Nearly three years after the SARS-CoV-2 pandemic was declared over, conservative estimates suggest that between 80 million and 400 million people around the world are still suffering from long-term illness from the novel coronavirus. The chronic illnesses associated with this infection are associated with more than 200 symptoms, including fatigue and shortness of breath, as well as neuropsychiatric problems ranging from cognitive dysfunction and sleep disorders to depression and memory loss. These problems affect quality of life and interfere with daily tasks and work performance.
The underlying pathophysiological mechanisms (processes that occur within the body and help explain certain symptoms and changes) include viral persistence of SARS-CoV-2, herpesvirus reactivation (when immune stress activates latent viruses of the herpesviridae family), and chronic immune activation. Other mechanisms include dysregulation of the immune system, imbalance in the function of gut microorganisms (dysbiosis), coagulation abnormalities, and endothelial damage. Regarding the brain, structural changes and functional connectivity abnormalities are observed.
However, significant advances in our understanding of long-lasting COVID-19 require further scientific research to standardize the definition and nomenclature of the disease, as well as more clinical trials with potential treatments.
First review article published in the journal Nature Review Disease Primer provides an overview of this topic and specializes in neurological, psychological, and psychiatric symptoms related to COVID-19. This paper provides a comprehensive analysis of the epidemiology, biological mechanisms, diagnosis, therapeutic approaches, impact on quality of life, and challenges facing the science.
The paper was written by an international committee of 14 experts, including Brazilian author Clarissa Yasuda, a neurologist and professor at the Faculty of Medicine at the State University of Campinas in São Paulo (UNICAMP). Mr. Yasuda is also a researcher at the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), a FAPESP Research, Innovation and Dissemination Center (RIDC). Since 2020, she has coordinated a series of studies on the long-term novel coronavirus (For more information, please visit agencia.fapesp.br/41738.).
This disease is new and poorly understood. Many people are studying it and trying to understand it. That’s not only because of the current cases, but also because humans are susceptible to other viruses that can cause problems on a pandemic scale. We need to learn from it and investigate effectively and quickly. The long-term coronavirus infection has greatly disrupted people’s lives, and there is currently no specific treatment. The important thing is to get vaccinated and prevent reinfection. That’s another message of this article. ”
Clarissa Yasuda, Faculty of Medicine, State University of Campinas
In their study, researchers stress that so far the only way to prevent long-lasting coronavirus infection is to avoid SARS-CoV-2 infection. They point out that diagnosis is based on clinical evaluation. Due to the lack of available biomarkers, a recent history of viral infection and persistent or recurrent symptoms for at least 3 months are required. Other diseases must be ruled out and blood tests, imaging tests, electrocardiography, and echocardiography may be required.
In Brazil, although the number of reported new coronavirus infections has been decreasing year by year, it remains at a high level. The Ministry of Health reported approximately 432,400 cases in 2025, compared to 984,000 the previous year. From January to the second week of February this year, around 25,200 cases were reported.
quality of life
In the section on quality of life, the article discusses, in addition to the health effects, the impact of prolonged COVID-19 on the labor market and the stigma associated with the disease.
The authors note that a lack of support from the social welfare system can result in individuals experiencing loss of work or income, and even difficulty returning to work. They also say that those affected may experience periods of “up and down”, “weakness”, “depression”, and “lowness” and feel unable to maintain the same level of activity.
In 2024, scientists from a US research institute published a paper. natural medicine It is estimated that over 803 million working hours will be lost in Brazil alone in the same year due to the prolonged impact of COVID-19, with potential costs exceeding US$11 billion. This equates to approximately 400,000 full-time workers being removed from the labor market per year. The same study estimates that the long-term impact of COVID-19 on the global economy could be around US$1 trillion a year, or about 1% of the global economy.
Professor Yasuda himself experienced difficulties in resuming his activities due to the long-term effects of the new coronavirus infection. She contracted the virus in August 2020 and had mild symptoms without a fever. However, after about a month, she realized that her cognitive impairment was interfering with her schoolwork.
She detailed her experience in the article “I want my brain back” published in the Cielo Brasil Digital Library in June 2022. “At the time, I described my recovery efforts and the strategies I used to cope with my persistent cognitive limitations. After much effort and discipline, I improved,” she says.
The long-lasting coronavirus disease, also known as the “post-COVID-19 state,” has been monitored by Brazil’s national public health system, SUS (integrated medical system), applicable from 2021 and updated in 2023 by Technical Note No. 57. An epidemiological bulletin on this topic published in 2025 estimated the number of cases of “post-COVID-19” in Japan to be 13.8 million, the majority of whom were women (8.58 million). The most affected age group was 30-49 years old (6.2 million Brazilians).
stigma
Regarding stigma, scientists point out that patients face multiple barriers when trying to have their condition acknowledged and receive care and support. These experiences range from discrimination and mistreatment to stigmatization. People from ethnic minorities experience particularly high levels of prejudice.
They also point out that it can have a serious impact on the social and educational interactions of children and adolescents.
Therefore, they recommend that patient care be provided by a multidisciplinary team that includes experts from various medical fields.
They recommend that future studies recruit diverse and representative patient populations and consider the perspective of patients with long-term COVID-19 infection and the role of social and health determinants.
In this context, Yasuda’s group is conducting longitudinal studies to understand how the disease changes the brain. “Being invited to participate in this review is very important and provides international recognition for the research we are developing at BRAINN RIDC,” says Yasuda. Yasuda also receives support from the National Council for Scientific and Technological Development (CNPq), a funding agency associated with the Ministry of Science, Technology and Innovation.
sauce:
São Paulo Research Foundation (FAPESP)
Reference magazines:
Wilson, J.E.; Others. (2025). Neurological and psychological symptoms associated with COVID-19. Nature Review Disease Primer. DOI: 10.1038/s41572-025-00674-7. DOI: 10.1038/s41572-025-00674-7. https://www.nature.com/articles/s41572-025-00674-7
