Long COVID-19

Last revised by Liz Silverstone on 28 Nov 2023

Long COVID-19 also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or post COVID-19 condition, is a post-viral syndrome affecting people who have recovered from COVID-19 infection. Symptoms are similar to those experienced by patients with chronic inflammatory response syndrome (CIRS) rather than myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) 6. To aid research, codes have been introduced to identify certain cohorts (ICD-10, U09.9) 11.

Clinical presentation

It can manifest weeks or months after the apparent clinical resolution of the acute phase of the disease. Dyspnea and fatigue are among the most common symptoms 1,2. However, the signs, symptoms and possible clinical manifestations are grouped into two classes 3,4:

  • general syndrome, e. g. fatigue, fever

  • organ-specific clinical manifestations

    • neurological, e. g. headache, sleep disturbances, brain fog, anxiety (or depression)

    • cardiovascular, e. g. tachycardia, myocarditis, chest pain 

    • dermatologic, e. g. rash, alopecia, urticaria


The aetiopathogenetic mechanisms by which the SARS-CoV-2 infection determines the post-acute sequelae are not have not yet been fully clarified. Various hypotheses include direct organ damage caused by the virus, innate immune response with release of inflammatory cytokines or the development of a pro-coagulative state. According to some authors, anti-idiotype antibodies play a possible role in the pathogenesis of the disease 5. Basophil function make affect the course of the disease 7, 8 and mast cell activation may play a role in long Covid 9, 10.

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