not requiring hospitalization in the acute phase, would not have long term consequences has also had downstream effects on research. these so called mild cases that result in long covid often have an underlying biology different from acute severe cases, but the same types of tests are being used to evaluate patients. this is despite basic tests such as d dimer, c reactive protein (crp) and antinuclear antibody tests and complete blood count being known to often return normal results in patients with long covid. tests that return abnormal results in patients with me/cfs and dysautonomia, such as total immunoglobulin tests, natural killer cell function tests, the tilt table or nasa lean test, the four point salivary cortisol test, reactivated herpesvirus panels, small fibre neuropathy biopsy, and tests looking for abnormal brain perfusion96, should instead be prioritized. other recurring issues include studies failing to include the full range of symptoms, particularly neurological and reproductive system symptoms, and not asking patients about symptom frequency, severity and disability. cardinal symptoms such as postexertional malaise are not widely known, and therefore are rarely included in study designs. the widespread lack of knowledge of viral onset illnesses, especially me/cfs and dysautonomia, as well as often imperfect coding, prevents these conditions from being identified and documented by clinicians; this means that they are frequently absent from electronic health record data. further, because me/cfs and dysautonomia research is not widely known or comprehensively taught in medical schools194, long covid research is often not built on past findings, and tends to repeat old hypotheses. additionally, long covid research studies and medical histories tend to document only the risk factors for severe acute covid 19, which are different from the risk factors for conditions that overlap with long covid such as me/cfs and dysautonomia (for example, connective tissue disorders such as ehlers danlos syndrome, prior illnesses such as infectious mononucleosis and mast cell involvement)33,195,196. clinicians who are not familiar with me/cfs and dysautonomia often misdiagnose mental health disorders in patients; four in five patients with pots receive a diagnosis with a psychiatric or psychological condition before receiving a pots diagnosis, with only 37% continuing to have the psychiatric or psychological diagnosis once they have received their pots diagnosis117. researchers who are unfamiliar with me/cfs and dysautonomia often do not know to use specific validated tools when conducting mental health testing, as anxiety scales often include autonomic symptoms such as tachycardia, and depression scales often include symptoms such as fatigue, both of which overestimate mental health disorder prevalence in these conditions197,198. although research into long covid has been expansive and has accelerated, the existing research is not enough to improve outcomes for people with long covid. to ensure an adequate response to the long covid crisis, we need research that builds on existing knowledge and is inclusive of the patient experience, training and education for the health care and research workforce, a public communication campaign, and robust policies and funding to support research and care in long covid. we need a comprehensive long covid research agenda that builds on the existing knowledge from me/cfs, dysautonomia and other viral onset conditions, including but not limited to brain and brainstem inflammation, appropriate neuroimaging techniques, neuroimmunology, metabolic profiling, impaired endothelial function, mitochondrial fragmentation, antiviral and metabolic phenotypes, hypoperfusion/cerebral blood flow, nanoneedle diagnostic testing, overlaps with connective tissue disorders, autoimmunity and autoantibodies, viral/microbial persistence, intracranial hypertension, hypermobility, craniocervical obstructions, altered t and b cells, metabolomics and proteomics, elevated blood lactate level, herpesvirus reactivations, immune changes in the early versus late postviral years, and changes to the gut microbiota. the mechanisms of and overlaps between long covid and connective tissue involvement, mast cells and inflammatory conditions such as endometriosis are particularly understudied and should be focused on. because of the high prevalence of me/cfs, pots and other postinfectious illnesses in patients with long covid, long covid research should include people who developed me/cfs and other postinfectious illnesses from a trigger other than sars cov 2 in comparator groups to improve understanding of the onset and pathophysiology of these illnesses113. additionally, there is a known immune exhaustion process that occurs between the second and third year of illness in me/cfs, with test results for cytokines being different between patients who have been sick for shorter durations (less than 2 years) than for those who have been sick for longer durations43. because of this, studies should implement subanalyses based on the length of time participants have been ill. because me/cfs and dysautonomia research is not widely known across the biomedical field, long covid research should be led by experts from these areas to build on existing research and create new diagnostic and imaging tools. robust clinical trials must be a priority moving forward as patients currently have few treatment options. in the absence of validated treatment options, patients and physicians conduct individual experiments, which result in the duplication of efforts without generalizable knowledge and pose undue risks to patients. robust study design and knowledge sharing must be prioritized by both funding institutions and clinician researchers. it is critical that research on long covid be representative of (or oversample) the populations who had covid 19 and are developing long covid at high rates, which is disproportionately people of colour35. medical research has historically under represented these populations, and over representation of white and socio economically privileged patients has been common in long covid research. researchers must work within communities of colour, lgbtq+ communities and low income communities to build trust and conduct culturally competent studies that will provide insights and treatments for long covid for marginalized populations. as a subset of patients will improve over time, and others will have episodic symptoms, care should be taken to incorporate the possibility of alleviation of symptoms into the study design, and care should be taken not to ascribe improvement to a particular cause without proper modelling. finally, it is critical that communities of patients with long covid and associated conditions are meaningfully engaged in long covid research and clinical trials. the knowledge of those who experience an illness is crucial in identifying proper study design and key research questions and solutions, improving the speed and direction of research. to prepare the next generation of health care providers and researchers, medical schools must improve their education on pandemics, viruses and infection initiated illnesses such as long covid and me/cfs, and competency evaluations should include these illnesses. as of 2013, only 6% of medical schools fully cover me/cfs across the domains of treatment, research and curricula, which has created obstacles to care, accurate diagnosis, research and treatment194. to ensure people with long covid and associated conditions can receive adequate care now, professional societies and government agencies must educate the health care and research workforce on these illnesses, including the history of and current best practices for me/cfs to not repeat mistakes of the past, which have worsened patients’ prognoses. the research community has made a misstep in its efforts to treat me/cfs199, and some physicians, poorly educated in the aetiology and pathophysiology of the disorder, still advise patients to pursue harmful interventions such as graded exercise therapy and cognitive behavioural therapy, despite the injury that these interventions cause200 and the fact that they are explicitly not advised as treatments163,164,166. in addition to providing education on long covid to the biomedical community, we need a public communications campaign that informs the public about the risks and outcomes of long covid. finally, we need policies and funding that will sustain long covid research and enable people with long covid to receive adequate care and support. for instance, in the usa, the creation of a national institute for complex chronic conditions within the nih would go a long way in providing a durable funding mechanism and a robust research agenda. further, we need to create and fund centres of excellence, which would provide inclusive, historically informed and culturally competent care, as well as conduct research and provide medical education to primary care providers. additionally, research and clinical care do not exist in silos. it is critical to push forward policies that address both the social determinants of health and the social support that is needed for disabled people. long covid is a multisystemic illness encompassing me/cfs, dysautonomia, impacts on multiple organ systems, and vascular and clotting abnormalities. it has 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search for this author in pubmed google scholar you can also search for this author in pubmed google scholar the authors contributed equally to all aspects of the article. correspondence to eric j. topol. the authors declare no competing interests. nature reviews microbiology thanks akiko iwasaki, ziyad al aly and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. publisher’s note springer nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. springer nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. reprints and permissions davis, h.e., mccorkell, l., vogel, j.m. et al. long covid: major findings, mechanisms and recommendations. nat rev microbiol 21, 133 146 (2023). https://doi.org/10.1038/s41579 022 00846 2 download citation accepted: 05 december 2022 published: 13 january 2023 issue date: march 2023 doi: https://doi.org/10.1038/s41579 022 00846 2 anyone you share the following link with will be able to read this content: sorry, a shareable link is not currently available for this article. provided by the springer nature sharedit content sharing initiative series nature reviews microbiology (nat rev microbiol) issn 1740 1534 (online) issn 1740 1526 (print) © 2025 springer nature limited sign up for the nature briefing newsletter   what matters in science, free to your inbox daily.

supported by funcionarios de otros países advierten de los peligros para la salud del consumo de alcohol en cualquier cantidad. a los estadounidenses se les sigue diciendo que beber moderadamente es seguro. ¿qué ocurre? by roni caryn rabin officials in other countries are warning about the health hazards of alcohol in any amount. americans are still told that moderate drinking is safe. what gives? by roni caryn rabin a new report calls for public education and closing of legal loopholes to keep the public safe. by matt richtel the national academies said the condition could involve up to 200 symptoms, make it difficult for people to work and last for months or years. by pam belluck after dropping two harvard experts who had received industry support, the national academies turned to a colleague with a similar background. by roni caryn rabin two researchers with ties to beer and liquor companies had been named to a panel that will review the health evidence on alcohol consumption. but after a new york times story was published, the panel’s organizers decided to drop them. by roni caryn rabin the academies accepted millions of dollars from members of the sackler family   including some who led purdue pharma, makers of oxycontin   even while advising federal officials on opioid policy. by christina jewett even as the nation’s drug crisis mounted, the national academies of sciences, engineering and medicine continued to accept funds from some members of the sackler family, including those involved with purdue pharma. by christina jewett the covid 19 pandemic demonstrated the promise of tracking pathogens in sewage. now, the nation needs to act on it, experts say. by emily anthes on astronomers’ wish list for the next decade: two giant telescopes and a space telescope to search for life and habitable worlds beyond earth. by dennis overbye

nebraska’s difference is an all star, all volunteer team that dedicated itself to being ready for any biocontainment crisis at any time. the global center is led by experts in biopreparedness and high consequence infections research, education and clinical care. our scholars are leading advancements in global health security. our affiliates are innovative experts collaborating to advance global health security. c stars, the center for sustainment of trauma readiness skills  omaha is a collaboration between unmc, nebraska medicine, and the air force research laboratory’s school of aerospace medicine. c stars omaha works closely with unmc’s global center for health security, iexcel, and the nebraska biocontainment unit to take advantage of the medical center’s capabilities and expertise in biopreparedness training and research. our team consists of a variety of professionals providing support and project management to further the global center for health security’s mission. the global center for health security is the premier u.s. institution for management of high consequence infections. further, our clinical capabilities include biological, chemical, burn, and radiation domains. our expertise is now sought worldwide and officially sanctioned by the u.s. government. the gchs is the home base to the national training, simulation, and quarantine center and the nebraska biocontainment unit. the gchs has laser focused existing work by our leading scientists in fields like chemical weapons, drug discovery and public health. the gchs has partnered with many academic groups at unmc and external partners to tackle the most pressing problems in emerging infectious diseases. learn about the gchs’ 4 core capabilities: emerging pathogens lab , nebraska biocontainment unit , the national quarantine unit, and deployable teams. the gchs works with multiple core programs to enhance our capabilities to respond effectively to public health challenges. the gchs partners with many outside organizations to strengthen our commitment to addressing global health challenges through research and innovation. learn more about the impactful programs led by gchs leadership, scholar, and affiliates. explore gchs academic programs which include the health security fellowship and the biological defense and health security program. find information about emerging pathogens, diseases and outbreaks from around the world. stay updated on the most recent information on worldwide global health and emerging pathogens outbreaks. explore our covid 19 page for recent news, resources, manuals, and playbooks. biweekly overviews of new data and developments presented by james v. lawler, md, mph, fidsa can now be found on the health emergencies page. learn more about the current worldwide outbreak of hpai h5n1  avian influenza and explore resources, news, webinars, and our unofficial map. explore this page for comprehensive resources, information, news, and situational updates on the ongoing marburg virus disease outbreak. the global center for health security is currently monitoring the spread of mpox. learn more by viewing our resources. the gchs is currently monitoring the rise of dengue fever. this page provides information, resources, and news. read recent highlights, articles, events, recognition and updates on the work of our programs and partners. find scheduled and past events involving the global center for health security. find annual reports for our center and several of our programs. nyt the national academies said the condition could involve up to 200 symptoms, make it difficult for people to work and last for months or years. one of the nation’s premier medical advisory organizations has weighed in on long covid with a 265 page report that recognizes the seriousness and persistence of the condition for millions of americans. more than four years since the start of the coronavirus pandemic, long covid continues to damage many people’s ability to function, according to the national academies of sciences, engineering and medicine, a nongovernmental institution that advises federal agencies on science and medicine. “long covid can impact people across the life span, from children to older adults, as well as across sex, gender, racial, ethnic and other demographic groups,” it said, concluding that “long covid is associated with a wide range of new or worsening health conditions and encompasses more than 200 symptoms involving nearly every organ system.” here are some of the national academies’ findings, drafted by a committee of 14 doctors and researchers: the report cited data from 2022 suggesting that nearly 18 million adults and nearly a million children in the united states have had long covid at some point. at the time of that survey, about 8.9 million adults and 362,000 children had the condition. share your email address will not be published. required fields are marked * comment * name * email * website save my name, 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covid 19 guidance supported by the national academies said the condition could involve up to 200 symptoms, make it difficult for people to work and last for months or years. by pam belluck one of the nation’s premier medical advisory organizations has weighed in on long covid with a 265 page report that recognizes the seriousness and persistence of the condition for millions of americans. more than four years since the start of the coronavirus pandemic, long covid continues to damage many people’s ability to function, according to the national academies of sciences, engineering and medicine, a nongovernmental institution that advises federal agencies on science and medicine. “long covid can impact people across the life span, from children to older adults, as well as across sex, gender, racial, ethnic and other demographic groups,” it said, concluding that “long covid is associated with a wide range of new or worsening health conditions and encompasses more than 200 symptoms involving nearly every organ system.” here are some of the national academies’ findings, drafted by a committee of 14 doctors and researchers: the report cited data from 2022 suggesting that nearly 18 million adults and nearly a million children in the united states have had long covid at some point. at the time of that survey, about 8.9 million adults and 362,000 children had the condition. surveys showed that the prevalence of long covid decreased in 2023 but, for unclear reasons, has risen this year. as of january, data showed nearly 7 percent of adults in the united states had long covid. there is still no standardized way to diagnose the condition and no definitive treatments to cure it. “there is no one size fits all approach to rehabilitation, and each individual will need a program tailored to their complex needs,” the national academies said, advising that doctors should not require patients to have a positive coronavirus test to be diagnosed with long covid.

 fizkes / istock today a new report from the national academies of sciences, engineering, and medicine presents a number of conclusions about long covid diagnosis, symptoms, and impact on daily function, including that the condition can cause more than 200 symptoms, and that a positive covid 19 test is not necessary to make a long covid diagnosis. the findings are meant to guide the social security administration (ssa) and are published one week before the national academies of sciences, engineering, and medicine is set to offer a new single definition of long covid that can be used across us governmental groups as a way to streamline treating the condition in the years to come. "this report offers a comprehensive review of the evidence base for how long covid may impact a patient's ability to engage in normal activities, such as going to work, attending school, or taking care of their families," said victor j. dzau, md, president of the national academy of medicine, in a national academies press release. "its findings will be useful to anyone attempting to understand how long covid may affect the millions of people in the u.s. who have reported symptoms." according to the centers for disease control and prevention, 5.3% of americans currently have long covid, with a significant proportion of those experiencing disability from the condition. in today's report, more than 200 symptoms are formally listed as possible signs of long covid, affecting every organ system. women are twice as likely to men to experience long covid, but people who have never received a diagnosis or even a positive covid 19 test may be experiencing symptoms of the condition. though people with mild or even asymptomatic cases of acute covid can develop long covid, the report recognizes that people whose infection required hospitalization are two to three times more likely to experience long covid than are those who were not hospitalized. emphasized throughout the report is the similarity long covid has to other chronic conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (me/cfs), fibromyalgia, and postural orthostatic tachycardia syndrome (pots). like those conditions there is no current way to treat long covid, though long covid does have a better prognosis than does me/cfs.