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. 2023 Jul 4;28(12):4968–4976. doi: 10.1038/s41380-023-02161-5

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Coronaviruses, such as SARS-CoV-2, can enter the brain through a direct infection pathway (e.g., blood circulation and neuronal pathways), and other mechanisms. Studies using autopsies from patients who died from COVID-19 detected SARS-CoV-2 in the brain. The ability of SARS-CoV-2 to enter the brain implies its role in the long-term neurological symptoms (e.g., difficulty thinking or concentrating, headaches, dizziness, cognitive impairment) and psychiatric symptoms (e.g., depression, anxiety, sleep problems) observed in COVID-19 survivors. The other most common symptoms of long COVID were general symptoms (e.g., loss of smell or taste, tiredness or fatigue), respiratory and heart symptoms (e.g., difficulty breathing or shortness of breath, cough, chest pain, fast-beating or pounding heart), and gastrointestinal symptoms (e.g., nausea, abdominal pain, loss of appetite, heartburn, constipation). There is also increasing evidence that alterations in the gut, nasal, oral, and lung microbiomes may contribute to long COVID symptoms. Part of the figure was designed using resources from Biorender.com.