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Are You Especially Vulnerable to Long COVID?

Are you experiencing fatigue? Could you be vulnerable to long COVID even if you don't think you were infected? Find out about other symptoms.

With cases of COVID-19 on the rise again, a new study deserves attention. While some people recover from the infection within a a few weeks or months, others are still suffering up to two years after coming down with the coronavirus. Long COVID is still creating confusion within the medical community. Some researchers are struggling to define which symptoms may persist long after the initial infection. Others are trying to find out which patients may be most vulnerable to long COVID. Even after all this time, we have more questions than answers.

Hospitalized Patients Are More Vulnerable to Long COVID:

An analysis of data from patients treated in Veterans Affairs hospitals shows that troublesome symptoms may linger up to two years after the infection (Nature Medicine, Aug. 21, 2023). This information comes from an analysis of data from nearly 140,000 veterans who had a SARS-CoV-2 infection and almost 6 million VA patients who remained uninfected. VA patients who had been hospitalized with COVID were at a higher risk of death during the subsequent two years than people who had never been infected.

Although those who were hospitalized for COVID-19 are most vulnerable to long COVID’s lasting health problems and death, some individuals who had mild cases experienced any of more than 20 medical conditions. They were more likely to die during the first six months after COVID and more likely to be hospitalized for a complication during the second year afterwards. Many people gradually improved; even after two years, though, a significant number were not back to their original state of health. They were more likely to experience trouble with blood clots, kidney problems, digestive disorders, diabetes and cardiovascular complications.

Multiple Studies on Long COVID:


A study from Israel published in BMJ reviewed 70 long COVID outcomes in unvaccinated infected patients (BMJ, Jan. 11, 2023). Those researchers concluded that mild COVID-19 infections led to symptoms such as loss of smell and taste along with brain fog, shortness of breath and weakness. Most of these symptoms disappeared within a year.


A small Canadian study confirmed that most patients recover from long COVID within a year (European Respiratory Journal, Jan. 12, 2023). On the other hand, 25% had persistent autoantibodies even after a year. Those who did were significantly more likely to report cough, shortness of breath and exhaustion.


Another study reached a somewhat different conclusion (Nature Reviews Microbiology, Jan. 13, 2023). Researchers analyzed more than 200 peer-reviewed studies and concluded that about 10% of people recovering from COVID-19 suffer persistent symptoms. The investigators warn that long COVID affects multiple organ systems. As a result, they worry that it may lead to lifelong disability for many patients if no action is taken. This paper is available to all readers, and the illustration of symptoms and pathology is excellent.


A study published in JAMA Network Open (October 27, 2022) reveals that long COVID symptoms could be affecting 15% of American adults. We are closing in on 100 million coronavirus cases in the US. If we extrapolate from the latest research, that would mean approximately 15 million people are likely suffering symptoms. Who is most vulnerable to long COVID?

Symptoms of Chronic COVID:

Have you caught the SARS-CoV-2 virus? How would you know? Millions of people were asymptomatic or had such a mild reaction that they assume they avoided COVID-19. That does not mean, however, that they did not catch the coronavirus. More important, it does not mean they have dodged long COVID.

Have you experienced any of the following symptoms?

Exhaustion after any degree of exercise (exercise intolerance)
Brain fog or memory problems
Shortness of breath or breathing problems
Problems with the sense of smell
Sleeping difficulties
Anxiety and/or depression

Of course, there are lots of reasons for people to feel anxious and depressed these days. COVID articles like this one, politics, economics, news stories and work challenges are all enough to make anyone upset or trigger insomnia.

Post Exercise Malaise:

Many of us feel tired at some point during the day, especially if we don’t get a good night’s sleep. But a key tip-off to determine if you are vulnerable to long COVID is something called post-exercise malaise.

Someone who has PASC (post-acute sequelae of SARS-CoV-2) may discover that taking a walk can trigger overwhelming fatigue a day or two later. For other people, just doing the dishes or walking upstairs can lead to exhaustion the next day.

Severe Dizziness:

Another unusual complication of long COVID is called dysautonomia. This condition is linked to disruption of the autonomic nervous system. It is characterized by heart palpitations and dizziness upon standing. Some people also experience rapid heart rate, irregular heart rhythms, trouble catching their breath and chest pain if they stand up suddenly (Clinical Medicine, Jan. 2021).

Who Is Vulnerable to Long COVID?

The study in JAMA Network Open published on October 27, 2022 surveyed over 16,000 individuals who tested positive for COVID. These were people who had ongoing health problems at least two months after the initial COVID symptoms. Many were at least 6 to 12 months out from a positive test. Although almost anyone can develop post-COVID syndrome, this is what the authors found.

Individuals of an:

“…older age per decade above 40 years and female gender were associated with greater risk of persistence; individuals with a graduate education vs high school or less and urban vs rural residence were less likely to report persistence.”

Does Vaccination Make You Less Vulnerable to Long COVID?

The authors reviewed the medical literature and compared it to their own data:

“Two recent studies directly examined the question of protection afforded by prior vaccination, using different designs. One study examined more than 33 000 previously vaccinated individuals with breakthrough COVID-19 infection from Veterans Affairs electronic health records. The Veterans Affairs population may not fully reflect the general adult population in the US, and coded clinical data may be less sensitive to symptoms than narrative notes or patient-reported symptoms. Still, despite these differences, the approximately 24% reduction in odds of long COVID that we observed after a single vaccination (approximately 33% when applying a stricter definition of long COVID) does approximate the 15% reduction in hazard of long COVID in that study.”

The investigators conclude that their results:

“…support the potential protective association of vaccination in reducing but not eliminating long COVID risk.”

They also suggest that if their results are confirmed, intervening early in the course of the infection might:

“…minimize the effect of long COVID, and could contribute to efforts to prevent this syndrome altogether.”

What Is It Like to Have Long COVID?

We describe the symptoms of post-COVID syndrome above, but it is far better to listen to real people describing what they have gone through. Should you wish to learn more about long COVID, here are two radio shows that we hosted on this topic. Not only were our guests health care professionals, they also experienced symptoms of long COVID themselves. They will describe what it has been like for them.

Here is a link to Show # 1230:

What Happens When COVID Symptoms Don’t Go Away

Here is a link to Show # 1254 about POTS (postural orthostatic tachycardia syndrome) and long COVID:

Combating the Long-Term Effects of Post-COVID Syndrome

We also interviewed two experts about the latest understanding of long COVID and possible new treatments early in 2023. It is Show 1327: What Have We Learned About Long COVID? You will not want to miss this podcast.

If you found this article of value, please share it with friends or family. And if you have experienced any symptoms of long COVID, please describe your experience in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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  • Bowe B et al, "Postacute sequelae of COVID-19 at 2 years." Nature Medicine, Aug. 21, 2023. DOI https://doi.org/10.1038/s41591-023-02521-2
  • Mizrahi B et al, "Long covid outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort study." BMJ, Jan. 11, 2023. DOI: 10.1136/bmj-2022-072529
  • Son K et al, "Circulating anti-nuclear autoantibodies in COVID-19 survivors predict long COVID symptoms." European Respiratory Journal, Jan. 12, 2023. DOI: 10.1183/13993003.00970-2022
  • Davis HE et al, "Long COVID: major findings, mechanisms and recommendations." Nature Reviews Microbiology, Jan. 13, 2023. DOI: 10.1038/s41579-022-00846-2
  • Perlis, R.H., et al, "Prevalence and Correlates of Long COVID Symptoms Among US Adults, JAMA Network Open, Oct. 27, 2022, doi:10.1001/jamanetworkopen.2022.38804
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