How long does COVID-19 linger in your body? New report offers clues. (2023)

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  • Coronavirus Coverage

A comprehensive study found that viral remnants can survive for months after infection in certain people, perhaps causing some symptoms of long COVID.

Most COVID-19 patients recover from their acute infection within two weeks, but bits of the virus don’t always disappear from patients’ bodies immediately. Now a new study, one of the largest focusing on hospitalized COVID-19 patients, shows that some patients harbor these viral remnants for weeks to months after their primary COVID-19 symptoms resolve.

The study suggests that when the genetic material of the virus, called RNA, lingers in the body longer than 14 days, patients may face worse disease outcomes, experience delirium, stay longer in the hospital, and have a higher risk of dying from COVID-19 compared with those who cleared the virus rapidly. The persistence of the virus may also play a role in long COVID, the debilitating suite of symptoms that can last for months. Estimates suggest between 7.7 and 23 million people in the United States alone are now affected by long COVID.

Without immunity from vaccination or a previous infection, SARS-CoV-2—the virus that causes COVID-19—replicates and spreads throughout the body and is shed through the nose, mouth, and gut. But for most infected people, virus levels in the body peak between three and six days after the original infection, and the immune system clears the pathogen within 10 days. The virus shed after this periodis generally not infectious.

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Even after accounting for disease severity, whether the patients were intubated, or had underlying medical comorbidities, “there is something here that signals that patients who are persistently PCR positive have worse outcomes,” says Ayush Batra, a neurologist at Northwestern University Feinberg School of Medicine, who led the new study.

Batra’s study shows that patients who had prolonged shedding during an acute infection risk more severe outcomes from COVID-19, says Timothy Henrich, a virologist and immunologist at the University of California, San Francisco who was not involved in the new research. But the study doesn’t investigate whether this persistent virus is directly responsible for long COVID.

“There are multiple leading hypotheses out there about the cause of long COVID, including viral persistence, and it may be that there are multiple pathways at play, perhaps to some varying degree in any one person,” says Linda Geng, a doctor at Stanford Health Care who co-directs a newly opened Post-Acute COVID-19 Syndrome Clinic for treating long COVID sufferers.

Persisting virus causes worse COVID-19 outcomes

Batra and his team began studying persistent coronavirus infections after observing that some patients who were returning to the hospital were still testing positive for the virus four or five weeks after they were diagnosed with the initial infection.

For their new study, the team analyzed 2,518 COVID-19 patients hospitalized in the Northwestern Medicine Healthcare system between March and August 2020. They focused on PCR tests, which are considered the gold standard, because such tests detect genetic material from the virus and so are highly sensitive and less likely to return false negatives.

The team found that 42 percent of patients continued to test PCR positive two weeks or longer after their initial diagnosis. After more than 90 days, 12 percent of the persistent shedders were still testing positive; one person tested positive 269 days after the original infection.

Viral persistence has been noted before in previous smaller studies. Researchers showed that even patients without obvious COVID-19 symptoms harbored SARS-CoV-2 for a couple of months and beyond. In some immunocompromised patients, the virus may not be cleared for a year. Four percent of COVID-19 patients in a trial on chronic COVID-19 infection at Stanford continued to shed viral RNA in feces seven months after diagnosis. However, Batra’s study illustrates that a larger number of patients take longer to clear the virus than previously realized.

(Video) What Causes Long Covid and Who Is Most at Risk? | WSJ

“Persistent RNA shedding would mean that there still is a reservoir of virus somewhere in the body,” says Michael VanElzakker, a neuroscientist affiliated with Massachusetts General Hospital, Harvard Medical School and Tufts University. Such reservoirs are thought to allow the virus to persist over a long period of time and could trigger the immune system to act aberrantly, perhaps causing long COVID.

“Some patients, for variety of reasons, are not able to clear this reservoir, or their immune system reacts in some abnormal way that results in these persistent symptoms that have come to be termed as long COVID,” says Batra.

Still, many scientists don’t think there is sufficient evidence yet to link the persistence of viral RNA to long COVID.

Sleeping viruses

The list of human tissues where SARS-CoV-2 hides long after the initial infection is growing. Studies have identified the virus, or genetic material from it, in the intestines of patients four months after initial infection, and inside the lung of a deceased donor more than a hundred days after recovery from COVID-19. One study that’s not yet peer reviewed also detected the virus in theappendix and breast tissues 175 and 462 days, respectively, after coronavirus infections. And research from the U.S. National Institutes of Health that’s also not yet peer reviewed detected SARS-CoV-2 RNA persisting at low levels across multiple tissues for more than seven months, even when it was undetectable in blood.

“It is not surprising to find viruses encountered during the lifetime” surviving in human tissues, says Kei Sato, a virologist at the University of Tokyo. Indeed, Sato’s work has shown that humans frequently accumulate viruses such as Epstein-Barr virus, varicella zoster virus (which causes chicken pox), and many herpes viruses in dormant forms. These persisting viruses are typically present at low levels, so only extensive genetic sequencing can identify them.

This highlights how complicated it is to prove or disprove the association between persisting SARS-CoV-2 and long COVID. Shingles, for example, occurs decades after a chickenpox infection, when the latent virus gets reactivated during immune stress.

Likewise, lingering SARS-CoV-2 could cause long-term health problems. Henrich thinks when the virus is seeded in deep tissues, it potentially causes the immune system to shift into a dysregulated inflammatory state. Such a state is “probably evidence that the virus is capable of persisting, and maybe getting down into sort of an uneasy truce with the body,” says VanElzakker.

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Still, associating any lingering virus with long COVID will require extensive studies. “We still don't know enough to make strong conclusions about any of the current proposed mechanisms, but research is actively underway to answer those questions,” says Geng.

Clearing up persistent virus might cure long COVID

Both Geng and Henrich’s groups have reported preliminary case studies that show an improvement in long COVID symptoms after patients were treated with Pfizer's COVID-19 oral antiviral Paxlovid. Paxlovid stops the virus from replicating, which is why some experts think it can clear any lingering virus. But both authors urge caution before assuming that Paxlovid will be safe, effective, or sufficient and thereby a reliable cure for long COVID.

“There are some interesting hypotheses about how Paxlovid may be useful in the treatment of long COVID, but we’d need further investigation and clinical trials before coming to any conclusions,” says Geng.

The U.S. Food and Drug Administration has warned against off-label uses of Paxlovid, which is not approved for long COVID treatment. The agency has given Paxlovid an emergency use authorization to treat mild to moderate COVID-19 in those who are at risk of developing severe disease, twice daily for five days soon after a positive test.

“It would be important to consider the optimal duration of treatment [of Paxlovid] to ensure long-term and sustained results,” says Geng.

President Joe Biden has directed the secretary of Health and Human Services to create a national action plan on long COVID, and the NIH has launched a multi-year study called RECOVER to understand, prevent, and treat long-term health effects related to COVID-19.

In the meantime, vaccines not only continue to protect against severe disease, but evidence is also emerging that they can prevent many long COVID symptoms. One new study compared 1.5 million unvaccinated COVID-19 patients to 25,225 vaccinated patients with breakthrough infections, and it found that vaccines significantly reduced the risk of developing long COVID symptoms 28 days after an infection. The protective effect of vaccination got even larger at 90 days post-infection.

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"Although a majority of people do not develop long COVID, it's certainly a risk, and COVID doesn't stop after the first 10 days of becoming infected,” says Henrich. “For those who don't take COVID seriously, it can be life changing."

FAQs

How long does Covid last in your body? ›

Most people with COVID-19 get better within a few days to a few weeks after infection, so at least four weeks after infection is the start of when post-COVID conditions could first be identified. Anyone who was infected can experience post-COVID conditions.

How long will I test positive for Covid after having it? ›

If negative, multiple tests may be necessary. After a positive test result, you may continue to test positive for some time after. You may continue to test positive on antigen tests for a few weeks after your initial positive. You may continue to test positive on NAATs for up to 90 days.

How long does Covid stay in your system NHS? ›

Many people with COVID-19 will no longer be infectious to others after 5 days. If you have a positive COVID-19 test result, try to stay at home and avoid contact with other people for 5 days after the day you took your test.

Are you still contagious after 5 days? ›

People are most contagious with COVID-19 during the first 5 days of their illness. Many people don't have any symptoms during the first 2 to 3 days of their illness. This is why COVID-19 outbreaks are so hard to contain. On average, people are contagious for 5 to 10 days.

Does COVID get better after 5 days? ›

If you test positive for COVID-19 and have no symptoms – you may end after day 5. If you test positive for COVID-19 and have symptoms – you may end after day 5 if: You are fever-free for 24 hours (without the use of fever-reducing medication) Your symptoms are improving.

How long does COVID fatigue last? ›

This normally gets better after four weeks; however some people might have fatigue for longer. There are many reasons why you could feel tired after COVID such as: Your body is still getting better even when you no longer have the virus.

How long are you contagious Omicron? ›

We know that people tend to be most infectious early in the course of their infection. With Omicron, most transmission occurs during the one to two days before onset of symptoms, and in the two to three days afterwards.

How long does Omicron symptoms last? ›

How long do omicron symptoms last? Most people who test positive with any variant of COVID-19 typically experience some symptoms for a couple weeks.

Can you get Covid twice? ›

Reinfection with the virus that causes COVID-19 means a person was infected, recovered, and then later became infected again. After recovering from COVID-19, most individuals will have some protection from repeat infections. However, reinfections do occur after COVID-19.

Does Omicron come on suddenly? ›

How quickly do omicron symptoms appear? The time it takes for an infected person to develop symptoms after an exposure is shorter for the omicron variant than for previous variants — from a full week down to as little as three days or less, according to the CDC.

Can COVID get worse after 10 days? ›

A hallmark of COVID-19 is its ability to get worse quickly and aggressively. While the 10 to 12 days after a positive COVID-19 test are when many patients are hospitalized, researchers do not understand what changes occur early in the disease and how they may predict hospitalization later.

What does your throat feel like with COVID? ›

Well, it can feel exactly the same as a cold, according to Brian Curtis, MD, vice president of Clinical Specialty Services for OSF HealthCare. That makes it hard to tell the difference between a cold and a mild case of COVID. It's even harder to tell the difference knowing that sore throat is a COVID symptom.

Is Covid still contagious after 7 days? ›

Those with severe COVID-19 may remain infectious beyond 10 days and may need to extend isolation for up to 20 days. People who are moderately or severely immunocompromised should isolate through at least day 20.

Can you test negative for Covid and still be contagious? ›

You can have COVID-19 and spread it to others even if you do not have symptoms. Your COVID-19 test can be negative even if you are infected. Most people do not test positive for the virus until days after exposure. You may also be exposed to the virus afteryou are tested and then get infected.

Can you have Covid and test negative? ›

A negative result means it's likely you are not infectious. But a negative test is not a guarantee you do not have COVID-19 and there's still a chance you may be infectious. You should follow advice on how to avoid catching and spreading the virus.

How do you know if COVID is getting better? ›

If you have COVID-19
  1. At least five days have passed since your symptoms started. ...
  2. At least 24 hours have passed with no fever without the use of fever-reducing medication on day six.
  3. Other symptoms are improving — loss of taste and smell might last for weeks or months after recovery but shouldn't delay ending isolation.

When does COVID cough start? ›

Based on what researchers have learned about COVID-19 thus far, the first symptoms—which generally occur within seven days after infection—can include the following, which are listed in order of their usual appearance: Fever or chills. A persistent cough.

Which cough syrup is best for COVID? ›

Use medications containing guaifenesin, such as Robitussin, Mucinex, and Vicks 44E. keeping you from getting rest. Coughing is useful because it brings up mucus from the lungs and helps prevent bacterial infections. People with asthma and other lung diseases need to cough.

How do I get my energy back after COVID? ›

Fatigue is common after viral infections like COVID-19. Most people recover after 2 to 3 weeks. Fatigue is feeling like you lack energy.
...
It's important to:
  1. eat well.
  2. have a healthy sleep routine.
  3. drink plenty of water to keep hydrated.

Does COVID make you sleep all day? ›

Extreme tiredness (fatigue) is common when you recover from coronavirus (COVID-19). Living with this symptom is difficult. It affects things that you would like to do, which can be frustrating. It takes time to build up your strength and energy levels again.

How long can shortness of breath linger after COVID? ›

Managing shortness of breath

Most people will make a full recovery within 12 weeks. But for some people, symptoms can last longer.

Can you test negative for Covid after 3 days? ›

One study from researchers at Johns Hopkins suggested that COVID-19 PCR tests conducted 3 to 5 days after a person is exposed that return a negative result shouldn't be relied on alone to gauge infection status, and that in addition, the clinical and epidemiologic situation should be carefully evaluated by health ...

How long test positive Covid Omicron? ›

During the Omicron BA. 1 period, 80.2% of symptomatic persons with COVID-19 returning for repeated testing were RAT–positive after 5 days, and 34.9% were still positive after 10 days, regardless of vaccine status.

What are Omicron symptoms if vaccinated? ›

Symptoms of Omicron can be similar to the original COVID-19 virus and other variants, which can include a combination of the following: fever, cough, congestion, runny nose, headache, sore throat, muscle pains/aches and fatigue.

How long does a COVID cough last? ›

In the case of COVID-19, this cough could last for as long as six months after the viral infection, especially if the patient contracted Omicron because it is more airway dependent than the original strain.

Does Omicron start with a sore throat? ›

Compared to other SARS-CoV-2 variants, the Omicron variant is associated with generally less severe symptoms that may include fatigue, cough, headache, sore throat or a runny nose.

Is sneezing a symptom of Omicron? ›

The study found that sneezing is the fourth most common reported symptom associated with omicron.

Can you get Covid 3 times? ›

In fact, with the highly infectious omicron variant in circulation, it's becoming less unusual to have COVID-19 three times — or even four.

How many times can I catch Covid? ›

Can you get Covid-19 twice? Yes, it is possible to get Covid-19 two, three or even more times. Covid reinfections have become more common because of the Omicron variant, and because immunity from previous infection and immunisation has reduced over time.

Can you get Covid again after 2 months? ›

The short answer is yes, though it's not common.

This is why it's so important to get your bivalent booster to further protect yourself against the Omicron variants! The majority of reinfections occur at least 90 days after the initial COVID-19 infection.

What does a COVID headache feel like? ›

Researchers have discovered that some of the prominent features of a COVID-19 headache include: Having a pulsing, pressing, or stabbing sensation. Occurring bilaterally (across the whole head) Presenting with severe pressure that won't respond to typical pain relievers, like ibuprofen and acetaminophen.

Do symptoms get worse with Omicron? ›

For a few weeks after most symptoms recover, you may feel lingering symptoms like fatigue, loss of taste and smell, brain fog, and headaches. If, after feeling better, you experience worsening cough, new fever, new chest pain, or worsening shortness of breath, Morris said to seek medical attention.

Is Omicron a milder? ›

Early studies suggested Omicron appears to be milder than previous strains, although some experts have attributed this to the fact that many more people were vaccinated, and some had immunity from infection.

What does mild Covid feel like? ›

Many people who are infected have more mild symptoms like a scratchy throat, stuffy or runny nose, occasional mild cough, fatigue, and no fever. Some people have no symptoms at all, but they can still spread the disease.” Fever seems to be one of the more common early markers of COVID-19, Kline noted.

What is mild Covid like? ›

Fatigue. Muscle or body aches. Headache. New loss of taste or smell.

What day of Covid do you lose taste? ›

Conclusion: The present study concludes that the onset of symptoms of loss of smell and taste, associated with COVID-19, occurs 4 to 5 days after other symptoms, and that these symptoms last from 7 to 14 days.

What color is COVID mucus? ›

Green and cloudy: viral or bacterial infection

A lot of the symptoms of viral infections – fever, cough, headache, loss of smell – overlap for COVID-19 and other viral infections like the flu, respiratory syncytial virus and the common cold.

Do you cough up phlegm with COVID? ›

You may find that you are still coughing up phlegm or mucus after an infection with COVID-19 (coronavirus). This is normal after respiratory infections. It is how the lungs and airways keep themselves clear.

What is COVID tongue? ›

A July 2020 study published in Integrative Medicine Research found that people with COVID-19 had greasier and more tender tongues. 5 Tongue discoloration was also observed in patients with mild to moderate infections, who had a light red tongue with a white coating.

Can COVID get worse after 10 days? ›

A hallmark of COVID-19 is its ability to get worse quickly and aggressively. While the 10 to 12 days after a positive COVID-19 test are when many patients are hospitalized, researchers do not understand what changes occur early in the disease and how they may predict hospitalization later.

How long does a virus last in adults? ›

A viral infection usually lasts only a week or two. But when you're feeling rotten, this can seem like a long time! Here are some tips to help ease symptoms and get better faster: Rest.

When do COVID symptoms get worse? ›

In some people, COVID-19 causes more severe symptoms like high fever, severe cough, and shortness of breath, which often indicates pneumonia. A person may have mild symptoms for about one week, then worsen rapidly. Let your doctor know if your symptoms quickly worsen over a short period of time.

Can you get COVID twice? ›

Reinfection with the virus that causes COVID-19 means a person was infected, recovered, and then later became infected again. After recovering from COVID-19, most individuals will have some protection from repeat infections. However, reinfections do occur after COVID-19.

How long is omicron contagious? ›

We know that people tend to be most infectious early in the course of their infection. With Omicron, most transmission occurs during the one to two days before onset of symptoms, and in the two to three days afterwards.

Does omicron come on suddenly? ›

How quickly do omicron symptoms appear? The time it takes for an infected person to develop symptoms after an exposure is shorter for the omicron variant than for previous variants — from a full week down to as little as three days or less, according to the CDC.

How long does omicron symptoms last? ›

How long do omicron symptoms last? Most people who test positive with any variant of COVID-19 typically experience some symptoms for a couple weeks.

What are signs your body is fighting a virus? ›

If it's a viral illness, typically symptoms are shorter lasting and classically the symptoms include fever, chills, sore throat, nasal congestion, runny nose, cough, and a lot of times you can have some body aches. A lot of times the symptoms last for maybe three days to a week and then slowly get better over time.

How do you get rid of a virus in your body? ›

Antiviral medications can treat certain viruses, putting an end to symptoms. For people with chronic viral infections, antiviral drugs can stop the virus from multiplying and causing problems. The medicine also lowers your chances of giving the virus to others.

How do you get over Covid fast? ›

To care for yourself, follow these steps:
  1. Keep a daily routine, such as taking a shower and getting dressed.
  2. Take breaks from COVID-19 news and social media.
  3. Eat healthy meals and drink plenty of fluids.
  4. Stay physically active.
  5. Get plenty of sleep.
  6. Avoid use of drugs, tobacco and alcohol.

When does COVID cough start? ›

Based on what researchers have learned about COVID-19 thus far, the first symptoms—which generally occur within seven days after infection—can include the following, which are listed in order of their usual appearance: Fever or chills. A persistent cough.

What does your throat feel like with COVID? ›

Well, it can feel exactly the same as a cold, according to Brian Curtis, MD, vice president of Clinical Specialty Services for OSF HealthCare. That makes it hard to tell the difference between a cold and a mild case of COVID. It's even harder to tell the difference knowing that sore throat is a COVID symptom.

What helps COVID cough? ›

If you have a wet cough with lots of mucus, you want to take an expectorant to help get the mucus out. If you have a dry cough, a cough suppressant is what you want. Make sure you choose the right one. For pain, try acetaminophen.

Can you get Covid 3 times? ›

In fact, with the highly infectious omicron variant in circulation, it's becoming less unusual to have COVID-19 three times — or even four.

How many times can I catch Covid? ›

Can you get Covid-19 twice? Yes, it is possible to get Covid-19 two, three or even more times. Covid reinfections have become more common because of the Omicron variant, and because immunity from previous infection and immunisation has reduced over time.

Can you get Covid again after 2 months? ›

The short answer is yes, though it's not common.

This is why it's so important to get your bivalent booster to further protect yourself against the Omicron variants! The majority of reinfections occur at least 90 days after the initial COVID-19 infection.

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