Long-COVID / Post-COVID
Long-Covid syndrome is associated with symptoms that persist for weeks or even months after someone has recovered from an acute COVID-19 infection. If you have symptoms for more than three months, it is called long COVID. COVID can disrupt the immune system and the autonomic nervous system, among other things.
Possible long-term complaints after COVID infection
After a COVID infection people may continue to have many complaints:
- Severe fatigue, lethargy, head/muscle/joint pain,
- Palpitations, shortness of breath, dizziness, orthostatic intolerance/dysautonomia (POTS) With orthostatic intolerance, a person experiences difficulty standing or remaining upright because the body has difficulty regulating blood pressure and blood flow to the heart and brain. Symptoms such as dizziness, fainting, palpitations, and fatigue are common.
- Concentration problems
- Memory problems
- Problems with executive functions.
- Difficulty with visuospatial and visuoconstructive skills. These are two important cognitive functions. Visuospatial skills involve the ability to see and understand spatial relationships between objects, such as estimating distances, recognizing patterns, and orienting oneself in space. Visuoconstructive skills go a step further and focus on the ability to use complex visual and spatial information to create or reproduce something, such as drawing a figure, building a model, or solving puzzles. These skills play a crucial role in daily life, from navigating a city to performing practical tasks.
- Hypersensitivity to sensory stimuli and to cognitive stimuli, which is when sensory stimuli make one physically ill with neurological complaints, among other things.
- Insomnia, anxiety / frustration / depression / gloom.
- Persistent COVID symptoms, all kinds of complaints in your body, (for example: coughing, fever, temperature changes, night sweats, shortness of breath, less or no smell (hyposmia / anosmia).
- alternating good / bad days.
This is a selection of the large number of complaints that people may experience with Long COVID. The complaints can last a long time and can have a major impact on daily life, physical and mental health, social contacts and work. The complaints often become worse after exertion.
COVID may disrupt the immune system and the autonomic nervous system
The immune system protects you against diseases and infections, but is not always resistant to a COVID attack. Your cells pick it up, but continue to fight back and attack the virus. This can cause the immune system to enter a state of stress, whereby all kinds of immune substances are activated and react overactively. Remaining virus particles can also cause problems. This causes your immune system to be activated again and again because there appears to be an inflammatory response.
The autonomic nervous system regulates automatic processes such as: breathing, blood pressure, heart rate, digestion. It consists of two systems: an 'accelerator pedal' for action, which costs energy. A 'brake' for rest, this provides relaxation and recovery. The brain stem controls the autonomic nervous system and also influences, for example, alertness and sleeping / waking up. The vagus nerve is the nerve that carries information about the condition of the organs to the brain and signals from the brain to the organs. This nerve plays a major role in various functions and returns the body from the action position to rest. Normally the body automatically maintains a good balance, but COVID has disrupted this balance and significantly disrupted automaticity. The body and brain are therefore constantly in survival mode, day and night action in the body.
It is understandable that this can cause many complaints throughout the body. The intensity and complaints of Long COVID are therefore very diverse and sometimes last a long time. Children of all ages can also experience the same complaints! It is important to go to the doctor if the complaints persist, so that any examinations and paramedical recovery care can start. This is recovery care in addition to medical care and can consist of: physiotherapy, occupational therapy, dietetics, exercise therapy, speech therapy. The general practitioner / medical specialist assesses whether recovery care is necessary and refers if this is the case. This is often done, because recovering without help is very difficult. The body is disrupted, which means that people often cross the line unnoticed.
Long COVID is called a multisystem disease.
Cognitive complaints and sensory overstimulation
COVID can cause cognitive complaints (thinking, understanding, organizing, remembering). This can cause serious problems:
cognitive and concentration problems, cognitive overstimulation,
brain fog. Cognitive complaints are often very difficult to accept and can cause a lot of uncertainty.
That is understandable, it is confrontational and frustrating. You can't think of words or mix them up, feel tired and foggy and can't remember things. You have chaos in your head. If this bothers you a lot, try to exercise outside and relax if possible.
Focus on your breathing and take your time, also to find the right words. Working against it worsens the complaints. Try to get enough sleep and not ask too much of yourself. Give yourself some rest.
All the stimuli around you can hit your brain hard, because the stimulus processing has been disrupted by COVID. This can cause headaches, tinnitus, fatigue and inability to tolerate sounds, light and movements.
Get to know these signals from your body well. If your system is disrupted, a small stimulus can cause an imbalance. A quiet environment is therefore important, silence. Mental effort is also effort, even if you are sitting on the couch. Try to limit your screen time. Explaining your situation can be helpful. Understanding is important, misunderstanding often causes a lot of stress.
Mental complaints
Because you are ill, you now have a completely different life, which can cause mental complaints. Frustration, sadness, anxiety, gloom and irritability. Try to accept your situation, this is happening to you. Try to find a way to relax yourself. If you notice that you are stuck, don't keep walking around with this but share it with someone close to you or your doctor. These are invisible consequences of Long COVID, but important to pay attention to.
Research January '25
Patients with Long-COVID show various symptoms that persist in the long term after SARS-CoV-2 infection. Among these symptoms, cognitive impairment is one of the most common and is related to structural and functional changes in the brain.
It is not yet clear how it changes the brain, but neuroinflammation and immune mechanisms are most often thought of. In this sense, the volume of the choroid plexus (ChP) has been proposed as a 'marker' of neuroinflammation in immune-mediated diseases.
A 'marker' is a measurable indicator that provides information about the functioning, activity or situation of something. The lining of the inside of the choroid plexus (the ChP epithelium) has namely proven to be particularly sensitive to the effects of SARS-CoV-2.
Choroid plexus (ChP) volume was found to be increased in Long-COVID patients participating in this study and has been associated with cognitive complaints and brain changes.
There appears to be a link between gray matter reduction and enlarged choroid plexus (ChP). Importantly, ChP volume enlargement was associated with gray matter reduction, decreased cognitive functioning, and gray matter reduction in frontal and subcortical brain areas.
Patients with higher ChP volume were found to have greater
cognitive impairment compared to patients with smaller ChP volume. The larger the ChP volume, the worse the cognitive performance.
These results are in good agreement with recent findings in other conditions, such as multiple sclerosis, where an enlarged ChP is closely related to neuroinflammation (inflammation of the central nervous system), as well as disease severity and cognitive dysfunction.
Post-COVID showed striking associations with reductions in gray matter (GM volume) in the inferior and middle orbitofrontal cortex, frontal inferior and rolandic operculum, insula, caudate cingulum, putamen, pallidum, thalamus and hippocampus. It mainly affects cognitive deficits, mainly in attention, executive functions and episodic memory.
The research can be found by this link.
You can download the PDF of the research here
Choroid Plexus
The choroid plexus or ChP is a network of specialized cells in the brain that is responsible for the production of cerebrospinal fluid (CSF). It is located in the ventricles of the brain and plays a crucial role in protecting and supporting the central nervous system.
The cerebrospinal fluid not only provides a cushioning effect to protect the brain from shock, but also helps remove waste products and maintain a stable chemical environment.
The choroid plexus consists of specialized epithelial cells and is rich in blood vessels, which is important for filtering blood plasma during the production of cerebrospinal fluid.
The brain is a complex and sensitive organ that must remain in constant balance to function properly. This balance, also called
homeostasis, is crucial for regulating processes such as maintaining the correct ion concentration, removing waste products and providing nutrients.
The choroid plexus was also found to be involved in regulating the entry of immune cells into the brain, indicating the complex role this structure plays in inflammation of the central nervous system (neuroinflammatory disorders).
This emphasizes that the choroid plexus is not just a passive barrier, but can be actively involved in inflammatory processes in the central nervous system.
Neuroinflammation
Neuroinflammation refers to inflammation in the central nervous system, including the brain and spinal cord. This process can occur in response to infection, trauma, autoimmune disease, or other damage. While inflammation is the body’s natural response to repair damage, chronic neuroinflammation can be harmful and contribute to the development of neurological disorders such as Alzheimer’s, multiple sclerosis, and Parkinson’s. Symptoms can range from cognitive decline and memory problems to physical complaints such as muscle weakness and fatigue.
Immune-mediated disorders
Immune-mediated disorders are health problems that arise from a dysregulated immune system. Instead of only attacking harmful invaders such as viruses and bacteria, the immune system accidentally targets healthy cells and tissues in the body. This can lead to chronic inflammation and damage to various organs.
A lot of research is being done on this in the Netherlands and abroad. As soon as more is known, we will post it here.
We have a special page about neurological complaints and symptoms as a complication after COVID infection.
What you can do yourself to recover
Now that you know more about Long COVID, many complaints may have already been explained. Sometimes it suddenly falls into place. It is important to get to know the signals your body gives and listen to them. This takes time and energy, but can ultimately lead to fewer complaints and more inner peace. Calm your body regularly by consciously relaxing and calming your nervous system. This can be done by:
- control breathing as much as possible and pay particular attention to proper exhalation
- alternating effort and rest, alternating mental and physical activities
- rest without telephone, TV, visitors
- take several short rest moments, for example twenty minutes of low-stimulus rest
- stop exerting yourself before you get tired, relax and do breathing exercises regularly.
The page about Long-COVID on our Dutch website was written by Marjan van Herk, author of the book (in Dutch) 'Je ziet er gezond uit, fysiek en cognitief overmeesterd door het virus'.
This page is a translation of the Dutch page.
Research
Research has shown that physical activity causes more damage to muscle tissue in people with Long COVID.
Furthermore the mitochondria, the power plants in the cells, function less well in people with Long COVID. See here.
Choroid plexus volume is enlarged in long COVID and associated with cognitive and brain changes Diez-Cirarda M, Yus-Fuertes M, Delgado-Alonso C, Gil-Martínez L, Jiménez-García C, Gil-Moreno MJ, Gómez-Ruiz N, Oliver-Mas S, Polidura C,Jorquera M, Gómez-Pinedo U, Arrazola J, Sánchez-Ramón S, Matias-Guiu J, Gonzalez-Escamilla G, Matias-Guiu JA. Choroid plexus volume isenlarged in long COVID and associated with cognitive and brain changes. Mol Psychiatry. 2025 Jan 15. doi: 10.1038/s41380-024-02886-x. Pubmed