People call Long COVID by many names, including Post-COVID Conditions, long-haul COVID, post-acute COVID-19, long-term effects of COVID, and chronic COVID. The term post-acute sequelae of SARS CoV-2 infection (PASC) is also used to refer to a subset of Long COVID.
Long COVID is a wide range of new, returning, or ongoing health problems that people experience after being infected with the virus that causes COVID-19. Most people with COVID-19 get better within a few days to a few weeks after infection, so at least 4 weeks after infection is the start of when Long COVID could first be identified. Anyone who was infected can experience Long COVID. Most people with Long COVID experienced symptoms days after first learning they had COVID-19, but some people who later experienced Long COVID did not know when they got infected.
Infection Definition
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There is no test that determines if your symptoms or condition is due to COVID-19. Long COVID is not one illness. Your healthcare provider considers a diagnosis of Long COVID based on your health history, including if you had a diagnosis of COVID-19 either by a positive test or by symptoms or exposure, as well as based on a health examination.
People with Long COVID can have a wide range of symptoms that can last weeks, months, or even years after infection. Sometimes the symptoms can even go away and come back again. For some people, Long COVID can last weeks, months, or years after COVID-19 illness and can sometimes result in disability.
People with Long COVID may develop or continue to have symptoms that are hard to explain and manage. Clinical evaluations and results of routine blood tests, chest X-rays, and electrocardiograms may be normal. The symptoms are similar to those reported by people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and other poorly understood chronic illnesses that may occur after other infections. People with these unexplained symptoms may be misunderstood by their healthcare providers, which can result in a delay in diagnosis and receiving the appropriate care or treatment.
Some people, especially those who had severe COVID-19, experience multiorgan effects or autoimmune conditions with symptoms lasting weeks, months, or even years after COVID-19 illness. Multi-organ effects can involve many body systems, including the heart, lung, kidney, skin, and brain. As a result of these effects, people who have had COVID-19 may be more likely to develop new health conditions such as diabetes, heart conditions, blood clots, or neurological conditions compared with people who have not had COVID-19.
Researchers are working to understand which people or groups of people are more likely to have Long COVID, and why. Studies have shown that some groups of people may be affected more by Long COVID. These are examples and not a comprehensive list of people or groups who might be more at risk than other groups for developing Long COVID:
The best way to prevent Long COVID is to protect yourself and others from becoming infected. For people who are eligible, CDC recommends staying up to date on COVID-19 vaccination, along with improving ventilation, getting tested for COVID-19 if needed, and seeking treatment for COVID-19 if eligible. Additional preventative measures include avoiding close contact with people who have a confirmed or suspected COVID-19 illness and washing hands or using alcohol-based hand sanitizer.
People experiencing Long COVID can seek care from a healthcare provider to come up with a personal medical management plan that can help improve their symptoms and quality of life. Review these tips to help prepare for a healthcare provider appointment for Long COVID. In addition, there are many support groups being organized that can help patients and their caregivers.
CDC is using multiple approaches to estimate how many people experience Long COVID. Each approach can provide a piece of the puzzle to give us a better picture of who is experiencing Long COVID. For example, some studies look for the presence of Long COVID based on self-reported symptoms, while others collect symptoms and conditions recorded in medical records. Some studies focus only on people who have been hospitalized, while others include people who were not hospitalized. The estimates for how many people experience Long COVID can be quite different depending on who was included in the study, as well as how and when the study collected information. Estimates of the proportion of people who had COVID-19 that go on to experience Long COVID can vary.
CDC and other federal agencies, as well as academic institutions and research organizations, are working to learn more about the short- and long-term health effects associated with COVID-19, who gets them and why.
Scientists are also learning more about how new variants could potentially affect Long COVID. We are still learning to what extent certain groups are at higher risk, and if different groups of people tend to experience different types of Long COVID. CDC has several studies that will help us better understand Long COVID and how healthcare providers can treat or support patients with these long-term effects. CDC will continue to share information with healthcare providers to help them evaluate and manage these conditions.
Some new multitest algorithms lead to a conclusion that laboratories might classify as a "presumptive positive" result. Persons with a presumptive positive test result are expected to receive subsequent tests, such as a quantitative viral load, to confirm their HIV diagnosis, but results of those tests might not be immediately available to surveillance programs. To avoid unnecessary complexity for surveillance, the revised surveillance case definition, like the earlier definition, does not make a distinction between presumptive and definitive diagnoses. If subsequent test results reveal that the person is not infected, the case and previous test results should be deleted from the surveillance database.
Another important change is the addition of "stage 0" based on a sequence of negative and positive test results indicative of early HIV infection. This addition takes advantage of tests incorporated in the new algorithms that are more sensitive during early infection than previously used tests, and that together with a less sensitive antibody test, yield a combination of positive and negative results enabling diagnosis of acute (primary) HIV infection, which occurs before the antibody response has fully developed. The addition of stage 0 allows for routine monitoring of the number of cases diagnosed within several months after infection, which includes the most highly infectious period when viral loads are extremely high and intervention might be most effective in preventing further transmission. The definition of stage 0 also will reduce confusion between acute HIV infection (part of stage 0), when CD4+ T-lymphocyte counts can be transiently depressed, and stage 3 (AIDS), an advanced stage of HIV infection when CD4+ T-lymphocyte values are usually persistently depressed (9).
The revised case definition adds other criteria and eliminates several criteria that were impractical or difficult to implement uniformly across all states and territories. Specifically, the revised case definition:
The revised case definition was developed in several stages. First, in 2010, HIV surveillance experts at CDC convened six work groups that included both CDC and external subject matter experts, including health-care providers, surveillance health department staff, and representatives from academic institutions and public health and commercial laboratories. The names of work group members are listed at the end of this report. The six topic areas were new HIV testing algorithms, acute HIV infection, HIV-2 infection, opportunistic illnesses, pediatric HIV infection, and physician-documented diagnosis. Each work group examined research and program information about the topic areas and elicited experience and expert opinion from federal, state, and local HIV surveillance programs; clinicians who diagnose HIV infection; and laboratories that report HIV test results.
Second, all work groups presented a summary of their reports at a consultation convened by CDC in February 2012. The consultation included additional experts in HIV surveillance, laboratory testing, and clinical care, including members of CSTE.
Third, most of the recommendations from the consultation were incorporated in a position statement developed in collaboration with CDC that was approved at the June 2012 annual meeting of CSTE (18). The revisions of the surveillance case definition in this document are based largely on that position statement. Finally, this document underwent peer review (described at _PRP_Revised_HIV_Case_Def.pdf) by health-care professionals in compliance with the Office of Management and Budget requirements for the dissemination of influential scientific information.
Laboratory criteria require reporting of the date of the specimen collection for positive test results in multitest algorithms or stand-alone virologic tests and enough information about the tests to determine that they meet any of the following criteria:
Clinical criteria for a confirmed case (i.e., a "physician-documented" diagnosis for which the surveillance staff have not found sufficient laboratory evidence described above) are met by the combination of:
If the diagnosis was based on clinical evidence ("physician-documented") rather than laboratory evidence, the diagnosis date is defined as the date (at least the year) of diagnosis reported in the content of the medical record. If the diagnosis date was not reported in the note, the date when the note was written can be used as a proxy.
All HIV infections in the United States should be assumed to be type 1 (HIV-1) unless laboratory test results are sufficient to classify the infection as type 2 (HIV-2), dual HIV-1 and HIV-2 infections, or undifferentiated HIV infection, as described below. Clinical or epidemiologic evidence might lead to laboratory testing for HIV-2 but is insufficient for classifying the HIV type as HIV-2. 152ee80cbc