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Chrissy Bernal has caught COVID-19 three times, most recently in October 2023. “My symptoms were always pretty mild,” she says. But after her third round of the virus, she developed extreme allergies to foods she used to eat all the time: oats, dairy, gluten, sesame seeds and peanuts.
“I literally have some level of anaphylaxis every single day,” she says. In May, Bernal, 46, a public relations professional in Houston, went into anaphylactic shock during a virtual meeting. “I had to inject myself with an Epi while everyone watched in horror on Zoom,” she says.
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Natalie Nichols, 53, has been struggling with debilitating asthma and severe food allergies since she first caught COVID more than three years ago. “Last fall, I spent two-and-a-half months confined to bed, motionless, because moving, including holding a cellphone, made me too short of breath,” she says.
She’s also experienced brain fog, high blood pressure, hyperglycemia, fatigue and gastrointestinal symptoms. Nichols, the founder of a nonprofit in Nacogdoches, Texas, recently underwent surgery to repair joint damage caused by COVID-induced inflammation.
Lorraine W., of Clarence Center, New York, was looking forward to an active retirement when she was diagnosed with COVID in March 2020. “I’ve never returned to my pre-COVID self,” says Lorraine, 65.
She’s on medication to treat small blood vessel damage to her heart and continues to battle a lingering cough, fatigue and breathlessness, as well as kidney disease. Neurological changes have made her legs unsteady when she walks, requiring her to use balance poles. “None of these conditions were present before COVID,” Lorraine says.
In June, the National Academies of Sciences, Engineering, and Medicine released a comprehensive definition of long COVID: “an infection-associated chronic condition that occurs after COVID-19 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.” According to that definition, 18 million Americans have experienced long COVID; currently, more than 1 in 20 of us are living with its symptoms. Researchers have begun to link long-term COVID with another recent phenomenon: our shrinking life expectancy.
The disease we’re forgetting
COVID doesn’t seem that scary anymore. More than 98 percent of the U.S. population has some degree of immunity — from vaccination, prior infection or both — and Paxlovid and other medications are available to counteract acute symptoms. For many of us, contracting COVID is like having a bad upper respiratory infection.
But “COVID isn’t gone,” says Ryan Hurt, M.D., director of the Long COVID Research and Clinical Program at the Mayo Clinic. The World Health Organization (WHO) estimates that COVID still kills at least 1,000 people every week around the globe — but “we only have data from about 40 countries,” says Maria Van Kerkhove, M.D., director of WHO’s Department of Epidemic and Pandemic Preparedness and Prevention.
Older adults and those with preexisting conditions remain among the most at-risk populations for severe, acute COVID. People 65 and older accounted for 63 percent of COVID-related hospitalizations and 88 percent of in-hospital deaths during the first seven months of 2023, according to CDC data.
Although the dangers of acute COVID infection may have ebbed for many, the reality of long COVID is coming into view. Of those who contracted COVID-19 within the past four years, 10 to 20 percent have experienced long COVID.
“With every new case of acute COVID [the initial phase of infection when diagnosed or symptoms first appear], there is risk for developing long COVID,” says Caitlin McAuley, D.O., a family physician at the Keck COVID Recovery Clinic in Los Angeles. She’s had patients who developed long COVID fully recover, get reinfected several times with no lingering effects, then develop another case that leads to a new bout of long COVID. She’s also seen patients who got COVID twice with no lingering effects, and the third time they ended up with prolonged symptoms.
“We still have a number of individuals who had the first wave of COVID who are suffering from long COVID symptoms now, several of them many years out,” says Jerrold Kaplan, M.D., medical director of the COVID Rehabilitation and Recovery Program at Gaylord Specialty Healthcare in New York.
Having escaped long COVID previously doesn’t mean you won’t face it in the future. Indeed, some research has suggested that catching multiple COVID-19 strains puts you at increased risk. A study published in 2022 found that reinfection can increase the risk of complications in major organ systems, and these risks persist at least six months beyond the initial infection.
We don’t yet know the true impact of catching COVID. “Many chronic disease processes, such as cardiovascular disease, dementia and cancer, take years to develop. And whether acute COVID-19 puts people at risk for some of these issues? Time will tell,” Hurt says. What doctors do know is that patients are flocking to their offices complaining of symptoms they never had before COVID.
Is long COVID boosting our death rate?
In July, COVID accounted for less than 1 percent of all deaths in the U.S. Life expectancy in the U.S. is 77.5 years, reflecting an uptick over the past two years but still lower than prepandemic levels. Many factors contribute to that statistic, but it’s clear that the long-term effects of COVID have played a role.
For example, a study in the journal Nature Medicine found that those hospitalized with COVID had a 29 percent greater risk of death in the three years after their infection.
“But what was also alarming is that in people who weren’t hospitalized, there was also an increased risk of a variety of medical issues,” says John Baratta, founder and codirector of the COVID Recovery Clinic at the University of North Carolina at Chapel Hill. Even patients who’d had mild bouts of COVID-19 had an increased risk of respiratory, cardiovascular, metabolic and neurological issues lingering for three years after the initial infection. Long COVID patients had a significantly increased risk of severe health issues affecting the brain, lungs and heart.
We have long known that an acute case of COVID can compromise heart health: Compared with those who didn’t contract COVID, people who caught the virus were 81 percent more likely to die of a cardiovascular complication in the ensuing three weeks, according to a study of 160,000 patients published by the European Society of Cardiology. But the risk lingers long after the symptoms abate. Those who caught the virus were five times more likely to die from cardiovascular disease as long as 18 months after infection, the same study found. Heart disease deaths, which had been on a downward trend for decades, began to spike in 2020 and remained high through 2022, the last year for which data is available.
Stroke, blood clots in the legs leading to clots in the lungs, abnormal heart rhythm (arrhythmia) and inflammation of the heart are among the challenges COVID poses, says Mohanakrishnan Sathyamoorthy, M.D., professor and chair of internal medicine at the Burnett School of Medicine in Fort Worth, Texas. In long COVID, this collection of cardiovascular disruptions can present as postural orthostatic tachycardia syndrome (POTS), in which patients’ heart rates increase abnormally when they go from sitting or lying down to standing up.
One theory to explain COVID’s long-term effect on the heart — and the body in general — centers on inflammation. “Every time you get infected with COVID, there is a possible increased risk of long COVID, and some cardiac disorders can occur — especially if you have a history of heart disease, including stroke, heart disease and heart attacks,” says Pragna Patel, M.D., senior adviser for long COVID at the CDC. All of these problems can be exacerbated by the virus entering coronary tissue and triggering inflammatory responses that can damage the heart.
Researchers say COVID may also alter the gut microbiome, a primary controller of inflammation, thereby triggering the immune system to rev up the condition. “There is no single agreed-upon mechanism that’s causing the issues,” Baratta says. “An individual may have multiple factors going on in their body, and not everyone will have the same underlying mechanism causing their symptoms,” which increases the complexity of both research and treatment.
One factor that seems to matter: vaccination status. “Several studies show that vaccination can decrease the risk of developing long COVID,” Patel says. Vaccination rates tend to increase with age, with people 75 and older being the most well vaccinated — hence the most well protected from long COVID, Patel theorizes. That may explain why long COVID most commonly affects people ages 35 to 64; the risk seems to drop for those 65-plus, according to CDC data.
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