Long COVID: Why aren't my symptoms going away? Why did they come back? Am I a long-hauler?

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For most people who contract COVID-19, the symptoms are mild or moderate -- or even non-existent -- and they pass between a few days to about two weeks

But for some COVID patients symptoms never go away, or they resurface after weeks of apparent health. Sometimes symptoms appear weeks later for people who never experienced symptoms when they first caught it. Fatigue. Shortness of breath. Coughs, headaches, difficulty thinking clearly and more, and they can be debilitating.

Researchers are still investigating why some people see lasting problems from COVID infection, but here's what we know now.

For millions, COVID-19 won’t quit: Doctors strive for answers on how to ease long-hauler misery.

What is long COVID?

It has a lot of names. Post-COVID syndrome, post-acute COVID-19, chronic COVID, long-term COVID. The National Institutes of Health call it post-acute sequelae of SARS-CoV-2 (PASC).

Whatever term you use, it means patients experience a wide range of new, returning, or ongoing health problems four or more weeks after first being infected with the coronavirus that causes COVID-19. These conditions can present as different types and combinations of health problems for different lengths of time.

Long COVID isn't a condition or syndrome as much as multiple medical issues persisting or emerging after the initial infection, which makes it tougher to diagnose and tougher to deal with.

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More: Is long COVID a syndrome or a series of coronavirus complications? What we know now about lingering symptoms.

What causes long COVID?

COVID-19 attacks practically every organ and system in the body, including the lungs, kidneys, brain, nervous system, liver, heart and others. In a detailed, though not-yet-peer-reviewed study of 107 long-haul patients, about 20% to 25% showed lung damage, blood clots, heart failure or similar symptoms caused by their initial infection. COVID-19 also can cause autoimmune conditions where your immune system attacks healthy cells in your body by mistake, causing inflammation or tissue damage.

But there are no definite answers yet about what causes ongoing symptoms for some people. According to an article from Harvard Medical School, some researchers suspect that COVID-19 infection can trigger long-lasting changes in the immune system or can affect the autonomic nervous system to impact heart rate, blood pressure, and sweating, among other things.

Long COVID symptoms also can come from or be aggravated by the stress of ongoing medical problems and lengthy hospitalizations. There's something called post-intensive care syndrome (PICS), which refers to health effects that begin when you're in an intensive care unit that can continue after you go home. According to the CDC, these effects can include severe weakness, problems with thinking and judgment, and post-traumatic stress disorder (PTSD).

“We're seeing a spectrum of symptoms after acute COVID-19, some of which would be expected after other critical illnesses," said respirologist Dr. Emily Brigham. "Some are minor, but other people may need continuing care and even readmission to the hospital.”

But even people who were never very sick with COVID-19 are getting long COVID symptoms. It can tricky to tell if long COVID symptoms are caused by the long-term effects of the virus, from the effects of hospitalization, from mental health effects from isolation, economic situations, grief, or combinations of all or any of these.

"We have patients who were Olympians who struggle with basic activities of daily life. Patients who are academics and professors who forget what button to push on the washing machine to make it go," said Dr. Nir Goldstein, a pulmonologist and director for The Center for Post-COVID Care and Recovery at National Jewish Health in Denver.

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What are the most common long-term symptoms of COVID-19?

According to the CDC, the most common lasting symptoms are fatigue, shortness of breath, cough, joint pain and chest pain. But a study of 3,762 participants in 56 countries, published July 15 in The Lancet, identified more than 200 symptoms across 10 organ systems associated with long COVID, including problems thinking clearly (brain fog), difficulty concentrating, depression, muscle pain, endless headaches, rapid heartbeat and intermittent fever.

The symptoms range from being annoying to leaving the patient unable to work, drive or live a normal life.

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Who can get long COVID?

Long COVID can happen to anyone who has had COVID-19, even if the initial illness was mild, even if they didn't display any symptoms when they caught it. People with this condition are sometimes called “long-haulers.”

Studies aren't definitive yet, but as many as one-third of the people who have had COVID, with symptoms or not, may still suffer more than a month after infection, and some people may have symptoms persisting for months or even years.

The people who were severely ill with COVID-19 and are taking a long time to recover tend to be older people with the highest risk. The people who saw no initial symptoms or very mild ones who see more symptoms appearing later tend to be younger adults with healthy, possibly overactive immune systems, experts said.

COVID patients with the most risk for long COVID are those who experience more initial symptoms. Other factors that may increase the risk for long COVID are age, a history of asthma, and immune markers in the blood, according to a paper published by Dr. Onur Boyman, an immunologist at University Hospital Zurich in Switzerland.

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Can COVID cause long-term breathing problems?

"From a lung perspective, patients have persistence of shortness of breath, or dyspnea, and require ongoing oxygen treatment even after discharge and for weeks to months because of permanent damage to the lungs,” said Dr. Devang Sanghavi, medical director of the medical intensive care unit at Mayo Clinic in Jacksonville. “As far as the cardiac system is concerned, there’s chest pain and shortness of breath.”

Serious COVID infections can cause scarring to lung tissue and other permanent problems, but even people with mild infections can experience persistent shortness of breath that can be debilitating.

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Can COVID cause long-term heart problems?

According to Johns Hopkins Medicine, one study showed that 60% of people who recovered from COVID-19 -- even in those with a mild case -- had signs of ongoing heart inflammation. This can bring on the common long COVID symptoms of shortness of breath, palpitations and rapid heartbeat.

If I lost my sense of smell or taste, will I get it back?

While not every COVID patient experiences it, the loss of smell or taste has been one of the symptoms the public has long identified with COVID-19 since it's not also a common cold or flu symptom. People who contract COVID-19 might lose those senses entirely, or find that things taste or smell strange, bad or just different.

For about 25% of people with COVID-19 with one or both of those symptoms, the problem goes away after a few weeks. But according to Johns Hopkins, the symptoms persist and can cause serious problems including lack of appetite, anxiety and depression. Some studies suggest there's a 60-80% chance of improvement within a year.

Can long COVID be treated?

“This is a huge and tremendous problem,” said Dr. Peter Staats, a pain specialist and president of the Institute of World Pain. “This is going to be a wave of health care problems that we have not seen the likes of before.”

Currently, health professionals are treating the symptoms but they're running into the problem of a patient needing multiple specialists for their specific range of symptoms, and that's simply not practical or affordable for many people.

Health care systems are pivoting toward treating long COVID patients, and multidisciplinary long-COVID clinics have begun forming where doctors of different specialties can talk about the same patient and see what works.

Individual patients report 21 symptoms on average, ranging from fatigue to debilitating headaches, from all-over body pain to trouble breathing, from gastrointestinal problems to heart concerns, said Natalie Lambert, an Indiana University biostatistician studying the many ways COVID-19 can affect health.

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How can I prevent long COVID?

The easiest and best way to prevent long COVID is to prevent getting it in the first place, and that means masks, social distancing and, for anyone eligible, vaccination.

'I'd never been sick in my life': Young, healthy COVID long hauler thanks vaccine

C. A. Bridges is a Digital Producer for the USA TODAY Network, working with multiple newsrooms across Florida. Local journalists work hard to keep you informed about the things you care about, and you can support them by subscribing to your local news organization. Read more articles by Chris here and follow him on Twitter at @cabridges

This article originally appeared on Palm Beach Post: Long COVID: What it means when your COVID symptoms won't go away