Long COVID Symptoms

Long COVID reaches more body systems than ME/CFS or fibromyalgia, and it is not defined by any single core symptom. The triggering infection is the unifying feature, not a particular symptom pattern.

Symptoms vary enormously between people. Some have a relatively narrow presentation: ongoing breathlessness, or persistent loss of smell. Others develop a fuller multi-system picture that closely resembles ME/CFS. Most fall somewhere between.

This page groups the most commonly reported symptoms by body system. For any one person, only some of these will apply.

Across large studies, the symptoms most consistently reported in long COVID are:

• Fatigue
• Post-exertional symptom exacerbation
• Cognitive difficulties (‘brain fog’)
• Breathlessness
• Sleep disruption
• Changes to smell and taste
• Orthostatic intolerance and palpitations

How disabling each of these is varies between individuals. People with similar symptom profiles can have very different daily lives.

Fatigue is the most commonly reported long COVID symptom. It is heavy, persistent, and not relieved by sleep, unlike ordinary tiredness after a busy day. For many people, it sits at the centre of their daily experience.

A substantial proportion of people with long COVID also experience post-exertional symptom exacerbation (PESE). This is a delayed and disproportionate worsening of symptoms after activity, typically 12 to 48 hours later.

This is the same pattern that defines ME/CFS, where it is called post-exertional malaise (PEM). Where PESE is present, treatment approaches developed for ME/CFS, particularly pacing, apply. See our PEM page for more.

Exercise intolerance, meaning symptoms that worsen during activity rather than after it, is also common and overlaps with PESE.

Cognitive difficulties are sometimes the most disabling aspect of long COVID, and one of the longest-lasting. They commonly include:

• Word-finding problems
• Short-term memory lapses
• Slowed thinking and difficulty concentrating
• Trouble switching between tasks
• A sense of mental thickness or fog

The patterns are similar to those seen in ME/CFS and fibromyalgia. Cognitive symptoms can persist long after some other long COVID symptoms have resolved.

Many people with long COVID develop symptoms reflecting autonomic nervous system dysfunction. The most common are:

• A racing or pounding heart, particularly on standing
• Orthostatic intolerance, where symptoms worsen upright and improve when lying down
• Postural tachycardia syndrome (POTS), which is increasingly recognised after COVID-19
• Chest pain or tightness
• Temperature regulation problems

Long COVID has produced a substantial increase in POTS diagnoses since 2020. POTS is treatable in its own right, and worth raising specifically with a GP if cardiovascular symptoms are part of your picture.

Many long COVID presentations include lasting respiratory symptoms, often persisting even after lung scans return normal results:

• Breathlessness on exertion, and sometimes at rest
• A persistent cough
• Chest tightness
• A sense of being unable to take a full breath

These can be specifically long COVID in origin, distinct from any underlying asthma or lung damage. Pulmonary rehabilitation programmes may help some people but can worsen symptoms in others, particularly where PESE is part of the picture. Worth approaching cautiously.

Several of the symptoms most distinctive to long COVID sit in this cluster.

Anosmia
Loss of smell, sometimes persisting for months or years.

Parosmia
Distorted smell, where familiar foods and environments may smell offensive. It is often described as rotten, burning, or chemical.

Dysgeusia
Distorted taste, often making previously enjoyable foods unpalatable.

These are not commonly seen in ME/CFS or fibromyalgia. Parosmia in particular can significantly affect quality of life, because eating, intimacy, and ordinary environments all become harder to navigate.

Smell training has evidence behind it for some people. The UK charities AbScent and Fifth Sense both support it.

Pain in long COVID varies widely. Most commonly reported:

• Headaches, often persistent or migraine-like
• Muscle and joint pain
• Chest pain, which should be medically assessed
• Neuropathic pain: burning, tingling, or electrical sensations

Pain is less central in long COVID than in fibromyalgia, but is significant enough in many people to need its own management..

Unrefreshing sleep is common across long COVID, as are insomnia and shifted sleep patterns. The mechanism overlaps with what is seen in ME/CFS, so see our sleep page for more.

Anxiety and low mood are also frequently reported. Where these appear, they are typically a response to the illness rather than its cause, which is the same pattern seen in other chronic conditions.

Long COVID affects more body systems than this page can cover in depth. Less common but recognised symptoms include digestive changes, hair loss, skin rashes, menstrual changes, new allergies, and mast cell activation-like presentations. Any persistent new symptom following a COVID-19 infection deserves clinical assessment.

Long COVID symptoms tend to fluctuate. Some resolve over months. Others persist for years. New symptoms can emerge well after the initial infection, and symptoms that had improved can return, particularly after a reinfection.

Tracking your own pattern over time helps. The Visible app is widely used in the long COVID community and may be useful if heart-rate-based pacing is relevant for you.

Most long COVID symptoms need careful management rather than urgent treatment. Some, however, warrant immediate medical attention:

• Severe or worsening chest pain
• Significant breathlessness at rest
• Fainting or loss of consciousness
• New neurological symptoms: weakness, vision changes, speech changes
• Severe headache that is new or different from any previous pattern

Long COVID does not protect against other conditions developing. New symptoms should not be attributed to the condition without proper assessment.