Long Covid (Post-Covid syndrome)

Brief overview

  • What is Long Covid? Novel clinical picture that may occur as a late sequelae of cleared covid-19 infection.
  • Causes: Subject of current research; presumably direct damage due to viral replication in acute phase; indirect damage due to inflammation, autoimmune phenomena, circulatory disturbances or altered blood clotting; consequences of intensive care; possibly persistence (persistence) of coronavirus in the body.
  • Incidence: data vary widely; estimated to affect one in eight persons affected by Covid-19; Omicron virus variant and vaccine prevention probably reduce risk; further development uncertain.
  • Prevention: Vaccination reduces risk of long covid.
  • Risk factors: Not conclusively determined.
  • Diagnosis: Imaging; physical, neurologic, and cognitive performance and function tests; laboratory diagnostic tests; and others.
  • Prognosis: No general prognosis possible, since Long Covid develops very individually; in many cases, certain constellations of complaints improve; however, there are increasing reports of chronic Long Covid with (often neurological) limitations lasting for months; long-term limitations are common with previous intensive medical Covid 19 treatment.

What is Long Covid?

If health complaints persist for longer than twelve weeks, doctors refer to this as post-Covid syndrome. In the English-speaking world, patients are also referred to as “long haulers”, i.e. patients who “drag” symptoms around for a long time.

In a mild course, a corona infection lasts on average two to three weeks. In more severe cases, the acute phase of the disease can double. But in many cases, this is not the end of the disease.

But it also often affects people whose disease course was mild or asymptomatic.

What are the symptoms of Long Covid?

Long Covid causes different symptoms. This means that not every patient shows the same constellation of complaints.

This variety of documented symptoms makes it difficult even for experts to assign them to a clearly delineated clinical picture.

Main symptoms of Long Covid

The following symptoms are frequently observed in Long Covid:

  • Exhaustion and fatigue (fatigue)
  • Loss of sense of smell and taste (anosmia)
  • Headache, muscle and joint pain
  • Nausea, diarrhea and decreased appetite
  • Concentration and memory problems (brain fog)
  • Dizziness and balance problems (vertigo)
  • Tinnitus, earache or sore throat
  • Nerve disorders (neuropathies, tingling in hands/feet)
  • Cardiovascular problems (e.g.: palpitations, heart palpitations, chest pain, shortness of breath)
  • Disorders of the skin as well as hair loss

According to current knowledge, the symptom complex “fatigue and tiredness” seems to occur more frequently in women than in men. Headache, as a possible Covid-19 late effect, is also overrepresented in younger women.

Men, on the other hand, are likely to show persistent cough and shortness of breath as primary corona long-term sequelae. This primarily affects middle-aged and older men.

Other Long Covid Abnormalities

Extended observational studies now suggest that Long Covid may also be associated with other symptoms previously neglected in the discussion.

These include, for example:

  • Downstream inflammatory phenomena (anaphylaxis, mast cell activation syndrome, PIMS, etc.).
  • New-onset allergies and swelling
  • Altered sensitivity or new-onset intolerance to existing medications
  • erectile and ejaculatory dysfunction and loss of libido
  • Paralysis of the facial muscles (facial palsy) – and other less common abnormalities.

There is currently limited data on these above observations – but they are increasingly becoming the focus of research. Therefore, how frequently they occur is not yet known.

Experts have long assumed that around one in ten Covid 19 patients could also suffer from forms of Long Covid. Recent studies conclude that as many as one in eight Covid 19 patients could develop long-term consequences.

However, the current studies mostly look at past periods from earlier phases of the pandemic – those with lack of vaccine availability and a different viral variant distribution.

The outlook for further development is uncertain. The “milder” Omikron variant that now prevails seems likely to reduce the long covid risk. Higher vaccination rates also show a prevention effect.

Risk factors for Long Covid

An assessment of Long Covid risk is not conclusive at this time, as the mechanisms of disease development continue to be part of current research efforts.

It is observed that women are probably more frequently affected than men. Severe (hospitalized) covid-19 sufferers are also more likely to have forms of long covid than milder courses. Nevertheless, long covid is often reported even in covid-19 courses with few symptoms.

In a recent large-scale observational study from the United Kingdom published in the journal Nature, which retrospectively examined the period of the alpha variant propagation peak in particular, identified the following risky conditions:

  • COPD
  • Benign prostatic hyperplasia (BPH)
  • Fibromyalgia
  • Existing psycho-neurological abnormalities (anxiety disorders, depression, migraines, learning disabilities)
  • Multiple sclerosis
  • Chronic pancreatitis
  • Celiac disease
  • Asthma
  • Type 2 diabetes

Does the risk of Long Covid decrease after vaccination?

Vaccination against coronavirus reduces the risk of long covid.

However, how effective such prevention is (in absolute terms) remains the subject of ongoing investigation. Some earlier studies suggest that vaccinated individuals carry a good half the risk of developing corona long covid in the event of vaccine breakthrough. More recent studies suggest a smaller reduction in risk.

However, the respective disease-causing virus variant also has a high influence on the long covid risk: Earlier variants (especially the alpha and later the delta variant) carried a higher risk for long-term consequences than the currently circulating omicron variant.

Causes for Long Covid

One thing stands out: there is no “one reason” or “one trigger” for Long Covid. The clinical picture varies from case to case – from person to person.

However, there is increasing evidence of damaging mechanisms that influence how Long Covid develops in individual cases. Depending on their constellation and interaction, the prognosis for affected patients also varies.

Direct effects: These are consequences of viral replication in the body that damage certain tissues and organs during the acute phase of Covid-19. Experts also discuss whether the mere presence of viral particles in the body disrupts blood pressure-regulating mechanisms.

Emergency treatment: If Covid-19 takes a severe course, the function of the respiratory system can be so severely impaired that independent breathing is no longer possible for affected individuals. In such cases, physicians must perform artificial respiration to save the life of the affected person. This life-saving but invasive form of treatment is usually accompanied by severe physical and psychological stress and late effects (post-intensive care syndrome – PICS for short).

No. They can occur in combination – but they do not have to. In practice, their individual contribution to the overall complaints is usually not clearly distinguishable in mild and mild Long Covid forms. Not all affected persons develop all of the above-mentioned “main complaints”.

Therefore, there is currently a partly contradictory picture of observed and documented Long Covid cases with mild and moderate courses.

Gastrointestinal symptoms, for example, often develop two to three weeks after covid-19 recovery, whereas skin changes may well develop over the course of a few weeks and then slowly subside.

In severe courses, the consequences of intensive medical treatment and the indirect consequences of the “defensive struggle of the immune system” through excessive immune reactions often seem to take a larger share in the observed overall constellation of complaints.

Long-lasting direct tissue damage as a reason for Long Covid?

For example, ACE2 occurs on the following cells:

  • Epithelial cells – cell type that covers all internal and external body surfaces, as well as the
  • cells of the airways, as well as in the
  • intestinal mucosa, pancreas and others.

Indirect complications – such as the consequences of the body’s own defense against pathogens – damage, on the other hand, due to excessive inflammation (hyperinflammation) in the acute phase of the disease, misdirected (chronic) inflammation or autoimmune phenomena.

Circulatory and coagulation disorders as a reason for Long Covid?

The above-mentioned inflammatory phenomena in turn impair the function of the blood vessels, resulting in poorer blood supply to the tissue. We then speak of so-called microcirculatory disorders, which result in a deficient supply of oxygen and nutrients in the affected regions.

In addition, a possible interaction of the coronavirus or its viral components with the so-called “renin-angiotensin-aldosterone system” – or RAAS system for short – is being discussed. The assumption is that Sars-CoV-2 could throw the finely tuned processes of blood pressure regulation out of balance.

Persistence of viruses as a reason for long covid?

Doctors attribute this to insufficient viral elimination. This suggests that in these rarer cases, the immune response is probably not strong enough on its own to render the virus completely harmless in the body. However, why the coronavirus appears to form reservoirs in these cases is unknown.

Doctors refer to persistence as the persistence of a pathogen in parts of the body over an extended period of time.

Pre-existing conditions as a reason for Long Covid?

The reactivation of “dormant viral diseases” is also observed in parts. Typical examples of such reactivated pathogens are, for example, the herpes zoster virus (Varicella zoster), the Epstein-Barr virus (EBV), but also the cytomegalovirus (CMV).

Can a vaccination trigger Long Covid?

The cause of these rare observations is unknown. Explanations include reactivation of latent viruses, misdirected autoantibody responses, or the presence of an undiagnosed underlying disease. According to one hypothesis, vaccination would act as a trigger.

Long Covid of the Lung

In most cases, the coronavirus initially causes a respiratory infection. This can cause pneumonia in a more severe course, usually beginning in the second week of illness.

Changes in lung tissue

A Dutch study showed that 86 percent of hospitalized patients also developed changes in the lungs (pulmonary fibrosis).

Those affected suffered from

  • shortness of breath and shortness of breath – even with moderate physical exertion such as walking or climbing stairs, as well as a
  • persistent coughing.

This was not only true for severely ill patients. Even supposedly mild or asymptomatic courses of Covid-19 caused fibrotic changes in the lung tissue in many cases.

Diagnosis of lung function

Spirometry: A routine test for lung function is spirometry. Your doctor measures the force and volume of your breaths. Ergospirometry can also be used to check the resilience of your lungs in conjunction with your cardiovascular system.

CT and MRI: Imaging procedures such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) allow your doctor to obtain a detailed (three-dimensional) picture of the condition of your lungs.

Patients with a previously diseased heart or other cardiovascular risk factors (e.g., chronic hypertension) are at higher risk for severe courses of Covid 19.

Since the beginning of the pandemic, it has also become apparent that the heart can sustain damage beyond the acute phase of the disease.

Changes in the cardiovascular system

Physicians often observe persistent chest pain, heart palpitations, shortness of breath and reduced exercise tolerance in their patients.

Heart damage: In a severe course of Covid-19, the heart muscle can be damaged. In a Frankfurt hospital study, about three-quarters of 45- and 53-year-old Covid-19 patients developed heart damage. A prolonged course of heart muscle inflammation can lead to heart failure or even severe cardiac arrhythmias.

Postural tachycardia syndrome (POTS): It is observed in the course of long covid symptomatology and describes a condition in which the change to the upright body position triggers an increased pulse and drowsiness. Once patients lie down, the symptoms usually subside. The possible cause is thought to be (virus-related) functional impairment of the autonomic nervous system.

Altered blood cells: A past covid-19 infection can impair the functionality of red and white blood cells – in some cases even for months. In this context, researchers at the Max Planck Center for Physics and Medicine found characteristically altered biomechanical properties of such cells in the blood of convalescents.

Diagnosis of cardiac function

During the admission examination, your doctor will examine your cardiovascular system. Various methods are available for this purpose.

ECG: An established diagnostic method is the so-called electrocardiography – also called stress ECG. This examines the electrical activity of your heart muscle – in other words, your heartbeat.

MRI, CT: Imaging procedures such as magnetic resonance imaging (MRI) or computed tomography (CT) can detect changes in the heart or blood vessels.

Blood count: A laboratory diagnostic examination of the blood for certain cardiac enzymes or values (CRP, ESR, leukocytes, autoantibodies) provides indications of cardiac damage.

Neurological damage in long covid

In addition, Sars-CoV-2 infection can cause severe and uncontrolled inflammation throughout the body – experts call this systemic inflammation (inflammation) and suggest that this results in multiple nerve damage.

Neurological changes

Children, younger adults with no previous illness, or those who are only mildly affected may also develop neurologic long covid symptoms after they have been exposed to Sars-CoV-2 infection.

Fatigue: Frequently, patients with post-Covid syndrome also suffer from postviral fatigue. This is a chronic fatigue associated with a severe drop in performance. Patients enter a prolonged, debilitating state of exhaustion in which even the smallest activities overwhelm them. This severely limits their quality of life as well as their ability to work.

Pain: Other sufferers experience a persistent feeling of illness, muscle, head and joint pain – as well as tingling sensations in the hands and feet.

Cognitive symptoms: Other long-term effects of Covid-19 include concentration, consciousness and sleep disorders. The latter occur more frequently after more severe courses.

PIMS: In rare cases, children affected by Covid-19 develop symptoms similar to those of Kawasaki syndrome. The symptoms usually start a few weeks after the Sars-CoV-2 infection has subsided. Read more about this condition, also called PIMS, here.

Patients’ cognitive, emotional and motor skills are impaired. The quality of life and everyday life of those affected can suffer considerably as a result of PICS.

Diagnosis of nerve function

If complications of nerve function are suspected, your doctors will perform neurological examinations. This gives them an accurate picture of the functional and performance status of your brain and nervous system.

For example, the exams include tests on

  • Cognition (Montreal Cognitive Assessment, MoCA test)

Depending on the severity of the limitations, other tests may follow:

  • Imaging procedures such as magnetic resonance imaging (MRI), computed tomography (CT) and
  • Measurement of nerve conduction velocity by electroneurography (ENG).
  • Laboratory diagnostic tests of your blood also provide information about existing inflammatory reactions or the presence of damaging autoantibodies.

Research into the possible causes of neurological damage is still in its infancy and is the subject of current scientific debate.

Even the individual (isolated) studies cannot yet provide a complete picture of the complex underlying damage mechanisms. The investigative approaches are too different, the observed patient collectives too diverse, and the expression of covid-19 too individual.

What was special about this study was that the researchers compared current MRI brain scans with previous image findings from before the pandemic. This was possible because these data were stored in the UK Biobank Register.

Despite a mostly mild course of the disease, the researchers found a decline in gray matter in the following brain areas in particular:

Insular cortex: The function of the insular cortex has not yet been fully elucidated. Among other things, it is involved in the sense of smell and taste. In addition, there is a connection to the amygdala. The amygdala itself is responsible for the evaluation of dangerous situations. It is thus conceivable that changes in the insular cortex could influence emotional sensations.

It was striking that the imaging findings showed that mainly the left hemisphere of the brain was affected. This study cannot answer whether this damage remains permanent or whether it regresses.

Long-term psychological and cognitive consequences of Long Covid

Covid-19 disease can be traumatic for patients but also for family members. This is especially true if the patient had to receive intensive care.

The acute phase of the Corona pandemic was a drastic and extremely stressful exceptional situation: a time characterized by lockdown measures, social isolation, fear of losing one’s job and challenges in the family, school and training.

However, it is important that you do not let this paralyze you. There are programs available to help you specifically rebuild your skills and overcome your anxiety and depression.

Covid 19 disease can trigger cognitive and mental disorders or exacerbate existing ones.

Possible conditions include:

  • Psychological disorders such as depression, anxiety disorders, or post-traumatic stress reactions.
  • Cognitive disorders such as concentration problems, forgetfulness, language difficulties, problems grasping the content of texts

Psycho-cognitive testing

  • Attention and concentration tests
  • Tests for mental disorders such as depression and anxiety disorders

Long Covid: further complications

As described above, the coronavirus is capable of affecting very many different organ systems. Since the ACE2 receptor – the “gateway of the virus” – is also present on the organ surface of the kidney, liver and digestive tract, these can also be damaged.

The cause is thought to be a combination of direct influences such as viral replication in the kidney and indirect damage due to oxygen deficiency or altered blood clotting.

It is not known whether such kidney complications also occur more frequently with “light or mild” Long Covid.

There seems to be a possible connection between the persistent gastrointestinal symptoms and a prolonged excretion of virus particles via the stool – even though nasal swabs of the study participants were already PCR-negative again.

In addition, it is being discussed whether Sars-CoV-2 could change the composition of the gut microbiome. What this might entail is unclear.

Whether the liver is also affected in mild and mild Long Covid courses is currently unclear.

New onset of diabetes due to Long Covid?

Pre-existing diabetes mellitus is considered a risk factor for severe covid 19 courses. However, it has also been observed that after coronavirus infection, the risk for new-onset diabetes probably appears to increase.

It has therefore not yet been conclusively clarified whether such Long Covid-associated diabetes manifestations in certain patient groups now persist permanently – or only occur temporarily and then slowly subside again.

It is also not conclusively clear how many Long Covid patients are affected.

Skin changes in Long Covid

In some cases, affected skin areas also take on a characteristically marbled skin structure. In addition, vascular occlusions or damage to vessel walls can result in bluish thickenings on fingers and toes (“covid toes”).

The best possible treatment path is decided by dermatology specialists on a case-by-case basis after appropriate clarification.

Hair loss in Long Covid

It is thought that inflammatory processes, during acute covid 19 disease, disrupt the growth phase of hair follicles. As a result, hair may fall out more and less hair grows back.

The chances of recovery are probably good in many cases. This is because in this phenomenon (telogen effluvium, TE) the hair follicles do not necessarily suffer lasting damage despite the “growth pause”. Normally, after a few months – on average three to six – the disturbed growth cycles should settle down again.

The administration of hair growth stimulating drugs (e.g.: Minoxidil) is usually not recommended at present.

Prognosis: Does Long Covid regress completely?

The disease Covid-19 and the long-term consequences are novel and complex. However, one thing is clear: blanket estimates of prognosis are not possible, as the underlying causes and manifestations are as varied as the affected patients themselves.

Some symptom complexes may resolve better than others – such as respiratory symptoms, muscle pain, or gastrointestinal problems (e.g., nausea or loss of appetite). The frequently observed lung changes also seem to recede over time.

The German Heart Foundation summarizes the current knowledge on Long Covid prognosis as follows:

  • Respiratory and gastrointestinal symptoms may resolve within three months.
  • Neuropsychiatric (fatigue) and cardiovascular symptoms (cardiac symptoms), on the other hand, decline much more slowly. They usually persist for longer than three months.

Long Covid Treatment

The aim of treatment is to restore the original state of health to the best possible extent. Depending on the severity of Long Covid, physicians can resort to different procedures that have already proven successful in other clinical pictures.

When to see a specialist?

It is always advisable to make a medical follow-up appointment after you have had Covid 19 – your family doctor can be the first port of call.

While many cities now have Long Covid outpatient clinics, care capacity remains limited – waiting lists are long.

Specialized rehabilitation programs

In addition to the option of specialized Long Covid outpatient clinics, your doctor may also be able to help you with the following treatment options, depending on your health condition:

  • Inpatient or outpatient treatment at an appropriate rehabilitation facility (“rehab”).
  • Professional reintegration after a longer period of incapacity for work
  • Close control examinations and aftercare
  • Prescription of drug therapies
  • Psychotherapeutic support
  • Assistance in coordinating non-medical services (physiotherapy, nutritional counseling, nursing services, etc.)

Treatment: Long Covid of the lung

This can improve shortness of breath, cough or shortness of breath.

In the case of chronic cough, doctors may use inhaled cortisone preparations or long-acting beta-2 sympathomimetics. Doctors decide whether such drug treatment is appropriate on a case-by-case basis after first fully assessing your symptoms.

For everyday life, the WHO recommends adopting a posture that relieves the respiratory system at the onset of (mild) respiratory distress. For example, you can lean against a wall, sit with your upper body slightly bent forward (“carriage seat”) or (if the situation allows) lie on your side or stomach.

With your gradual recovery, feelings of tightness in the airways should slowly subside. However, if these restrictions do not improve – or even accumulate and worsen – further medical clarification of your symptoms is urgently needed.

It may also help to inhale with water vapor against the irritation of the cough or hoarseness. This moistens your airways and can thus relieve the discomfort.

Treatment: Long Covid of the cardiovascular system

In the event of acute inflammation of the heart, you must take it easy and avoid any physical exertion until the inflammatory processes have subsided. Based on the results of the examination, discuss with your doctor which course of action is most suitable in your case.

Your doctor can also work with you to develop an appropriate cardiac rehabilitation program. After the acute heart disease, special cardiac exercises specifically strengthen the function of your heart.

In special individual cases, special blood washing procedures are also discussed: By means of so-called plasmapharesis (also immunoadsorption), it is possible to remove autoantibodies from the patient’s blood. Studies on plasmapharesis in the Long Covid context are ongoing.

Vaccinations against Long Covid?

Some experts discuss whether vaccinations in the follow-up – i.e. in case of already existing Long Covid – could alleviate the symptoms. This is indicated in particular individual cases.

Therapy for neurological-cognitive and psychological Long Covid.

To overcome or alleviate your neurological symptoms, your doctor will work with you to develop an individual therapy program. The goal is for you to return to your daily life as best as possible.

Depending on what neurological problems are affecting you and how severe they are, there is training for breathing, awareness or cognition, language skills, perception, motor skills and sensory skills.

Short psychological interventions can often also help. Depression, anxiety and concentration problems can also usually be treated well. It is important to seek professional help quickly so that the problems do not become entrenched.

Help can be provided by:

  • Therapeutic methods such as cognitive behavioral therapy or depth psychological methods.
  • Appropriate medications that relieve anxiety
  • Special concepts for the treatment of PTSD

The WHO has also compiled some generally applicable recommendations for action for mental-cognitive combinations of complaints:

  • Exercise your cognitive skills (suitable are for example: Puzzles, word or number games, crossword puzzles, Sudoku or memory exercises, etc.).
  • Practice relaxation exercises for stress and anxiety (e.g.: autogenic training, grounding techniques, MBCT – Mindfulness Based Cognitive Therapy, MBSR – Mindfulness-Based Stress Reduction, etc.).
  • Reduce distractions and take more frequent breaks when needed.
  • Cut yourself some slack, give yourself plenty of time to recover, and reward yourself after goals are accomplished!

In addition, help:

  • sufficient sleep, good sleep hygiene and a regular sleep rhythm.
  • Refrain from using electronic devices such as phones and tablets before bedtime.
  • Sports activities as described above.
  • A healthy diet and limited consumption of nicotine, caffeine and alcohol.

Smell and taste training

Many patients lose some or all of their sense of smell and taste in the course of Covid 19 disease. This can also be treated specifically. With the help of special training, postviral disorders can be reversed. However, this requires patience.

Clarify this treatment option with your ENT physician – he can offer you the appropriate help in case of existing anosmia (loss of smell). In the majority of patients, the sense of smell and taste returns within a few months.

What can you do yourself?

Physical limitations – as well as emotional-psychological stress – should always be clarified by a doctor, psychologist or physiotherapist.

To regain your endurance, you should therefore continuously (but moderately) exercise. However, it is important here that you always keep your own individual stress limit in mind.

Such an individually adapted energy and activity management is also called pacing strategy in rehab.

After consultation with a physician, the following five phases described by the WHO will serve as a guide for you:

Phase 1 – Preparation: First, create the foundation for a gradual return to an active lifestyle. This can be controlled breathing exercises, slow walking, or stretching and balance exercises.

Phase 3 – moderate intensity: Gradually increase your physical exertion – for example, by walking faster, climbing stairs more often or even doing light strength exercises.

Phase 4 – moderate intensity with coordination training: Build on phase 3 and continue to increase the intensity and duration of your workouts. Ideally, move on to coordinative sports such as jogging, cycling, swimming or similar.

Keep in mind the WHO recommendation presented above: If you find a particular activity or intensity level difficult, or if it makes your symptoms worse again, return to the previous phase. Practice patience and pace yourself.

Do vitamin preparations or dietary supplements help with Long Covid?

Self-medication with dietary supplements or vitamin preparations to improve Long Covid symptoms is largely unexplored.

There are no systematic studies (yet) or even reliable data on supplementation with vitamin D, vitamin C, vitamin B12, trace elements or similar preparations that would suggest an accelerated cure of Long Covid.

If you are concerned that you have one, you should discuss this with your doctor. He or she can examine you closely and clarify your nutrient supply – and, if necessary, adequately and specifically compensate for a deficiency.

Keep an eye on your vaccination status

Vaccinations against typical seasonal pathogens such as influenza or other infectious diseases (e.g. pneumococcus) offer solid prevention against infection.

Are there special Long Covid drugs?

The intensive search for active agents against Long Covid is – despite all efforts – still in its infancy.

It is true that there are known treatment options such as cortisone-based anti-inflammatory drugs that can be used in cases of high inflammation levels in the blood count, autoantibodies or persistent fever. But these drugs – in the Long Covid context – are usually only applicable to a smaller group of patients.

Research projects for Long Covid treatment include (among others) the following drug candidates:

BC 007: A compound that is able to specifically “capture” certain autoantibodies – and thus neutralize their effect. BC 007 is in the early stages of testing – clinical trials are ongoing.

AXA1125: Among other things, a dysregulation of the mitochondria – the power plants of the human cell – is suspected to be behind the Long Covid-induced fatigue.

It is thought to stimulate cellular glucose uptake, increase sensitivity to insulin, enhance fat burning, have an anti-inflammatory effect, stimulate the formation of glutathione and also prevent oxidative stress.

All of this – it is thought – could increase mitochondrial energy turnover in a targeted way, possibly counteracting chronic fatigue syndrome. AXA1125 is in the early stages of testing – clinical trials are ongoing.

It is thought that MD-004 may thereby slow down the inflammatory processes in central nervous system tissues often observed in Long Covid – clinical trials are ongoing.

Long Covid in children

Children can also become infected with Sars-CoV-2 – and subsequently develop Long Covid as well. However, their most common symptoms differ from those of adults to some extent. Long Covid also seems to affect them less frequently than adults.