• Symptoms may persist from acute infection or may be new onset following initial recovery from acute infection. And symptoms may fluctuate or relapse over time.
• It is not viewed as a single illness, but instead a collection of numerous symptoms and diagnoses. Symptoms often occur in clusters, overlap with each other, and can involve all organ systems.
• Long-term symptoms are experienced by a significant number of patients irrespective of the severity of initial illness. 
• Common symptoms include:
  • Constitutional: fatigue, brain fog, headache, weight loss/gain
  • Psychiatric: anxiety, depression, PTSD, social isolation 
  • Neurological: peripheral neuropathy, persistent loss of smell/taste, encephalopathy, stroke, dysautonomia, speech difficulties
  • Cardiovascular: chest pain, palpitations, tachycardia, myocarditis, pericarditis, heart failure, arrhythmias, peripheral limb ischemia, congestive heart failure from cardiomyopathy
  • Musculoskeletal: muscle pain, joint pain, physical debility 
  • Dermatologic: erythematous or urticarial rash, alopecia, erythema multiforme-toes
  • Pulmonary: shortness of breath, cough, chest pain, oxygen dependence, interstitial lung disease 
  • Hematologic: venous thromboembolism, microclots
  • Gastrointestinal: diarrhea, nausea/vomiting, abdominal pain, bloating, low appetite, nutritional insufficiency 
  • Kidney: kidney injury (Chronic kidney disease) 
  • Endocrine: diabetes mellitus, thyroid abnormalities
  • Gynecological: painful, irregular periods; infertility
  • Genitourinary: overactive bladder symptoms

While Long Covid appears to be more prevalent in people with severe Covid-19 illness, anyone who had mild or no symptoms can experience persistent symptoms as well. Clinical evidence is pointing to a person’s prior immune system function, inflammation levels, toxin load, and infection load as potential risk factors; however, any otherwise “healthy” person irregardless of vaccine status can develop Long Covid. This likely occurs because the infection can tip the scale bringing occult disease into the light and/or lowers a person’s susceptibility to another disease process.

Initial work-up involves gathering an extensive patient history, physical exam, and testing to rule out other conditions and identify impaired organ systems. Bloodwork often includes CBC, CMP, vitamin D25OH, fibrinogen, d-dimer, hsCRP, AM cortisol, thyroid panel, sex hormones, insulin, HgA1c, ferritin, iron studies, CD57, auto-immune testing, and co-infection testing. It may also include referrals to specialists for evaluation and imaging (chest x-ray, EKG, colonoscopy, etc). Specialized testing may include stool analysis, tick borne diseases panel, mold mycotoxin levels, heavy metal testing, food sensitivity testing, genetic testing, and so forth.