Lingering Cough After COVID? Why It Happens and What to Do About It

A cough can last for quite a while after any viral infection, and it doesn't necessarily mean you're still contagious.

Man with lingering cough from COVID covering mouth with inside of elbow
Photo: cottonbro / Pexels

Having a cough is one of the main symptoms of COVID-19—but what if that cough lingers long after you've started feeling better or are no longer testing positive for the virus?

According to infectious disease doctors, a lingering cough after COVID-19 is possible, but it's not usually a cause for concern—nor is it strictly related to the SARS-CoV-2 virus. "Many viral infections leave people with a chronic cough," Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Health. "It is not an uncommon condition."

Though COVID-19 affects everyone differently, a cough from the virus can appear as early as day one of the virus, and last for as many as 19 days, according to research published in The Lancet Respiratory Medicine in May 2021. But that same research showed that as many as 5% of people have a cough that lasts for four weeks or more.

But why do some people have a lingering cough after having COVID-19—and what (if anything) can be done to help it clear up quicker? Here's what you need to know.

What Causes a Lingering Cough After COVID-19?

It goes back to the way COVID-19 affects your body—specifically the inflammation it causes. "COVID-19 can inflame the mucus membranes of the airways, starting back in the throat and getting down into the bronchial tubes," William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, told Health. "That inflammation may take quite a while to heal in some patients."

That "residual inflammation"—even after someone has recovered from the virus—is likely what triggers the cough reflex," said Dr. Adalja.

Though it can be annoying, having a lingering cough isn't necessarily a bad thing. "The whole purpose of a cough is for the body to clear the airway of stuff that shouldn't be down there," said Dr. Schaffner. "When you have inflammation in your airways, you have dying cells and extra mucus in there. Coughing is your body's way of trying to keep the airways clear."

Are You Still Contagious With a Lingering Cough?

According to the Centers for Disease Control and Prevention (CDC), people with mild to moderate COVID-19 have been shown to remain infectious no longer than 10 days after symptom onset; for people with more severe or critical illness, that period extends to 20 days.

Because symptom onset is an essential part of determining when to begin isolation, symptoms (including cough) do matter when it comes to infectiousness with COVID-19. However, if you're near the end of your isolation period and symptoms are still present but improving (most notably, if you have been fever-free for 24 hours), you're likely in the clear from spreading the virus.

"The data would indicate that, by the time 10 days have elapsed and you've generally improved, the virus is gone and you're no longer contagious to others," said Dr. Schaffner. "You don't have to be in perfect health."

This even extends to people who are possibly still testing positive after the full 10-day isolation and masking period. According to the CDC, some people who have recovered from COVID-19 may still test positive for the virus through more sensitive PCR testing for up to three months. But this prolonged positive testing doesn't necessarily indicate transmission risk.

Is Long COVID a Concern if You Have a Lingering Cough?

Long COVID, or post-COVID conditions (PCC), can include a wide range of new, returning, or ongoing health problems that people experience after being infected with SARS-CoV-2, according to the CDC. These issues can last more than four weeks, up to a few months after having COVID-19.

The symptoms can affect any bodily system—respiratory, digestive, cardiovascular, neurological—but because there's no official medical test for long COVID, it's a difficult condition to diagnose. "We don't really have a good definition for long COVID yet, so it feels like anything is game, depending on how you define long COVID," Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York, told Health. "Most of these pulmonary changes improve fairly quickly, but timing is everything."

Though cough is identified as a potential respiratory symptom of long COVID, experts are hesitant to definitively associate a lingering cough with the condition. "Categorizing something as part of long COVID means it has to interfere with activities of daily living," said Dr. Adalja. "Chronic cough does not usually interfere with people's activities in a way that some other symptoms associated with long COVID do."

Having a lingering cough alone, independent of other symptoms, may also indicate that it's not long COVID. "We wouldn't consider a lingering cough long COVID in and of itself," said Dr. Schaffner. "Usually, these airway irritations don't take that long to clear up."

How to Treat a Lingering Cough After COVID-19—And When to See a Doctor

Though it's not necessarily bad or harmful to have a lingering cough from COVID-19, you can try to keep it under control with over-the-counter cough medicine, said Dr. Adalja.

It's also a good idea to stay hydrated. "It will make it easier for your body to clear away any stuff that's in your airways and will promote healing," said Dr. Schaffner. But you should also do your best not to stifle a cough, too. "It's actually a bit better to allow yourself to cough to try to help your body restore itself," he added.

If you have a lingering cough from COVID-19 and it's getting worse, it's interfering with your life, it hasn't gone away or started to get better after a month, or you've developed a fever, you may want to seek advice from a health care provider. "If you're at all concerned, reach out,": said Dr. Russo, "If nothing else, for reassurance."

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