Long COVID

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 9 Aug 2025

Last updated: 31 Jul 2025

Long COVID is a heterogeneous condition that encompasses a wide spectrum of individuals with new or persistent symptoms following acute coronavirus disease 2019 (COVID-19).

A positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral test is not necessary to establish a diagnosis of long COVID. A long COVID diagnosis can be made on the basis of a previous patient-reported or clinical diagnosis of COVID-19.

Treatments are targeted at symptom palliation and improvement in quality of life.

Many patients can be managed effectively in primary care. Referral to a specialist may be required for ongoing management. Referral to a specialized or multidisciplinary long COVID clinic is recommended for those with severe or treatment refractory long COVID, where such services are available.

Definition

Long COVID is a general term for persistent and typically multisystem symptoms following acute COVID-19 infection. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body.[1]

The World Health Organization defines post-COVID-19 condition (long COVID) as a condition that occurs in adults with a history of probable or confirmed SARS-CoV-2 infection, usually occurring 3 months from the onset of COVID-19 symptoms and lasting for at least 2 months, that cannot be explained by an alternative diagnosis.[2] The same definition may also be used for children and adolescents.[3]

The Centers for Disease Control and Prevention endorses the 2024 National Academies of Sciences, Engineering, and Medicine (NASEM) definition: Long COVID, also known as post COVID conditions, is an infection-associated chronic condition that can occur after SARS-CoV-2 infection, the virus that causes COVID-19, 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.[4][5]

The UK National Institute for Health and Care Excellence uses the term post-COVID-19 syndrome, and defines this as signs and symptoms that develop during or after an infection consistent with COVID‑19, continue for more than 12 weeks, and are not explained by an alternative diagnosis. Post‑COVID‑19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed.[1]

Other common synonyms for the condition include post-acute COVID-19, post-acute sequelae of SARS-CoV-2 infection (PASC), post-COVID syndrome, chronic COVID-19, long-haulers syndrome, long-term COVID, and post-COVID condition (PCC).[6][7][8]

The definition of long COVID will continue to be evaluated as new data emerge.

History and exam

Key diagnostic factors

previous diagnosis of COVID-19 or history of suspected acute COVID-19 illness

Full details

Other diagnostic factors

fatigue/weakness
cognitive impairment (brain fog)
impaired sleep
headache
dizziness
dyspnea
cough
anosmia/dysgeusia
pain (including arthralgias and myalgias)
chest pain
postexertional malaise
anxiety/depression
palpitations
thirst/dry mouth
loss of sexual drive or capacity
numbness/tingling
hair loss
gastrointestinal symptoms

Full details

Risk factors

severe COVID-19 illness (requiring hospitalization or ICU admission)
not vaccinated or only partially vaccinated against COVID-19
female sex
age >40 years
BMI >30 kg/m²
smoking
anxiety/depression
asthma
chronic kidney disease
chronic obstructive pulmonary disease (COPD)
diabetes
immunosuppression
ischemic heart disease

Full details

Diagnostic tests

1st tests to order

clinical diagnosis
complete blood count
comprehensive metabolic panel
creatine kinase
C-reactive protein
erythrocyte sedimentation rate
serum ferritin level
thyroid function tests
serum 25-hydroxy vitamin D
pulse oximetry

Full details

Tests to consider

orthostatic testing-tilt table testing
electrocardiogram
pulmonary function testing
chest radiograph
chest CT
B-type natriuretic peptide
D-dimer
antinuclear antibody
rheumatoid factor
anti-cyclic citrulinated peptide
serum vitamin B12
blood thiamine
serum folate
plasma homocysteine
high sensitivity troponin
transthoracic echocardiogram
ambulatory cardiac monitoring
cardiac stress test
cardiopulmonary exercise test
cardiac MRI
autonomic function testing
overnight sleep study
MRI head
neuropsychological testing

Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Benjamin Abramoff, MD, MS

Assistant Professor of Physical Medicine and Rehabilitation

Perelman School of Medicine

University of Pennsylvania

Philadelphia

Disclosures

BA has served on medical advisory boards regarding long COVID for Pfizer, Axcella Pharmaceutical, AstraZeneca, Intrivo Diagnostics, and UnitedHealthcare. BA is an author of references cited in this topic.

Shawn Joshi, MD, PhD

Clinical Resident of Physical Medicine & Rehabilitation

Spaulding Rehabilitation Hospital

Clinical Fellow in Medicine

Harvard Medical School

Boston

Disclosures

SJ declares that he has no competing interests.

Eric Herman, MD

Assistant Professor of Family Medicine

School of Medicine

Oregon Health and Science University

Portland

Disclosures

EH speaks on evaluation and management of Long COVID nationally. EH is developing educational material for the AAFP. EH has published other manuscripts as part of his current academic role with other leading medical publications.

Acknowledgements

Dr Benjamin Abramoff, Dr Shawn Joshi, and Dr Eric Herman would like to gratefully acknowledge Dr Julie Silver, a previous contributor to this topic.

Disclosures

JS has participated in research funded by NIH and foundations on topics not related to COVID-19 including culinary medicine, prehabilitation, and chronic pain. JS is author of references cited in this topic.

Peer reviewers

Sarah Jolley, MD, MSc

Associate Professor

Division of Pulmonary Sciences and Critical Care Medicine

University of Colorado

Denver

Disclosures

SJ receives NIH funding for work related to long COVID via the RECOVER consortium and AHRQ related to long COVID care delivery.

Trisha Greenhalgh, MA, MD, FRCP, FRCGP, FFPH, PhD

Professor of Primary Care Health Sciences

University of Oxford

Oxford

Disclosures

TG is an author of references cited in this topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. January 2024 [internet publication].Full text

Centers for Disease Control and Prevention. COVID-19: clinical overview of long COVID. Feb 2025 [internet publication].Full text

Yelin D, Moschopoulos CD, Margalit I, et al. ESCMID rapid guidelines for assessment and management of long COVID. Clin Microbiol Infect. 2022 Jul;28(7):955-72.Full text Abstract

US Department of Veterans Affairs. Whole health system approach to long COVID: specialty care (nervous system). Sep 2024 [internet publication].Full text

US Department of Veterans Affairs. Whole health system approach to long COVID. August 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
- Post-intensive care syndrome
- Postural orthostatic tachycardia syndrome (POTS)
More Differentials
Guidelines
- Clinical overview of long COVID
- COVID-19 rapid guideline: managing the long-term effects of COVID-19
More Guidelines
Patient information
Anxiety: what are the treatment options?
COVID-19 (coronavirus)
More Patient information
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Long COVID

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

all patients

Contributors

Authors

Benjamin Abramoff, MD, MS

Disclosures

Shawn Joshi, MD, PhD

Disclosures

Eric Herman, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Sarah Jolley, MD, MSc

Disclosures

Trisha Greenhalgh, MA, MD, FRCP, FRCGP, FFPH, PhD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice