Study findings updated . AI-assisted evidence summary, not individual medical advice or a clinician endorsement.
Key findings
4.9× higher ME/CFS riskHazard ratio for new ME/CFS after infection vs matched uninfected adults
ME/CFS developed far more often after COVID than without infection.
In a large US study of adults not hospitalized for COVID, 4.5% of infected people met criteria for ME/CFS, a disabling fatigue illness, versus 0.6% of uninfected people. Tracked from infection, their rate of new ME/CFS was 4.93 times that of matched uninfected adults (hazard ratio). Crashes after even small effort (post-exertional malaise) were the top symptom, reported by 24.0% of infected people.
Because COVID infections are so widespread, even a modest rise in risk could mean many new people living with ME/CFS. Knowing that crashes after effort are its hallmark helps people and doctors recognize it. Observational study based on self-reported symptoms, which can wax and wane, so it cannot prove COVID caused ME/CFS.
A US cohort study at 83 sites in 33 states that followed 11,785 infected and 1,439 uninfected adults between October 2021 and September 2024.
From the study: “The proportion of all RECOVER-Adult participants that met criteria for ME/CFS following SARS-CoV-2 infection was 4.5% (531 of 11,785) compared to 0.6% (9 of 1439) in uninfected participants.”
4.9× higher ME/CFS risk
Vernon SD et al. Incidence and Prevalence of Post-COVID-19 Myalgic Encephalomyelitis: A Report from the Observational RECOVER-Adult Study. Journal of general internal medicine. 2025.
From the study: “a hazard ratio of 4.93 (95% CI 3.62-6.71)”
4.9× higher ME/CFS risk
Vernon SD et al. Incidence and Prevalence of Post-COVID-19 Myalgic Encephalomyelitis: A Report from the Observational RECOVER-Adult Study. Journal of general internal medicine. 2025.
From the study: “Post-exertional malaise was the most common ME/CFS symptom in infected participants (24.0%, 2830 of 11,785).”
4.9× higher ME/CFS risk
Vernon SD et al. Incidence and Prevalence of Post-COVID-19 Myalgic Encephalomyelitis: A Report from the Observational RECOVER-Adult Study. Journal of general internal medicine. 2025.
1 in 93 after infectionFrom pooled POTS rate of 1.08% after infection; 0.039% after vaccination
POTS followed COVID infection far more often than vaccination.
Pooling published studies, researchers estimated POTS in 1.08% of people after COVID infection (about 1 in 93) versus 0.039% after vaccination (about 1 in 2,600), based on 5 and 2 studies. Infected people were 2.12 times as likely as uninfected people to develop POTS (risk ratio). Post-vaccine POTS cases tended to start sooner after exposure.
For anyone worried that a COVID shot could trigger POTS, the pooled numbers point the other way: the infection itself was linked to far more cases. Vaccine-linked POTS appears possible but uncommon. A meta-analysis of just 5 infection and 2 vaccination studies with very wide uncertainty; the authors say evidence on post-vaccination POTS is limited.
A systematic review and meta-analysis of studies and case reports on POTS after COVID infection or vaccination, searched up to June 2023.
From the study: “cases per 10,000 (i.e., 1.08 % and 0.039 %) in infected and vaccinated individuals based on 5 and 2 studies, respectively.”
1 in 93 after infection
Yong SJ et al. Pooled rates and demographics of POTS following SARS-CoV-2 infection versus COVID-19 vaccination: Systematic review and meta-analysis. Autonomic neuroscience : basic & clinical. 2023.
From the study: “POTS was 2.12-fold more likely to occur in infected than uninfected individuals”
1 in 93 after infection
Yong SJ et al. Pooled rates and demographics of POTS following SARS-CoV-2 infection versus COVID-19 vaccination: Systematic review and meta-analysis. Autonomic neuroscience : basic & clinical. 2023.
From the study: “the time from exposure to symptom onset was shorter for cases of post-vaccination POTS”
1 in 93 after infection
Yong SJ et al. Pooled rates and demographics of POTS following SARS-CoV-2 infection versus COVID-19 vaccination: Systematic review and meta-analysis. Autonomic neuroscience : basic & clinical. 2023.
79 days to normal pulseAverage time for resting heart rate on wearables to return to baseline after COVID
Wearable trackers showed resting heart rate stayed raised for weeks after COVID.
Among people sharing wearable-tracker data, those who tested positive took longer than symptomatic people who tested negative to get back to their usual resting heart rate: on average 79 days after symptoms began. Steps and sleep recovered sooner, at 32 and 24 days. About 1 in 7 (13.7%) stayed more than 5 beats per minute above their own baseline for more than 133 days.
A lingering fast resting pulse is something many people can see on their own watch. The authors suggest it may reflect COVID unsettling the body's automatic heart-rate control, or ongoing inflammation, long after the acute illness. A small observational study of 234 people with COVID who chose to share wearable data; symptoms were tracked only during the acute illness.
An app-based study comparing wearable fitness-tracker data from 234 people who tested positive for COVID with 641 symptomatic people who tested negative.
From the study: “a prolonged relative tachycardia that did not return to baseline, on average, until 79 days after symptom onset.”
79 days to normal pulse
Radin JM et al. Assessment of Prolonged Physiological and Behavioral Changes Associated With COVID-19 Infection. JAMA network open. 2021.
From the study: “Step count and sleep quantity returned to baseline sooner than RHR at 32 and 24 days, respectively.”
79 days to normal pulse
Radin JM et al. Assessment of Prolonged Physiological and Behavioral Changes Associated With COVID-19 Infection. JAMA network open. 2021.
From the study: “(32 participants [13.7%]) maintained an RHR more than 5 beats per minute greater than their baseline RHR that did not return to their normal for more than 133 days.”
79 days to normal pulse
Radin JM et al. Assessment of Prolonged Physiological and Behavioral Changes Associated With COVID-19 Infection. JAMA network open. 2021.
3 years of symptomsMedian symptom duration (36 months) in an online group of adults with long COVID
Long COVID symptoms had lasted a median three years in 526 adults.
In this international online group of adults with long COVID, 71.9% had scores suggesting moderate-to-severe autonomic dysfunction (trouble with the body's automatic controls). 37.5% could no longer work or had to drop out of school. A third of the whole group (33%) had been newly diagnosed with POTS. Female sex and unusually flexible joints were linked to higher risk.
Autonomic problems after COVID are not always a few bad weeks: for many in this group they meant years of illness and lost jobs or schooling. That has real consequences for families, employers and schools. A self-selected online group of people with long COVID, mostly self-reported, so it shows how hard-hit patients fare, not how often this happens after COVID.
A follow-up survey of an international online cohort of adults aged 20 to 65 with long COVID; a subset also did a 10-minute standing test.
From the study: “A total of 71.9% of participants with LC had a Composite Autonomic Symptom Score-31 (COMPASS-31) score ≥ 20, suggestive of moderate-to-severe autonomic dysfunction.”
3 years of symptoms
Eastin EF et al. Chronic autonomic symptom burden in long-COVID: a follow-up cohort study. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. 2025.
From the study: “The median symptom duration was 36 [30-40] months, and 37.5% of participants could no longer work or had to drop out of school due to their illness.”
3 years of symptoms
Eastin EF et al. Chronic autonomic symptom burden in long-COVID: a follow-up cohort study. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. 2025.
From the study: “In addition, 40.5% of individuals with autonomic dysfunction were newly diagnosed with POTS, representing 33% of the total LC cohort.”
3 years of symptoms
Eastin EF et al. Chronic autonomic symptom burden in long-COVID: a follow-up cohort study. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. 2025.
1 in 14 had POTSFrom 7% of long COVID clinic patients meeting POTS criteria; no healthy volunteer did
A lean test flagged POTS in long COVID patients, not healthy volunteers.
Long COVID clinic patients in the UK did the NASA Lean Test: standing against a wall while pulse and blood pressure are checked. 15% had an abnormal result: 7% met criteria for POTS and 8% had a blood-pressure drop on standing (orthostatic hypotension). Of those with abnormal results, 45% had no earlier symptoms on standing. Healthy volunteers showed no POTS, though 10% had a symptom-free blood-pressure drop.
Relying on patients to report dizziness misses many cases. A cheap test needing little more than a wall and a blood-pressure cuff can flag them, which is why the authors urge offering it to everyone seen in long COVID clinics. Patients came from specialist UK long COVID clinics, so these rates describe people already seeking care, not everyone who has had COVID.
A multicenter UK study in which patients from long COVID clinics and healthy volunteers from the general population took the NASA Lean Test, a standing test.
From the study: “Forty-one (15%) had an abnormal NLT, 20 (7%) met criteria for PoTS, and 21 (8%) had OH.”
1 in 14 had POTS
Lee C et al. Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study. Journal of medical virology. 2024.
From the study: “Of patients with an abnormal NLT, 45% had no prior symptoms of OI.”
1 in 14 had POTS
Lee C et al. Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study. Journal of medical virology. 2024.
From the study: “Healthy volunteers had no history of OI symptoms or symptoms during NLT or PoTS, 10% had asymptomatic OH.”
1 in 14 had POTS
Lee C et al. Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study. Journal of medical virology. 2024.
92 bpm with compressionAverage tilt-test heart rate in full compression, vs 109 beats/min with none
Waist-high compression garments lowered heart rate and eased POTS symptoms on tilting.
Thirty adults with POTS (not specifically after COVID) each did a 10-min tilt-table test, being tipped upright, in 4 compression set-ups in random order. Average heart rate was 109 beats/min with none, 103 with leg-only, 97 with belly-and-thigh and 92 with full belly-and-leg compression, and symptoms improved step by step. Belly compression alone might help those who can't tolerate full garments.
Compression garments are already a common, drug-free prescription for POTS. This trial found that adding pressure around the belly and thighs, not just the calves, gave the biggest drop in heart rate during tilting. A small crossover trial of short tilt tests in people with POTS from any cause, not specifically COVID; everyday and long-term effects were not measured.
A randomized crossover trial in which thirty adults with POTS each did 10-minute tilt-table tests under 4 compression conditions.
From the study: “Thirty participants completed 10-min HUT with each of 4 compression conditions in a randomized crossover design.”
92 bpm with compression
Bourne KM et al. Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. Journal of the American College of Cardiology. 2021.
From the study: “The compression garment reduced heart rate (NONE: 109 ± 19 beats/min; LEG: 103 ± 16 beats/min; ABDO: 97 ± 15 beats/min; FULL: 92 ± 14 beats/min; p < 0.001)”
92 bpm with compression
Bourne KM et al. Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. Journal of the American College of Cardiology. 2021.
From the study: “Abdominal compression alone might also provide a clinical benefit if full lower body compression is not well tolerated.”
92 bpm with compression
Bourne KM et al. Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. Journal of the American College of Cardiology. 2021.
62% got betterOf 42 followed patients with new autonomic disorders, median 7 months later
Most people diagnosed with autonomic disorders after COVID or vaccination improved.
At a specialist center in Innsbruck, people newly diagnosed with heart-rate or blood-pressure disorders after COVID infection or vaccination all got lifestyle and non-drug advice; some also got medicines. Of 42 with follow-up a median of 7 months later, 26 (62%) markedly improved or fully recovered. POTS was the most common diagnosis. In 49% of new referrals, testing ruled out any such disorder.
A new POTS-type diagnosis after COVID or a vaccine is not necessarily permanent: most people tracked here felt clearly better within months. Careful testing also kept many from getting a wrong label. Records from one specialist clinic with no untreated comparison group, so it cannot show the care itself caused the improvement.
A review of records of people referred to the Innsbruck Dysautonomia Center from March 2020 to March 2023 with new dizziness or fainting after COVID infection or vaccination.
From the study: “Follow-up was available in 42 (81%) of post-COVID and post-vaccination newly diagnosed CAD (median follow-up time 7 [4; 10] months)”
62% got better
Leys F et al. Postural orthostatic tachycardia syndrome is the most frequent cardiovascular autonomic disorder following COVID-19 infection or vaccination. Journal of neurology. 2025.
From the study: “with a marked orthostatic symptom improvement or full recovery documented in 26 (62%) cases.”
62% got better
Leys F et al. Postural orthostatic tachycardia syndrome is the most frequent cardiovascular autonomic disorder following COVID-19 infection or vaccination. Journal of neurology. 2025.
From the study: “In half of newly referred individuals (n = 49/101, 49%), the diagnostic workup excluded any CAD.”
62% got better
Leys F et al. Postural orthostatic tachycardia syndrome is the most frequent cardiovascular autonomic disorder following COVID-19 infection or vaccination. Journal of neurology. 2025.
16 weeks, no benefitTailored exercise vs standard care on quality of life in COVID-triggered POTS
Tailored exercise did not beat standard care for COVID-triggered POTS.
Adults with POTS after COVID were randomly assigned to standard care alone or plus tailored exercise with weekly supervision. After 16 weeks, quality of life did not differ between groups, and the exercise group spent 31 fewer minutes a day upright than controls. Encouragingly, both groups improved in POTS symptoms, activity limits and physical capacity.
Exercise is often advised for POTS, but in this trial adding a tailored program did not improve quality of life over usual care. That supports the authors' view that exercise must be individualized and combined with other approaches. A small randomized trial of sixty adults, 85% women, followed for 16 weeks.
A randomized trial of sixty adults with COVID-induced POTS comparing standard care with standard care plus weekly-supervised tailored exercise for 16 weeks.
From the study: “Assessments were conducted at baseline and 16 weeks.”
16 weeks, no benefit
Svensson AM et al. Effectiveness of Individualized Physical Exercise in COVID-19-Induced Postural Orthostatic Tachycardia Syndrome. JACC. Advances. 2026.
From the study: “No time-by-group interaction effects were observed for HRQoL.”
16 weeks, no benefit
Svensson AM et al. Effectiveness of Individualized Physical Exercise in COVID-19-Induced Postural Orthostatic Tachycardia Syndrome. JACC. Advances. 2026.
From the study: “Upright time was reduced in the intervention group compared with controls, with an estimated between-group difference of -31 min/day, (95% CI -57 to -6).”
16 weeks, no benefit
Svensson AM et al. Effectiveness of Individualized Physical Exercise in COVID-19-Induced Postural Orthostatic Tachycardia Syndrome. JACC. Advances. 2026.
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[1]
Vernon SD et al. Incidence and Prevalence of Post-COVID-19 Myalgic Encephalomyelitis: A Report from the Observational RECOVER-Adult Study. Journal of general internal medicine. 2025.
Yong SJ et al. Pooled rates and demographics of POTS following SARS-CoV-2 infection versus COVID-19 vaccination: Systematic review and meta-analysis. Autonomic neuroscience : basic & clinical. 2023.
Eastin EF et al. Chronic autonomic symptom burden in long-COVID: a follow-up cohort study. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. 2025.
Lee C et al. Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study. Journal of medical virology. 2024.
Bourne KM et al. Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. Journal of the American College of Cardiology. 2021.
Leys F et al. Postural orthostatic tachycardia syndrome is the most frequent cardiovascular autonomic disorder following COVID-19 infection or vaccination. Journal of neurology. 2025.
Svensson AM et al. Effectiveness of Individualized Physical Exercise in COVID-19-Induced Postural Orthostatic Tachycardia Syndrome. JACC. Advances. 2026.
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