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Long COVID: The Causes, Symptoms, & Possible Treatments; And Its Relationship With POTS

Updated: Jun 18

Long COVID. For some of us, mentioning COVID brings back memories of a more difficult time. Some say their health transformed from having more time to exercise. Some people report they had more time for hobbies and activities. Despite what side of the coin you are on, thankfully, much of the world can say they have recuperated from this trying time and are balancing their lives out like before the pandemic.

Still, some people are not so lucky today. Millions of people worldwide have developed a novel condition called Long COVID, a subtle but serious condition with complex and often strenuous symptoms that develop after an initial COVID-19 diagnosis. A review article in Nature Reviews Microbiology states that over 65 million people worldwide suffer from Long COVID. Navigating a proper healing path through Long COVID while the science is still catching up can be scary and difficult. Even more, many patients with Long COVID may suffer from an additional condition called POTS without knowing it. Still, some emerging answers address Long COVID causes, symptoms, and possible treatments.

This blog post aims to establish what Long COVID is, its symptoms, and possible treatments. It also addresses what POTS, or Postural Orthostatic Tachycardia Syndrome is and how it relates to Long COVID. At the end of this blog, you will understand the ins and outs of Long COVID and the steps you or a loved one can take to heal.

Table of Contents:

What Is Long COVID?

Long COVID is a new condition (also called post-acute COVID-19 syndrome) that develops after an initial COVID-19 diagnosis. Long Haulers (people with Long COVID) may experience their initial COVID symptoms for longer, even after receiving a negative COVID test. Or, Long Haulers may experience new health symptoms independent of their initial COVID symptoms that remain for unknown periods.

Here is a list of common Long COVID symptoms individuals may experience:

Common Long COVID Symptoms:

1. Fatigue: Persistent and debilitating fatigue that significantly impacts daily functioning.

2. Respiratory Issues: Difficulty breathing or experiencing breathlessness, even during light physical activity. Coughs, chest pains, and a rapid heart rate are also reported.

3. Brain Fog: Cognitive difficulties like memory problems, difficulty concentrating, poor focus, mental confusion, forgetfulness, experience sensory overload, or a lack of mental clarity. ​

4. Digestion Issues: The CDC says diarrhea and stomach pain are common digestion symptoms of Long COVID.

5. Neurological Symptoms: Migraines, dizziness when standing, depression or anxiety, and long-term loss of taste or smell are other common Long COVID symptoms reported by the CDC. ​

6. Muscle & Body Pains: Muscular tension and joint pains have also impacted Long Haulers. ​

7. Vestibular Issues: Vertigo and balance (along with dizziness when standing) are sometimes present in patients with Long COVID. ​

8. Sleep Disturbances: Many patients with Long COVID experience disturbances in sleep or an inability to stay asleep at night. 9. Lung Inflammation: Long COVID symptoms also present as inflammation of the lungs, causing uncomfortable respiratory issues. 10. Legs Turning Blue: You heard that right. News Medical reports that a new symptom has emerged: patients who stand up for too long notice color changes in their legs, specifically blue.

Long COVID & POTS Syndrome

Interestingly, Long COVID presents itself similarly to another lesser-known condition called POTS. POTS is a form of “Dysautonomia” or autonomic nervous system dysfunction.

What is POTS Syndrome and How Does It Relate to Long COVID?

POTS (Postural Orthostatic Tachycardia Syndrome) causes dysfunction of the Autonomic Nervous System (ANS) from standing upright. When standing upright, patients with POTS experience an increased heart rate and other debilitating symptoms resulting from the dysfunction of the ANS (Dysautonomia), causing the heart to overcompensate to attempt to pump blood to all corners of the body.

Interestingly, many common symptoms of POTS have shown up in patients with Long-COVID, indicating to many scientists and doctors that POTS may be a condition a patient develops after a COVID-19 diagnosis, as the symptoms were not present before contracting COVID-19.

Standard POTS symptoms include chronic fatigue, brain fog, dizziness, heart palpitations, headache, GI distress, muscle fatigue, and difficulty performing everyday activities. If you compare this list of POTS symptoms to the Long COVID symptoms above, they are strikingly similar.

Genetic predisposition, viral infections, vitamin deficiencies, mycotoxin infections, hormonal imbalances, autoimmune diseases, physical trauma, and neurological disorders can all affect POTS’ development. However, Long COVID’s development is still being studied, and its direct causes are unknown.

How Do I Identify If I Have POTS or Long COVID?

It is important to stress that not all patients who had COVID-19 or currently have Long COVID fit the criteria for a POTS diagnosis. A POTS diagnosis requires a Tilt Table Test or an Active Stand Test. A Tilt Table Test involves a table that a patient is securely strapped into, and starting at a lying down position, the table is tilted until you are fully upright, mimicking a standing position. During this test, heart rate and blood pressure are recorded. If your heart rate surpasses 30 or more beats per minute or goes over 120 bpm after 10 minutes of being fully upright, you qualify for a POTS diagnosis.

The Active Stand Test is an alternative to the Tilt Table Test in diagnosing POTS. Blood pressure and heart rate are also measured during this test, but instead of being strapped to a table, you initiate standing from a lying down position on your own with a qualified physician. If the qualifying measurements in heart rate are recorded in the Active Stand Test, you also qualify for a POTS diagnosis. If your symptoms do not meet the criteria for a POTS diagnosis, then you do not have POTS. But that means you still have Long COVID. Read below for treatment strategies for Long COVID.

2-14% of people develop POTS after an initial COVID-19 diagnosis (Bryarly and Vernino, 2023). While not overwhelming statistics, they are still essential to pay attention to as 65 million people with Long COVID worldwide may suffer from POTS and Long COVID simultaneously without knowing it.

With Long COVID, symptoms present themselves after initially having a COVID-19 diagnosis. You cannot have Long COVID if you never had COVID-19. So, even if you contracted COVID-19 without knowing it, you can still develop Long COVID. However, while the direct causes of Long COVID are unknown and still being studied, POTS is a condition that can be swiftly identified with a qualified physician. Since POTS is a lesser-known condition in the modern medical era, it is imperative to find a doctor or clinic like Better Brain & Body who specialize in POTS or Dysautonomia to determine if your Long COVID symptoms result from undiagnosed POTS. This test will be done using the Tilt Table or Active Stand Tests. If a doctor rules you out for POTS and other potential conditions but you exhibit many of the Long COVID symptoms described above, then you have Long COVID.

Disclaimer: Both POTS & Long COVID diagnostic tests require a qualified physician overseeing your diagnosis.

Treatments for Long COVID

Currently, Long COVID does not have a cure. POTS is also not curable but responds well to effective and holistic treatment strategies. To learn about POTS treatment strategies, visit this blog post. Since Long COVID symptoms result from many different bodily systems, treating one specific area of your symptoms will not help your overall healing process.

Better Brain & Body believes in taking a holistic-centered approach, addressing the whole experience an individual with Long COVID is having. We have many different therapies that address the root cause of the symptoms associated with Long COVID.

Call 704-752-8100 today to schedule a free 15-minute phone consultation with Dr. Brown to discuss your specific symptoms and see if our therapies are right for you. You can also schedule an appointment online using the button below.

Reviewed by Dr. Alicia Brown, DC, DACNB.


Beusekom, Mary V. MS. "More than 65 Million People around the World May Have Long COVID." University of Minnesota CIDRAP, 18 Jan. 2023,

Bryarly, Meredith M.D. M.D., and Steven Vernino M.D., Ph.D. "POTS or Long COVID? How to Tell the Difference." UTSouthwestern Medical Center, 12 Jun. 2023,

"Research Focuses on Long Covid Patient's Legs Turning Blue After 10 Minutes of Standing." News Medical Life Sciences, 11 Aug. 2023,

Sreenivas, Shishira , and Dan Brennan M.D. "What Is Long COVID (PASC)?" WEBMD, 2 Jan. 2023,

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