8 Minutes
Persistent effects of COVID‑19: more than a lingering cold
For many people, SARS‑CoV‑2 infection now evokes a brief respiratory illness that resolves in days. However, a substantial minority experience ongoing symptoms that last well beyond the acute phase. The World Health Organization (WHO) defines long COVID—also known as post‑acute sequelae of SARS‑CoV‑2 infection (PASC)—as signs and symptoms that persist for at least three months after the initial infection. These prolonged effects have become a definitive and complex aspect of the pandemic.
Clinical research has catalogued more than 200 symptoms associated with long COVID, with common complaints including severe fatigue, cognitive impairment (“brain fog”), and breathlessness. Less attention, however, has been paid to how these symptoms translate into functional loss in everyday life. Our recent Australian study sought to quantify that lived impact using validated disability and quality‑of‑life instruments.
What is long COVID and how prevalent is it?
Long COVID affects an estimated 6% of people who have had COVID‑19 in some studies, although prevalence estimates vary by population, variant, vaccination status and study methods. For some patients, symptoms resolve within months; for others—often described as “long haulers”—symptoms persist for years.
Because presentations are heterogeneous and can wax and wane over time, measuring the population burden of long COVID is challenging. This variability prompted skepticism early in the pandemic about the condition’s nature and causes. Yet accumulating evidence from clinical cohorts and population surveys now documents significant and sometimes profound reductions in quality of life for people with long COVID—reductions comparable to established chronic conditions such as chronic fatigue syndrome, stroke, rheumatoid arthritis and Parkinson’s disease.
Study design and methods
To understand functional outcomes in an Australian context, we surveyed 121 adults living with long COVID who had their initial SARS‑CoV‑2 infection between February 2020 and June 2022. Most respondents were aged 36–50 and had managed their acute illness at home rather than in hospital. The study used two internationally validated patient‑reported outcome measures: the WHO Disability Assessment Schedule (WHODAS 2.0) to quantify disability across domains of functioning, and the Short Form Health Survey (SF‑36) to measure quality of life.
These instruments prioritize the patient’s voice, capturing how symptoms affect daily tasks, social roles and emotional wellbeing—dimensions that laboratory tests or imaging studies cannot fully capture.
Key findings: disability and everyday life
Findings from the survey were striking. People living with long COVID reported functional impairment exceeding that of 98% of the general Australian population on WHODAS measures. Overall, 86% of respondents met a threshold consistent with serious disability, compared with about 9% in the general population. On average, participants reported difficulty completing daily activities on roughly 27 days per month and complete inability to function on about 18 days per month.
Basic self‑care tasks—eating, dressing—were less frequently affected. However, more complex activities such as household chores, paid work and social participation were substantially impaired. Many participants could meet essential needs but struggled to contribute to their home life, workplace productivity, and community engagement.
Quality of life scores were on average 23% lower than population norms. The domains most affected were energy (reflecting pervasive fatigue) and social functioning (reflecting isolation, reduced participation and cognitive barriers to social interaction).
Life with long COVID can make normal activities a challenge. (Pavel Danilyuk/Pexels/Canva)
Interpreting functional scores
Comparison to other conditions is important for clinical and policy response. The degree of disability documented in this cohort is similar to levels reported in studies of stroke and Parkinson’s disease—conditions traditionally prioritized for rehabilitation services. This emphasises that long COVID is not merely inconvenient; for many, it is a disabling multisystem condition with measurable consequence for independence and participation.
Why self‑reported outcomes matter
Long COVID lacks a single diagnostic biomarker. Consequently, patients frequently report that clinicians and systems have minimized or dismissed their symptoms. Our analysis demonstrates that simple self‑reported recovery ratings strongly predict both disability and quality‑of‑life outcomes. Self‑reports therefore provide valid, actionable clinical information and should be central to assessment and care planning.
Fatigue in long COVID is not interchangeable with ordinary tiredness: it can manifest as abrupt loss of concentration while driving, inability to sustain hobbies, or withdrawal from social relationships—each with safety and psychosocial implications.
Fatigue can interfere with work, hobbies, and relationships. (KORN V./Quality Stock Arts/Canva)
Implications for health services and policy
International studies mirror our results: multi‑country analyses report similar disability burdens and show higher reported disability among women. Long COVID’s fluctuating and multisystem nature challenges traditional single‑discipline models of chronic care. Health systems must broaden beyond episodic medical treatment to offer integrated rehabilitation services, occupational supports and social care.
Practical interventions include fatigue management strategies such as pacing (planned activity‑rest cycles), cognitive rehabilitation for attention and memory deficits, and tailored workplace accommodations (reduced hours, flexible duties, phased return‑to‑work plans). Social reconnection supports are also essential to mitigate the isolation that compounds disability.
Failing to recognise and respond to long COVID risks amplifying socioeconomic inequities. Evidence to parliamentary inquiries suggests hundreds of thousands of Australians may be affected—disproportionately impacting those in disadvantaged communities through lost income, strained carers and reduced access to services.
Expert Insight
Dr. Emily Carter, Consultant in Rehabilitation Medicine, observes: “Long COVID presents a spectrum of functional loss that often requires interdisciplinary care—physiotherapy, occupational therapy, cognitive rehabilitation and psychological support. Listening to patients’ experiences is the first clinical step; structured patient‑reported measures then guide targeted interventions.”
Recommendations and next steps
Action requires three linked priorities: (1) routine use of validated patient‑reported outcome measures in primary and specialist care; (2) development of multidisciplinary rehabilitation pathways that integrate pacing strategies, cognitive support and vocational rehabilitation; and (3) policy commitments to fund services and workplace protections so people can remain economically and socially engaged.
These steps depend on clinical teams valuing lived experience as essential data, not anecdote. Thoughtful assessment, timely referral and flexible workplace policies can help restore function and dignity for people living with long COVID.
Conclusion
Long COVID is a real, measurable source of disability for many people. Our study shows its impact on daily life can be comparable to conditions like stroke and Parkinson’s disease, with profound consequences for work, family and community participation. Recognising long COVID as a disabling condition—validating patient reports, expanding rehabilitation services, and enacting supportive workplace and social policies—will be essential to reduce individual suffering and prevent widening social inequities.
Acknowledgements: We gratefully acknowledge the contributions of co‑authors and collaborators on the study, including Tanita Botha, Fisaha Tesfay, Sara Holton, Cathy Said, Martin Hensher, Mary Rose Angeles, Catherine Bennett, Bodil Rasmussen and Kelli Nicola‑Richmond. The research team included Danielle Hitch (Senior Lecturer, Occupational Therapy, Deakin University), Genevieve Pepin (Professor, School of Health and Social Development, Deakin University), and Kieva Richards (Lecturer, Occupational Therapy, La Trobe University).
Comments