Long COVID

Written by

Diana Bocco

Reviewed by

Dr. Bronwyn Holmes, MD, FAARFM

COVID doesn't always end when the test turns negative. Some people continue to deal with symptoms for weeks or months. Sometimes longer. The experience can be overwhelming, especially when there aren't clear answers or treatment options.

To make sense of long COVID, we need to look at the symptoms, what may be driving them in the body, and what both traditional care and newer regenerative therapies can do to help.

What Is Long COVID?

Long COVID is a group of symptoms that persist or develop after an acute COVID-19 infection. It's also known as post-COVID syndrome or simply "long-haul COVID."

Long COVID is a lot more common than many people realize, and 10-20% of people who contract COVID-19 will go on to develop long COVID (World Health Organization [WHO], 2022).

Long COVID can look very different from person to person. Some people might experience mainly respiratory symptoms, others neurological, and others a combination. Sometimes the symptoms change over time.

What Causes Long COVID?

We don't know what causes long COVID. But researchers have identified several biological changes that seem to explain why symptoms last so long.

Mitochondrial Dysfunction

Mitochondria are the parts of your cells that produce energy, and COVID-19 can disrupt how they work. When your cells don't make enough energy, this can affect the immune system, the brain, and the heart. Research suggests some of these changes may last beyond the initial illness (Yuan et al., 2025).

Immune Dysregulation

After infection, the immune system can stay overactive or become confused. In some cases, it starts attacking the body's own tissues. This can affect the nervous system and the gut (Castanares-Zapatero et al., 2022).

Viral Persistence

In some people, pieces of the virus may remain in the body, especially in the gut. In others, the infection may wake up dormant viruses like Epstein-Barr (EBV) or HHV-6 (Castanares-Zapatero et al., 2022).

Microvascular Dysfunction

An emerging hypothesis suggests that tiny fibrinaloid microclots can form and block oxygen and nutrient delivery at the capillary level (Kell et al., 2024). This may help explain why therapies that improve tissue oxygenation, such as hyperbaric oxygen therapy (HBOT), can be helpful in some cases.

Autonomic Nervous System Dysregulation

COVID-19 can disrupt the autonomic nervous system, which controls functions like heart rate, blood pressure, and digestion. This dysfunction often shows up as Postural Orthostatic Tachycardia Syndrome (POTS).

Who Is At Risk?

Long COVID can affect anyone who has had COVID-19, but some people are more likely to develop it. Older adults, women, and people with pre-existing conditions are at higher risk.

Symptoms to Look For

Long COVID can look different from person to person. Symptoms can include post-exertional malaise (PEM), trouble focusing, confusion, shortness of breath, headaches, trouble sleeping, heart palpitations, muscle or joint pain, and anxiety.

Long COVID symptoms also overlap heavily with fibromyalgia and chronic fatigue syndrome (ME/CFS).

How Is Long COVID Diagnosed?

There isn't a lab test for long COVID. A doctor might diagnose it after looking at your symptoms and medical history, typically if symptoms persist 12 weeks after a COVID infection.

How Is Long COVID Treated With Regenerative Therapies?

Standard treatment for long COVID can include medication for mood, breathing exercises, or therapy for fatigue. Regenerative and integrative medicine offer an alternative that addresses the underlying causes.

Hyperbaric Oxygen Therapy (HBOT)

HBOT has shown the most promising results among regenerative options. A randomized controlled trial found that HBOT improved quality of life, sleep, psychiatric symptoms, and pain in long COVID patients, with benefits persisting one year after treatment (Hadanny et al., 2024).

Nutrition Support

Good nutrition is a big part of recovery. You can support your body with the right nutrients, including magnesium, omega-3s, and CoQ10.

Gut Health Support

Changes to diet and adding probiotics may help, since problems in the gut can keep the immune system out of balance.

Stem Cell Therapy

Early research suggests that mesenchymal stem cell therapy may support recovery at the cellular level (Yuan et al., 2025).

Vagus Nerve Stimulation

For people with dysautonomia or POTS, vagus nerve stimulation can help restore nervous system balance. A 2024 pilot study showed significant improvements in cognition, anxiety, depression, fatigue, and sleep quality (Zhen et al., 2024).

Takeaway

Long COVID affects millions of people, and there is no single treatment that works for everyone. The most effective approaches look at it as a condition that affects multiple systems in the body. If Long COVID is affecting your quality of life, look for a provider who takes your symptoms seriously.

Frequently Asked Questions

Long COVID symptoms typically start within three months of the initial infection and can persist for weeks, months, or even years.

For many people, long COVID symptoms resolve spontaneously within three months. However, in more complex cases, recovery may take longer and benefit from treatment.

People at highest risk include older adults (especially 65+), women, those with severe initial COVID-19, unvaccinated individuals, and people with preexisting conditions like obesity or diabetes.

No, long COVID and ME/CFS are not the same thing, though they share about 80% symptom overlap (Wong & Weitzer, 2021). Long COVID stems directly from SARS-CoV-2 infection, while ME/CFS can develop after a range of triggers.

Start with your primary care doctor for initial assessment and referral to specialized post-COVID clinics with multidisciplinary teams.

What treatments may support Long COVID

Regenerative and integrative therapies may support individuals with long COVID by addressing persistent inflammation, autonomic dysfunction, mitochondrial impairment, and nervous-system dysregulation that can follow acute infection. These approaches are supportive and are used alongside medical evaluation and symptom-specific care.

Long COVID Treatment

Long COVID treatment aims to reduce inflammation, restore energy, rebalance immunity, and support multisystem recovery to ease fatigue, cognitive issues, breathing problems, and overall dysfunction.

8 Clinics
Biofeedback Therapy

Biofeedback therapy trains you to control involuntary body functions like heart rate and muscle tension — explore how it works, conditions it may help, and the evidence behind it.

94 Clinics
Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) uses magnetic pulses to stimulate nerve cells in the brain. Learn how it works, what the evidence shows, and who may benefit.

158 Clinics
Oxygen Therapy

Oxygen therapy is traditionally given in hospitals if your blood oxygen levels are low, such as with a respiratory condition or widespread infection.

413 Clinics

References

Castanares-Zapatero, D., et al. (2022). Pathophysiology and mechanism of long COVID. Annals of Medicine, 54(1), 1473-1487.

Hadanny, A., et al. (2024). Long-term outcomes of hyperbaric oxygen therapy in post-COVID condition. Scientific Reports, 13, 21953.

Kell, D. B., et al. (2024). Fibrinaloid microclots in long COVID. Research and Practice in Thrombosis and Haemostasis, 8(7), Article 102566.

Wong, T. L., & Weitzer, D. J. (2021). Long COVID and ME/CFS. Medicina, 57(5), Article 418.

World Health Organization. (2025). Post COVID-19 condition (long COVID).

Yuan, M.-Q., et al. (2025). Long-term outcomes of mesenchymal stem cell therapy in severe COVID-19 patients. Stem Cell Research & Therapy, 16, 94.

Zheng, Z. S., et al. (2024). Transcutaneous vagus nerve stimulation improves Long COVID symptoms. Frontiers in Neurology, 15, Article 1393371.

Zilberman-Itskovich, S., et al. (2022). Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition. Scientific Reports, 12, 11252.

Long COVID

What Is Long COVID?