In some parts, they are referred to as long-haulers. No, not the passengers on the flight from Cape Town to Newark in the US. Though spending upwards of 15 hours in the company of hundreds of strangers and their germs is enough to make anyone sick.

Long-haulers is, of course, one of the terms used to describe the 6–10% of patients who recover from acute Covid but still experience symptoms months later. While most people refer to it as long Covid, the official name, as per the World Health Organisation (WHO), is post-Covid condition or PCC. It’s also been referred to as ‘post-acute Covid-19 syndrome’ and ‘chronic Covid-19’.

‘While data [is] limited, the chance of developing [PCC] appears to be lower now than earlier in the pandemic. However, the virus is still circulating widely, and every new infection is associated with a risk,’ the WHO reported in February 2025.

Five years after the term ‘long Covid’ was first coined at the beginning of the pandemic by patients battling to recover from the Covid-19 virus, the WHO says it is still getting to grips with developing clinical practice guidelines to manage the condition.

The problem with PCC, or long Covid, is that the list of symptoms is vague and extensive – there are about 200, according to the Centers for Disease Control (CDC) in the US, and they ‘can overlap with multi-organ complications, or with effects of treatment or hospitalisation’.

That makes diagnosis difficult: in a March 2025 scoping review of diagnostic challenges in low- to middle-income countries published in the International Journal of Infectious Diseases (IJID), Wits University’s Kyrtania Pather reports that the overlap between long Covid symptoms and those of prevalent conditions like HIV/Aids and tuberculosis contributes to frequent misdiagnoses.

‘Limited training for healthcare workers in recognising long Covid further exacerbates the issue of under-diagnosis, and the lack of systematic patient follow-up and comprehensive diagnostic tools may also contribute to care gaps,’ she writes.

The WHO’s list of common symptoms includes ‘fatigue, breathlessness, muscle or joint pain and impaired sleep’. The CDC adds to the list: brain fog (aka ‘cog fog’), post-exertional malaise; heart palpitations; coughing; chest pain; headaches; light-headedness; pins and needles; change in smell or taste; stomach pain; depression or anxiety; diarrhoea; and even changes to menstrual cycles for women.

‘Most […] symptoms last up to nine months, although there have been cases where they’ve persisted for longer,’ says Rikus Louw, a physician at Mediclinic Stellenbosch.

While the symptoms may appear vague, the economic impact can be real. In 2022, Harvard researchers estimated that long Covid costs the US up to $200 billion per year in lost wages and increased medical costs.

Individually, long Covid symptoms don’t appear to present much of a health risk, which may explain why those suffering from their compounded effects, consequently becoming unproductive at work, could face accusations of malingering.

‘Many individuals suffer in silence and are hesitant to seek help due to the stigma surrounding long Covid,’ according to Noluthando Nematswerani, chief clinical officer at Discovery Health, who was speaking in an online workshop for human resources officers in 2023.

Another local study into long Covid, led by Waasila Jassat of SA’s National Institute for Communicable Diseases and published in the IJID in 2023, suggested that nearly half of all individuals who tested positive for Covid-19 and were treated in hospital, and one in five of those who had the virus but recovered at home, were affected by long Covid.

As for treatment, Discovery Health notes in its Covid recovery guide 2025 that there is no specific medicine approved to treat long Covid and that studies are ongoing. Vaccination against Covid remains ‘the best way to prevent post-Covid conditions’, it says.

The impact on patients’ lives – at work and at home – is undeniable. Catherine Ward, a psychology professor at UCT, shared her experience of living with long Covid in Daily Maverick in April 2024. ‘In 2020, I was swimming 40 lengths of the gym pool before working a 10-hour day. Now I can barely walk 400 steps in one go.’

The NCID’s Jassat told the journal Nature that in her study ‘quite a number of people said [long Covid] impacted their occupation and they either had to change jobs or take a role with lesser responsibilities because of the symptoms’.

Renata Schoeman, head of the Healthcare Leadership MBA programme at Stellenbosch Business School says the impact of long Covid on productivity and employee retention calls on employers to be flexible and adaptable to accommodate employees on the long road to recovery.

Quoting an early study, she says almost 50% of patients indicated they needed a reduced work schedule compared to before they became ill, and more than 20% said they were not working because of their health conditions.

Schoeman says employers need to review their occupational health services, employee assistance and wellness programmes, sick leave policies, post-illness return-to-work plans and ensure they are not discriminating on the grounds of mental health or disability.

‘The implications are far-reaching, and the likes of healthcare funders and income-protection insurers need to review their policies and guidelines on treatment and disability. The medical profession and policy-makers need to arrive at objective diagnostic and assessment criteria, and guidelines for best practice in evidence-based treatment and management of long Covid,’ she says.

Mediclinic’s Louw envisages ‘long Covid clinics where patients can be properly managed and monitored so that they can return to their original state of health and well-being’.

Schoeman emphasises the importance of developing objective criteria for a diagnosis ‘since many of its key aspects such as brain fog and fatigue are largely “invisible”, and employers would need to guard against abuse of sick leave, flexible work arrangements and workplace accommodations’.

It requires a delicate balance. If long Covid sufferers don’t get support from employers, it could lead to added stress and anxiety, according to Discovery Health’s Nematswerani, thus perpetuating a vicious cycle.

‘This mismanagement can lead to individuals resigning from their jobs without receiving the proper diagnosis or support,’ she says. ‘The culture of the organisation also plays a significant role in determining whether individuals feel safe to open up about their experiences,’ she says.

Nematswerani advises that employers offer flexible working options to those struggling with long Covid and provide support to access scheme benefits and employee benefits such as disability. ‘Interventions must be tailored to the needs of the patient, taking into consideration the severity of symptoms,’ she says.

Schoeman echoes this, saying that because the symptoms of long Covid are diverse and vary between individuals, and change and fluctuate over time, it is important for employers to discuss their condition with individual employees and understand what support they need, and to allow for flexibility in workplace set-ups.

She says that where long Covid persists for more than a month, where the person may need to take sick leave, by the second month the employer would need to consider ‘reasonable accommodation and/or reduced responsibilities’ for the employee.

Beyond two months, Schoeman advises assessment and treatment by a multi-disciplinary team, involving the general practitioner as well as professionals in areas such as psychiatry, neuropsychology and occupational therapy.

Long Covid may be hard to treat and hard to diagnose, but it looks like it’s here to stay – for the long haul.

By Robyn Leary
Image: Gallo/Getty Images