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Clinical Review State of the Art Review

Long covid—mechanisms, risk factors, and management

BMJ 2021; 374 doi: (Published 26 July 2021) Cite this as: BMJ 2021;374:n1648

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This article has corrections. Please see:

  1. Harry Crook, research assistant1,
  2. Sanara Raza, research assistant1,
  3. Joseph Nowell, research assistant1,
  4. Megan Young, clinical research officer1,
  5. Paul Edison, clinical senior lecturer, honorary professor12
  1. 1Faculty of Medicine, Imperial College London, London, UK
  2. 2Cardiff University, Cardiff, UK
  1. Correspondence to P Edison paul.edison{at}


Since its emergence in Wuhan, China, covid-19 has spread and had a profound effect on the lives and health of people around the globe. As of 4 July 2021, more than 183 million confirmed cases of covid-19 had been recorded worldwide, and 3.97 million deaths. Recent evidence has shown that a range of persistent symptoms can remain long after the acute SARS-CoV-2 infection, and this condition is now coined long covid by recognized research institutes. Studies have shown that long covid can affect the whole spectrum of people with covid-19, from those with very mild acute disease to the most severe forms. Like acute covid-19, long covid can involve multiple organs and can affect many systems including, but not limited to, the respiratory, cardiovascular, neurological, gastrointestinal, and musculoskeletal systems. The symptoms of long covid include fatigue, dyspnea, cardiac abnormalities, cognitive impairment, sleep disturbances, symptoms of post-traumatic stress disorder, muscle pain, concentration problems, and headache. This review summarizes studies of the long term effects of covid-19 in hospitalized and non-hospitalized patients and describes the persistent symptoms they endure. Risk factors for acute covid-19 and long covid and possible therapeutic options are also discussed.


  • State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: HC, SR, JN, and MY performed the primary literature search and drafted parts of the manuscript; HC was the first author of the manuscript who drafted the manuscript and revised it; PE was responsible for the concept and design of the work. PE reviewed and revised the manuscript. PE is the guarantor.

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: PE was funded by the Medical Research Council and now by Higher Education Funding Council for England (HEFCE). He has also received grants from Alzheimer’s Research, UK, Alzheimer’s Drug Discovery Foundation, Alzheimer’s Society, UK, Medical Research Council, Alzheimer’s Association US, Van-Geest foundation, and European Union grants. PE is a consultant to Roche, Pfizer, and Novo Nordisk. He has received educational and research grants from GE Healthcare, Novo Nordisk, Piramal Life Science/Life Molecular Imaging, Avid Radiopharmaceuticals and Eli Lilly. He is a member of the Scientific Advisory Board at Novo Nordisk.

  • Provenance and peer review: commissioned; externally peer reviewed.

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