Philip Levy MD, MPH: Understanding COVID’s Lingering Impact

In an interview with The Educated Patient, Phillip Levy, MD, MPH, discusses how Long COVID affects a subset of individuals who previously had COVID-19, with roughly two-thirds of long COVID cases arising in people who had severe initial infections.

However, a significant portion—around one-third—develops Long COVID despite having only mild or even asymptomatic initial cases, often experiencing symptoms that arise later and persist confusingly without clear triggers.

While exact reasons for why some people develop Long COVID remain unclear, Levy, a professor in the Department of Emergency Medicine at Wayne State University and associate vice president for Translational Science in the Office of the Vice President for Research, notes that the risk is reduced by vaccination. Vaccination seems to lower the likelihood of Long COVID by helping the body clear the virus more effectively, possibly preventing it from persisting in organs where it might re-emerge and continue causing issues.

He says one theory suggests that the virus can linger in small amounts within organs and potentially reactivate, which may lead to persistent symptoms even after recovery from the acute infection. People with immune system irregularities, such as autoimmune disorders, might be at a higher risk because their immune systems may struggle to clear the virus entirely or respond effectively to its reactivation. Additionally, those with certain chronic conditions, including cardiovascular disease, diabetes and high blood pressure, tend to be more susceptible to Long COVID.

Levy also highlights the wide variety of symptoms associated with Long COVID, noting that over 200 different symptoms have been reported. Common issues include chronic fatigue, cognitive problems often called “brain fog,” heart palpitations, ongoing respiratory symptoms and lingering loss of taste or smell. It can also manifest as difficulty regulating blood sugar or blood pressure.

According to Levy, diagnosing Long COVID is inherently challenging because there are no specific lab tests or blood work to confirm it directly. He explains that it’s largely a clinical diagnosis, often made by exclusion, and stresses the importance of patients being thorough and specific when discussing their symptoms with healthcare providers. Detailed symptom timelines, including onset and duration, help build a case for Long COVID, as diagnosis depends on documented persistence over time.