By Joseph E. Scherger, MD, MPH

Core Faculty, Eisenhower Health Family Medicine, Residency Program, Eisenhower Health Center, La Quinta, CA; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles

SYNOPSIS: Long COVID is the latest entry into a long list of potentially chronic, pandemic-associated infections. For many long COVID patients, some symptoms may be the result of a reactivation of an Epstein-Barr infection.

SOURCE: Gold JE, Okyay RA, Licht WE, Hurley DJ. Investigation of long COVID prevalence and its relationship to Epstein-Barr virus (EBV) reactivation. Pathogens 2021;10:763.

Persistence of symptoms after the acute phase of COVID-19 infection is common. The CDC is documenting and studying post-COVID conditions, and the list of symptoms and organ systems involved is growing.1 The Advisory Board estimates nearly 25% of patients who test positive for COVID-19 experience post-COVID symptoms, even if the initial infection was mild or asymptomatic.2

Long et al investigated long COVID prevalence among 185 randomly surveyed COVID-19 patients. They found 56 patients (30.3%) exhibited symptoms of long COVID. The unique finding of this study was 66.7% of long COVID patients experienced reactivation of Epstein-Barr virus (EBV), which may explain some of their symptoms.


The explosion of HIV in the 1980s made clinicians and the public aware that we may carry serious viral infections long term. Virologists have learned this always has been the case, with more than 90% of individuals worldwide testing positive for EBV.3 Hepatitis B and C are other examples of long-term viral infections. With better anti-virus medications, some of these long-term infections can be eradicated.

In a recently published book on infectious disease, the authors described how Lyme and many other similar infections become “long-haul” conditions.4 Both authors nearly died of Lyme disease and have dedicated themselves to informing the public of chronic infections.

At this point, long COVID is not described as a chronic infection associated with the virus. That likely will change soon as the identification of the active virus in patients becomes more accessible. COVID-19 will become the latest entry into a long list of chronic infections that may sap human health. Vaccines, better medications, and a robust immune system free of common chronic diseases like type 2 diabetes will help us survive and stay healthy. While we may not like to dwell on it, our survival is us vs. the pathogens. 


  1. Centers for Disease Control and Prevention. Post-COVID conditions. Updated July 12, 2021.
  2. Advisory Board. Just how common is ‘long Covid’? Here’s what a new study suggests. June 17, 2021.
  3. Smatti MK, Al-Sadeq DW, Ali NH, et al. Epstein-Barr virus epidemiology, serology, and genetic variability of LMP-1 oncogene among healthy population: An update. Front Oncol 2018;8:211.
  4. Phillips S, Parish D. Chronic: The Hidden Cause of the Autoimmune Pandemic and How to Get Healthy Again. Mariner Books; 2021.