Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), has become a concerning issue for many who suffer from lingering symptoms long after their initial infection has cleared. Although most people recover from COVID-19 without lasting issues, some continue to struggle with fatigue, difficulty breathing, neurological symptoms, and heart or lung problems for months, or even years. But can long COVID be fatal? The answer is complex and depends on multiple factors, including a person's overall health, the severity of their initial infection, and how long COVID affects their body.
What Is Long COVID?
Long COVID refers to symptoms that continue for more than four weeks after an initial COVID-19 infection. These symptoms can vary greatly, from mild fatigue and brain fog to severe respiratory and cardiovascular complications. Long COVID is believed to affect anywhere from 10-30% of people who contract COVID-19, with higher rates among those who experienced a severe initial infection.
Researchers and healthcare professionals have been working to understand long COVID, but there is still much that remains unknown. Some people recover from long COVID within a few months, while others experience symptoms that persist for years.
A majority of people with COVID-19, or coronavirus disease 2019, get better at home. For some, however, COVID-19 can be life-threatening. Some individuals may need to be hospitalized, treated in the intensive care unit, and even be put on a breathing machine. In some patients, severe COVID-19 related illness can cause death.
The whole story of the risk factors for severe COVID-19 has not been unraveled yet. However, some of them seem to be prominent because of the data that has been gathered since the beginning of the pandemic.
How Long COVID Affects the Body
One of the primary ways that long COVID can lead to serious health issues, and potentially death, is through the lasting damage it causes to major organs. During the initial infection, COVID-19 can inflame and damage organs like the lungs, heart, kidneys, and even the brain. In people who develop long COVID, this damage may be more pronounced, potentially leading to long-term health issues, including:
Lung Damage: COVID-19 is a respiratory virus, and severe cases can lead to pneumonia or acute respiratory distress syndrome (ARDS). This can damage lung tissue, leading to reduced lung function and, in extreme cases, a condition called pulmonary fibrosis, where scar tissue forms in the lungs and causes breathing difficulties.
Heart Inflammation: COVID-19 can cause myocarditis, an inflammation of the heart muscle, which can affect heart function. Long-term heart damage increases the risk of heart failure and other cardiovascular problems, especially in those who have underlying heart conditions.
Kidney Disease: In severe cases, COVID-19 can lead to kidney damage, which can become chronic. People with preexisting kidney conditions or those who suffered from acute kidney injury during their infection are at increased risk of developing chronic kidney disease.
Neurological Symptoms: Many with long COVID report brain fog, headaches, and difficulty concentrating. In severe cases, neurological damage may lead to cognitive decline and increase the risk of other neurological disorders.
Age and Health Conditions Increase COVID-19 Risks
People aged 65 and older face a higher risk of severe illness from COVID-19. These age groups are the most likely to need hospital care if they catch the virus.
For babies, the risk is greater because they aren't yet eligible for the COVID-19 vaccine. For older adults, the immune system weakens with age, making it harder to fight off infections. Also, older adults are more likely to have health conditions that raise the risk of severe COVID-19. In the U.S., around 76% of COVID-19 deaths as of March 2024 have been among people 65 and older.
Age and Health Conditions Together Raise Risks
Certain health issues, especially those common in older adults, make severe COVID-19 more likely. Some of these include:
Diabetes (both type 1 and type 2)
Heart disease (like heart failure or coronary artery disease)
Chronic lung diseases (such as airway diseases or lung damage)
Obesity, with higher risks as body mass index (BMI) increases, especially for a BMI over 40
Chronic kidney disease, particularly for those on dialysis
These health conditions are more common with age but can affect anyone. Having one or more of these conditions can increase the risk of serious COVID-19 illness.
Lung Diseases Also Raise COVID-19 Risks
People with lung diseases are at a higher risk of severe COVID-19. Moderate to severe asthma, for example, increases the chance of needing hospital care, intensive care, or breathing support.
Other lung conditions, like tuberculosis, cystic fibrosis, interstitial lung disease, bronchiectasis, and COPD (chronic obstructive pulmonary disease), also increase the likelihood of needing hospital care. Depending on the severity of the lung condition, the risk of requiring intensive care or even dying from COVID-19 may be higher.
Other conditions that impact the lungs, such as a history of pulmonary hypertension or blood clots in the lungs, can also raise the risk of serious illness of death from COVID-19.
There's still a lot we don't fully understand about long COVID. One main theory suggests that leftover virus fragments, or "zombie" particles, stay in the body after infection and cause ongoing inflammation. This lingering inflammation may lead to persistent health issues. Some studies have found that SARS-CoV-2 proteins might remain in the blood, which could help explain why some people continue to feel unwell.
Severe COVID infections are known to damage major organs, sometimes permanently. For instance, COVID-19 can cause lasting problems in the lungs, chronic heart inflammation, nerve and brain damage, and kidney disease. In some cases, these complications can lead to death-either shortly after the infection or much later.
Whether lang COVID itself directly causes death is still debated. In the U.S., by June 2022, there were 3,544 reported deaths connected to long COVID. In 67.5% of these cases, COVID-19 itself was listed as an underlying cause, suggesting they likely died due to long-term complications from the infection, like the issues mentioned above.
