Long COVID (post-acute sequelae of SARS-CoV-2 infection (PASC), refers to a variety of often debilitating symptoms that persist for weeks or months after a person recovers from a COVID infection. Long COVID involves both physical and psychological symptoms that affect people differently. For some, symptoms are mild and manageable. For others, symptoms are so severe that they are forced to drop out of the workforce and apply for disability.
According to the CDC’s latest long COVID statistics:
- About 7.5 percent of adults in the U.S. (one in 13) have been diagnosed with long COVID
- More women than men have long COVID (9.4 percent of women, 5.5 percent of men)
- Adults between the ages of 50 and 59 are more likely to develop long COVID symptom than adults over 80
- Hispanic adults have higher rates of long COVID (9 percent) than non-Hispanic White adults (7.5 percent) or non-Hispanic Asian adults (3.7 percent)
- Kentucky, Alabama, South Dakota, and Tennessee are states with the highest percentage of adults diagnosed with long COVID–around 12 percent in each state
Doctors do not know why some people recover completely from COVID-19 while others develop long COVID symptoms. However, they believe long COVID is attributed to one or more of the following conditions:
- Persistent viral presence in the body
- Negative autoimmune system response
- Blood vessel impairment from the original infection
- Nervous system damage
- Having a pre-existing condition that makes a person more susceptible to long COVID
- Differences in virus variations
Physical Symptoms of Long COVID and Their Mental Health Implications
Common physical symptoms reported by people with long COVID include:
- Persistent fatigue and exhaustion
- Shortness of breath during minimal physical activity
- Chest discomfort accompanied by heart palpitations
- Joint and muscle pain
- Recurring headaches
- Insomnia/poor sleep quality
- Chronic coughing that can be dry or productive
- Loss of taste and smell
- Abdominal pain, nausea, diarrhea
- Skin irritations/rashes/lesions
- Ringing in the ears (tinnitus)
- Changes in vision (blurriness/appearance of floaters)
- Swelling of the hands and feet
- Hair thinning
- Recurring low-grade fever
- Blood clotting issues
Coping with the chronic physiological problems of long COVID takes a heavy psychological toll on people who feel overwhelmed, frustrated, and depressed by this disabling condition. In addition to limiting your ability to perform work and daily activities, long COVID can significantly reduce your independence and quality of life. Consequently, long COVID patients not only feel unwell and bewildered by their health issues but also anxious, hopeless, and overwhelmingly depressed.
Mental health problems arising from the stressful impact of the physical symptoms of long COVID include:
- Distorted body image: visible changes in appearance can have a negative effect on self-esteem and self-consciousness
- Medication side effects: medications prescribed to treat long COVID symptoms may alter mood, energy levels, or cognitive function
- Isolation: social isolation due to stigma, physical limitations, or the need for specialized care due to long COVID symptoms exacerbates feelings of loneliness, helplessness, and hopelessness
- Financial stress: when long COVID prevents you from working, the stress of having unpaid medical bills and lack of income can contribute to existing levels of anxiety and depression.
- Cognitive impairments: problems with concentrating, remembering, and thinking clearly (brain fog) are frequently reported by long COVID patients.
- Adjusting to a chronic illness: the mental health challenges associated with long COVID can evoke feelings of anxiety, grief, and disbelief in people who previously had little to no health problems.
According to Dr. Anna Dickerman of New York Presbyterian Hospital and Weill Cornell Medicine: “Rates of PTSD, depression, and anxiety are higher among people with long COVID than rates of depression and anxiety in the general population”. In addition, Dr. Weill states that psychiatric symptoms seen in long COVID patients may arise from physiological reasons. For example, constant activation of the immune system by severe viral inflammation could increase depression, suicidal ideation, and suicide attempts by disrupting neurotransmitter levels in the brain.
Coping Strategies for Improved Quality of Life
Since long COVID symptoms differ widely among people affected by them, the type and severity of symptoms determines how much emphasis should be placed on each coping technique:
- Pain and discomfort: Pain relievers or anti-inflammatory medications may be prescribed for temporary pain relief
- Reducing fatigue: get plenty of rest, pace your activities, and eat a healthy diet
- Shortness of breath: Pulmonary rehabilitation and breathing exercises may help minimize breath difficulties
- Physical therapy: improve mobility and strength by working with a physical therapist
- Heart monitoring: periodic echocardiogram evaluations of heart rhythms can tell doctors what kind of medications are best to treat long COVID cardiac symptoms
- Mental health support: therapy, counseling, and support groups can help individuals cope with the emotional and psychological impact of Long COVID.
- Effective mental health treatments for long COVID patients with cognitive impairment, anxiety, PTSD, and depression include cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and group therapy. Moreover, mental health therapy can also help ease physical symptoms of long COVID by improving mood, enhancing immune system functioning, and reducing anxiety.
Studies show that high stress levels can exacerbate physical symptoms by weakening the immune system and increasing blood cortisol. CBT, ACT, and group therapy can facilitate positive behavioral changes that motivate long COVID patients to adopt a healthier lifestyle. Some people with long COVID may use drugs or alcohol to self-medicate when standard treatments don’t relieve symptoms. CBT or another addiction therapy are valuable tools that can help you cope with long COVID symptoms without resorting to substance abuse.
Supportive Care and Resources for Long COVID Mental Health Challenges
Services and Supports for Longer-Term Impacts of COVID-19
Last year, President Biden issued the Memorandum on Addressing the Long-Term Effects of COVID-19. This memorandum discusses the important actions needed to fully support long COVID patients in the U.S. and provides information about federal services available to people suffering mental health issues due to long COVID.
Long COVID health services are available from the federal government. That includes access to health insurance coverage for those who can no longer work due to long COVID disability. The State Health Insurance Assistance Program (SHIP) offers one-on-one assistance, education, and counseling to beneficiaries of Medicare and their families affected by long COVID.
Centers for Independent Living
Centers for Independent Living (CIL) provide referrals, independent living skills training, and peer counseling for long COVID patients– CIL Center and Association Directory
State-Assistive Technology Programs
State-Assistive Technology (AT) programs work to ensure accessibility to AT devices, equipment, and related services. State AT programs involve providing basic enhancements like ergonomic handles on utensils to facilitate gripping, computers operated through eye movement, and home automation solutions. People dealing with long COVID can get valuable support through their state program, including access to AT and technical guidance related to accessibility and assistive technology.