Here Are the 12 Symptoms That Best Support Long COVID Diagnosis

Significant disagreement exists over what symptoms constitute Long COVID, as well as how common and severe they were. That might change with the RECOVER-Adult study which came up with a list of the 12 defining symptoms of the condition also called Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Find out what those are.

BOSTON – So many symptoms can potentially be involved in Long COVID, or Post-Acute Sequelae of SARS-CoV-2 infection (PASC) that it can be hard to diagnose.

Symptoms are considered as part of Long COVID if they present or persist more than 30 days after COVID-19 infection. To better understand the prevalence and severity of symptoms, the National Institutes of Health (NIH) launched Researching COVID to Enhance Recovery (RECOVER-Adult).

Researchers from Massachusetts General and Brigham and Women’s Hospital led the statistical analysis for the study and came up with the defining symptoms of long COVID. Their findings, which were published in JAMA, also include a new scoring system for long COVID.

“Now that we’re able to identify people with long COVID, we can begin doing more in-depth studies to understand the biological mechanisms at play,” said corresponding author Andrea Foulkes, ScD, Principal Investigator of the RECOVER Data Resource Core (DRC), Professor at Harvard Medical School, and Director of Biostatistics at Massachusetts General Hospital (MGH) said in a press release. ,  “One of the big takeaways from this study is the heterogeneity of long COVID: Long COVID is not just one syndrome; it’s a syndrome of syndromes. Understanding this idea is a really important step for doing more research and ultimately administering informed interventions."

Before RECOVER, significant disagreement existed over long COVID symptoms, including how common and severe they were, and also over how long COVID should be defined based on symptoms.

Here are what the RECOVER researchers consider the signature symptoms of Long COVID:

  • post-exertional malaise,
  • fatigue,
  • brain fog,
  • dizziness,
  • gastrointestinal symptoms,
  • palpitations,
  • changes in sexual desire or capacity,
  • loss of or change in smell or taste,
  • thirst,
  • chronic cough,
  • chest pain, and
  • abnormal movements. 

Some of the symptoms, such as post-exertional malaise, appear to be experienced by most people with long COVID, while others, such as loss of or change in smell and taste, are less common. The researchers used an algorithm with the 12 symptoms to develop an overall PASC score.

RECOVER-Adult, a prospective study, began enrolling participants in October 2021 and used a symptoms survey distributed at 85 hospitals, health centers, and community organizations in 33 states, Washington, DC, and Puerto Rico. More than 9,500 adults completed the survey, including some who were uninfected and others who were six months past infection with COVID-19.

Other results of the study suggest that infection with a pre-Omicron SARS-CoV-2 variant and absence of vaccination is associated with a higher frequency and severity of long COVID, although the authors call for more study.

“This is a truly data-driven approach to defining long COVID as a new syndrome,” said first author Tanayott Thaweethai, Ph.D., Co-investigator for the RECOVER DRC, Instructor at Harvard Medical School, and an Associate Director at MGH Biostatistics. “We now have a definition for long COVID where there hasn’t been one previously, and we hope the ability to identify long COVID will enhance clinical awareness of this condition.”