What to Know About Long COVID and How to Reduce Your Risk – UC San Francisco

What are some of the most common long COVID symptoms?

Peluso: Symptoms include brain fog issues with memory or thinking trouble breathing and fatigue. Fatigue doesnt mean feeling a little tired its bone-crushing fatigue, or what we refer to as post-exertional malaise.

Post-exertional malaise occurs when a physical, cognitive or even social activity that a person used to be able to do easily causes debilitating fatigue for days afterward. Its often best demonstrated by people who were quite fit before they got COVID running miles or going on long hikes, for instance. Now, they can only do a fraction of that.

Some people also have prominent gastrointestinal symptoms like nausea, abdominal pain or diarrhea. Were even seeing genitourinary symptoms like pelvic pain and menstruation issues.

Flaherman: Generally, people who have had a more severe COVID infection are at a higher risk for developing long COVID, as are elderly people, and those with pre-existing conditions or who have not been vaccinated.

Flaherman: We still dont know for sure, but our data suggests that pregnant people may be at a lower risk of developing long COVID when we compare to the estimates were getting from the adult RECOVER cohort. Still, long COVID affects pregnant people in uniquely risky ways. Almost 1 in 10 pregnant people developed long COVID in our recent study done alongside the University of Utah. That study involved about 1,500 people who had contracted COVID during pregnancy.

The most common symptom was post-exertional malaise.

Flaherman: Its difficult to be certain, but if it is possible, it seems quite rare.

Flaherman: If a pregnant person is infected with SARS-CoV02 at the time of delivery, then its possible that she, like anyone else in the delivery room, could transmit the virus to the baby. We recommend that mothers who have SARS-CoV-2 around delivery wear a mask while holding or breastfeeding their baby and wash their hands frequently for five days after they have been fever-free.

Flaherman: Yes. Breastfeeding provides benefits to babies, including some immunity to SARS-CoV-2, which helps them fight off any COVID-19 that they might be exposed to. We encourage mothers to breastfeed babies directly, even if they have COVID-19, but to mask and wash their hands frequently.

Flaherman: In the pregnant people and new mothers we studied, those who developed long COVID had symptoms for nearly a year on average.

Peluso: Most of the data shows that this can go on for years and that the proportion of people who fully recover is disturbingly small. Sometimes, its as low as 10%.

Peluso: If you had told me four years ago that wed be having this conversation about SARS-Cov-2 persisting in peoples bodies, I wouldnt have believed you.

Recently, we reported that we could find SARS-CoV-2 protein in the blood of some people post-COVID. This must be coming from somewhere. Our hypothesis is that pieces of the virus persist in tissues and organs, so at UCSF, we started by looking at the GI tract of people with long COVID. This is relatively easy to do as anyone whos ever had a colonoscopy would know.

What we found was surprising. Some people with long COVID had pieces of the virus in their GI tract, even a year or two after they had COVID. And we at UCSF were the first to show that this virus could still be active.

Peluso: We dont know for sure yet. But we detected double-stranded RNA, which should only be present if the virus was moving through its lifecycle and replicating.

Peluso: One reason might be that the virus is in pockets cordoned off from the immune system. For example, immune cells might have walled it off as they worked to contain it. Another possibility is that it hides out in areas that are tougher to reach, like the nervous system. A third possibility is that the virus could evolve after infection so that the immune response is no longer effective against it.

You can imagine all sorts of scenarios. We dont know which one is true yet. But this is a major lead that we are chasing down.

Peluso: Not getting COVID in the first place is the best strategy, but thats easier said than done. Im still quite diligent about masking and vaccination because studies have shown that being up to date with your vaccine when you get COVID-19 can reduce your risk of developing long COVID.

We dont yet know if taking Paxlovid or an antiviral will reduce your risk of long COVID, but it could help you and is worth discussing with your doctor.

Peluso: Symptoms include brain fog issues with memory or thinking trouble breathing and fatigue. Fatigue doesnt mean feeling a little tired its bone-crushing fatigue, or what we refer to as post-exertional malaise.

Post-exertional malaise occurs when a physical, cognitive or even social activity that a person used to be able to do easily causes debilitating fatigue for days afterward. Its often best demonstrated by people who were quite fit before they got COVID running miles or going on long hikes, for instance. Now, they can only do a fraction of that.

Some people also have prominent gastrointestinal symptoms like nausea, abdominal pain or diarrhea. Were even seeing genitourinary symptoms like pelvic pain and menstruation issues.

Flaherman: Generally, people who have had a more severe COVID infection are at a higher risk for developing long COVID, as are elderly people, and those with pre-existing conditions or who have not been vaccinated.

Flaherman: We still dont know for sure, but our data suggests that pregnant people may be at a lower risk of developing long COVID when we compare to the estimates were getting from the adult RECOVER cohort. Still, long COVID affects pregnant people in uniquely risky ways. Almost 1 in 10 pregnant people developed long COVID in our recent study done alongside the University of Utah. That study involved about 1,500 people who had contracted COVID during pregnancy.

The most common symptom was post-exertional malaise.

Flaherman: Its difficult to be certain, but if it is possible, it seems quite rare.

Flaherman: If a pregnant person is infected with SARS-CoV02 at the time of delivery, then its possible that she, like anyone else in the delivery room, could transmit the virus to the baby. We recommend that mothers who have SARS-CoV-2 around delivery wear a mask while holding or breastfeeding their baby and wash their hands frequently for five days after they have been fever-free.

Flaherman: Yes. Breastfeeding provides benefits to babies, including some immunity to SARS-CoV-2, which helps them fight off any COVID-19 that they might be exposed to. We encourage mothers to breastfeed babies directly, even if they have COVID-19, but to mask and wash their hands frequently.

Flaherman: In the pregnant people and new mothers we studied, those who developed long COVID had symptoms for nearly a year on average.

Peluso: Most of the data shows that this can go on for years and that the proportion of people who fully recover is disturbingly small. Sometimes, its as low as 10%.

Peluso: If you had told me four years ago that wed be having this conversation about SARS-Cov-2 persisting in peoples bodies, I wouldnt have believed you.

Recently, we reported that we could find SARS-CoV-2 protein in the blood of some people post-COVID. This must be coming from somewhere. Our hypothesis is that pieces of the virus persist in tissues and organs, so at UCSF, we started by looking at the GI tract of people with long COVID. This is relatively easy to do as anyone whos ever had a colonoscopy would know.

What we found was surprising. Some people with long COVID had pieces of the virus in their GI tract, even a year or two after they had COVID. And we at UCSF were the first to show that this virus could still be active.

Peluso: We dont know for sure yet. But we detected double-stranded RNA, which should only be present if the virus was moving through its lifecycle and replicating.

Peluso: One reason might be that the virus is in pockets cordoned off from the immune system. For example, immune cells might have walled it off as they worked to contain it. Another possibility is that it hides out in areas that are tougher to reach, like the nervous system. A third possibility is that the virus could evolve after infection so that the immune response is no longer effective against it.

You can imagine all sorts of scenarios. We dont know which one is true yet. But this is a major lead that we are chasing down.

Peluso: Not getting COVID in the first place is the best strategy, but thats easier said than done. Im still quite diligent about masking and vaccination because studies have shown that being up to date with your vaccine when you get COVID-19 can reduce your risk of developing long COVID.

We dont yet know if taking Paxlovid or an antiviral will reduce your risk of long COVID, but it could help you and is worth discussing with your doctor.

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What to Know About Long COVID and How to Reduce Your Risk - UC San Francisco