Long COVID refers to long-term symptoms that persist after the initial illness from SARS-CoV-2, the virus that causes COVID-19. While most people recover fully within a few weeks, some continue to experience symptoms like fatigue, brain fog, shortness of breath, and more for months after the initial infection. Understanding whether long COVID will eventually go away on its own or require treatment is an important question for those living with the condition. In this article, we’ll examine the latest research on long COVID duration and recovery.
What is long COVID?
Long COVID is characterized by new or ongoing symptoms that last for more than 4 weeks after the initial COVID-19 illness. Common long COVID symptoms include:
- Shortness of breath
- Joint pain
- Chest pain
- Memory, concentration or sleep problems (brain fog)
- Muscle pain or headache
- Fast or pounding heartbeat
- Loss of smell or taste
- Depression or anxiety
These symptoms can fluctuate in intensity and may impair day-to-day functioning. While long COVID can occur after even mild COVID-19 illness, risk increases with more severe initial infection. It’s estimated 10-30% of people who get COVID-19 may develop long-term symptoms, meaning long COVID could impact millions globally.
How long does long COVID typically last?
There is no definitive answer yet on how long most long COVID cases persist. Early studies found that most people with long COVID symptoms see improvement within 6 to 12 months.
However, experts caution it’s still too early to know how long the condition may last for any given individual. Some emerging research suggests a subset of people with long COVID continue to experience debilitating symptoms beyond 12 months with no clear recovery timeline.
For example, one large study published in the journal Nature followed over 4,000 COVID-19 patients for up to 1 year after hospital discharge. Results showed:
- 76% of patients reported at least 1 ongoing symptom at 6 months.
- 55% still had symptoms at 12 months.
Fatigue and muscle weakness were among the most commonly reported persistent problems.
Another study in The Lancet medical journal tracked over 1,700 COVID-19 patients for up to 5 months after hospital discharge. They found:
- 76% had at least 1 lingering symptom after 5 months.
- The most common were fatigue and muscle weakness (63%), sleep difficulties (26%), and anxiety/depression (23%).
So while many people with long COVID get better within their first year, a significant portion continue to experience symptoms beyond this point. More long-term research is needed to understand the likelihood of eventual recovery.
Does the severity of the initial illness affect how long long COVID lasts?
Yes, research indicates there is a correlation between the severity of the initial COVID-19 illness and duration of long COVID symptoms.
In general, studies show people hospitalized for severe COVID-19 are more likely to experience long-lasting symptoms compared to those with mild initial infections. One study published in JAMA Network Open followed over 200 COVID-19 patients for up to 9 months after symptom onset. Results showed:
- 30% of outpatients reported persistent symptoms at 6 months.
- 49% of hospitalized patients reported symptoms at 6 months.
- Hospitalized patients also reported a greater number of persistent symptoms and more severe disability.
The reasons for this association are still under investigation but may relate to more extensive immune activation and inflammation during severe illness that contributes to persistent symptoms. However, long COVID can still occur after asymptomatic or mild COVID-19. One study found 27% of people who had mild initial infections reported symptoms 2-3 months later.
Are certain symptoms more likely to persist?
Yes, researchers have identified some common long COVID symptoms that tend to persist longer than others:
- Fatigue – Multiple studies report fatigue as one of the most prevalent and long-lasting long COVID symptoms. Fatigue lasting over 6 months was reported by 33-55% of patients in some studies.
- Dyspnea – Also known as shortness of breath, dyspnea is another commonly reported persistent symptom. One study found dyspnea lasted a median of 15 days but persisted for over 5 months in some patients.
- Cognitive dysfunction – Problems with memory, concentration and “brain fog” are frequent complaints with long COVID. One study saw minimal cognitive improvement over 6 months for long COVID patients with cognitive symptoms early on.
- Muscle weakness – Studies report persistent muscle weakness lasting over 5-6 months in some long COVID patients, especially those hospitalized with severe illness.
While other symptoms like cough, chest pain, headaches, and heart palpitations may last for some, they tend to resolve sooner on average based on current data. Ongoing research aims to better understand long-term prognosis for specific long COVID symptoms.
Does getting vaccinated reduce the risk of developing long COVID?
Emerging research indicates COVID-19 vaccination helps lower the risk of developing long COVID symptoms.
One large study followed over 1,200 healthcare workers for nearly a year. It found unvaccinated workers who caught COVID-19 had a 54% higher risk of reporting persistent symptoms over 6 months compared to vaccinated workers who had breakthrough infections. The unvaccinated group also had a 64% higher risk of 3 or more long COVID symptoms.
Other studies show similar trends of lower long COVID risk in vaccinated populations. Researchers theorize vaccines provide some protective benefit by lowering viral load and limiting severe inflammation during initial infection. However, breakthrough long COVID can still occur. The potential protective effect of vaccination underscores the importance of staying up-to-date with recommended COVID-19 vaccine doses.
Are recurring cycles of symptoms common with long COVID?
Many long COVID patients report experiencing “relapses” where symptoms flare up for a period of time after seeming to improve. This phenomenon is sometimes referred to as “long COVID waves” or “relapsing-remitting long COVID.”
In one survey of over 3,700 long COVID patients, over 90% reported symptom relapses triggered by things like physical or mental exertion, stress, or other infections. Symptoms most likely to relapse were fatigue, breathlessness, muscle aches, and headaches.
On average, patients reported about 3 or 4 relapse episodes within the first 18 months of illness, with a median duration of about 3-4 days per relapse. The mechanisms behind relapsing-remitting long COVID patterns remain poorly understood but could relate to factors like immune dysregulation, nervous system dysfunction, and viral persistence. More research is needed to confirm prevalence rates and predictors of relapse episodes.
What treatments help or exacerbate long COVID?
There are currently no FDA-approved medications specifically for long COVID. Treatment focuses on symptom management and rehabilitation strategies like:
- Pacing/energy management – Alternating periods of rest and activity to avoid crashes.
- Exercise – Light aerobic activity and strength training within limits of fatigue/symptoms.
- Physical/occupational therapy – For muscle weakness, breathing exercises, managing orthostatic intolerance.
- Mental health support – Managing anxiety, depression, and brain fog symptoms.
Some centers offer multidisciplinary long COVID clinics combining medical, rehab, and mental health services. Small studies provide provisional evidence that medications like metformin and maraviroc could improve some symptoms, but larger trials are needed.
Anecdotal reports indicate overexertion, mental stress, and illnesses like flu can exacerbate long COVID symptoms during relapses. Patients cite resting, pacing, hydration, and avoiding triggering factors as helpful during flare-ups. But clinical guidance on treating relapses is limited thus far. Ongoing studies aim to identify effective treatments and management strategies.
What percentage of long COVID patients eventually recover?
There are not yet definitive statistics on the percentage of long COVID patients who eventually make a full recovery over time. As a relatively new condition, long-term, multi-year studies are lacking.
However, current research provides some preliminary clues:
- One study saw 72% of patients report “full recovery” 10 months after hospital discharge, but relied only on patient self-reports.
- In another study, only 13% of patients felt fully recovered at 6 months, but many showed slow improvement over the full follow-up period up to 12 months.
- A study of over 270 long COVID patients found 44% felt “fully recovered or back to usual health” when surveyed between 4-12 months post-symptom onset.
While the percentages vary between different cohorts, most studies suggest at least half of patients continue experiencing some lingering symptoms a year out. Some may simply adapt and regain functional capacity despite persistent symptoms.
Experts caution it’s still too early to know what percentage will eventually make a full recovery. More time and longitudinal data is needed to understand long COVID prognosis and recovery rates beyond the first 12 months of illness.
Does permanent organ damage occur in long COVID?
For most, long COVID is thought to reflect a prolonged malaise of the immune system and dysfunction in regulating complex pathways rather than permanent tissue damage. However, some emerging research indicates certain organs may sustain lasting damage in a subset of patients – especially those hospitalized with severe COVID-19.
One study of over 200 hospitalized COVID-19 survivors found 71% exhibited impaired function in at least 1 organ system 6 months later. The most frequently impaired organs were:
- Lungs (reduced airflow and gas transfer)
- Kidneys (reduced filtration capacity)
- Heart (inflammation, scar tissue)
- Liver (elevated liver enzymes)
Whether these abnormalities constitute permanent damage versus slow recovery is still under investigation. For less severe long COVID, available imaging and lab tests are typically normal. However, small studies provide some evidence of subtle inflammation in heart, lungs and brain that could reflect ongoing healing processes.
While organ damage appears relatively rare overall, experts recommend testing for anyone with long COVID showing signs of major organ dysfunction. Monitoring organ function is also advised for severe COVID-19 survivors.
Does getting COVID again increase the risk of long COVID?
Reinfection with new COVID-19 variants remains a risk even after vaccination or prior infection. Emerging data suggest reinfections may increase the likelihood of developing long COVID symptoms compared to initial infections.
In one recent study, researchers analyzed health records of over 40,000 patients infected at least twice with COVID-19. They found:
- The risk of most long COVID symptoms was 3-5 times higher after repeat infections compared to initial infections.
- Long COVID risks included fatigue, brain fog, muscle pain, heart conditions, kidney disease, and diabetes.
Experts theorize each new infection may compound inflammatory damage and cellular aging effects that lead to lasting symptoms in some people.
However, major limitations include lack of an uninfected control group and reliance on electronic health records. Further research is needed, but reinfections appear to stack the odds against you when it comes to avoiding long COVID based on current evidence. Vaccination and other precautions remain important.
Long COVID remains a complex condition with many unanswered questions about its duration and recovery outcomes. While most patients see gradual improvement over months, a significant portion report persistent symptoms and limitations a year or more after initial infection. Fatigue, brain fog, dyspnea, and muscle weakness tend to be the most stubborn lingering symptoms.
Severe COVID-19, repeat infections, and lack of vaccination appear to increase risks of developing long-lasting symptoms. However, even mild and breakthrough cases can sometimes lead to long COVID. There is still no definitive data on what percentage of patients eventually make a full recovery and how long that may take beyond the first year of illness.
Proactive symptom management, a pacing approach, physical rehab, mental health support, and avoiding triggers may help mitigate symptoms during the long road to recovery for many long haulers. But large knowledge gaps remain regarding treatments to cure long COVID. Continued research on the longevity and prognosis of long COVID is critically needed to better understand outcomes for this growing patient population.