The U.S. Center for Disease Control (CDC) reports that 13.3 percent of patients who develop COVID-19 will suffer from Long COVID syndrome, which can last for two months or more and cannot be explained by a different diagnosis (CDC Weekly, May 27, 2022, 71(21);713–717). More than 30 percent of hospitalized patients still have symptoms at six months. People are at increased risk for Long COVID if they:
• have experienced severe COVID-19 disease, particularly if they were hospitalized or in intensive care
• had underlying health conditions such as chronic obstructive pulmonary disease (COPD), fibromyalgia, depression or diabetes
• did not get a COVID-19 vaccine
• were a smoker or former smoker
• were overweight or obese
Women are at increased risk, compared to men. Those of black Afro-Caribbean descent, mixed ethnicity, native American, Middle Eastern, or Polynesian origin are more likely to develop Long COVID than white ethnic groups. Those who are socially or financially deprived are at increased risk.

Symptoms of Long COVID Syndrome
A study of 2.4 million U.K. health records found 500,000 patients who had COVID-19 infection but were not hospitalized, and approximately 10 percent of these patients developed Long COVID, with persistent and often relapsing symptoms beyond 4-12 weeks after the initial infection (Nature Medicine, July 25, 2022). These patients had an average age of 43.8 years, and 55.3 percent were female. Their symptoms were classified into three main groups:
• 80 percent – pain, fatigue and rashes
• 5.8 percent – respiratory symptoms, including cough, shortness of breath, phlegm
• 14.2 percent – mental symptoms such as anxiety, depression, insomnia or brain fog
The list of Long COVID symptoms included muscle pain, joint pain, headache, chest pain, altered smell, altered taste, diarrhea, hair loss, sneezing, ejaculation difficulty, reduced libido, hoarse voice, fever and many more.

What Causes Long COVID?
Nobody knows what really causes Long COVID syndrome, but it could be due to:
• organ damage to the liver, lungs, heart, or kidneys
• chronic viral persistence
Inflammation, an overactive immune system that just stays active
• blood vessel damage
• blood clots

My Recommendations
You help to protect yourself from infection with isolation techniques, but each individual needs to make their own decisions on balancing reduced risk of infection with returning to “normal” life. If you have underlying conditions that put you at high risk for Long COVID, you will be better protected by severely restricting breathing indoor air where people congregate. The virus continuously accumulates indoors and is rapidly dissipated in outdoor air.