What To Do About a Lingering Cough After COVID

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

Fact checked by Vivianna ShieldsMedically reviewed by Karis Cho, MD

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?

A lingering cough after COVID-19 affects nearly 5% of people infected by the virus. While coughing is a common symptom of COVID-19, it can potentially linger for longer than four weeks—and up to six months—after testing negative. The Omicron variant targets upper airways more than the lower airways as compared to other variants.

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."

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 more quickly? Here's what you need to know.

What Causes a Lingering Cough After COVID-19?

A lingering cough after COVID-19 results from the way the virus affects your body. An upper respiratory infection (URI) like COVID can lead to inflammation.

"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."

A respiratory infection can also change the way vagal sensory nerves communicate with your brain, making you more sensitive to the cough reflex. Vagal sensory nerves are part of your parasympathetic nervous system, which helps your body relax. They help control involuntary functions like digestion, breathing, blood pressure, heart rate, and immune system responses.

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."

Does the Type of Cough Matter?

There are two primary types of coughs.

• Wet (productive) cough: Produces mucus or phlegm

• Dry (unproductive) cough: Does not produce mucus or phlegm

It's difficult to diagnose COVID based on the sound of the cough. About 60-70% of people COVID-19 experience a dry cough toward the beginning of the infection. However, many people have a wet cough. Your cough might also change.

Get tested if you think you might have COVID-19—or if you may have been exposed—and reach out to your healthcare provider with any concerns.

Related: How Talking Spreads COVID-19

Are You Still Contagious With a Lingering Cough?

A lingering cough after COVID-19 does not always mean you are still contagious. According to the Centers for Disease Control and Prevention (CDC), people with mild to moderate COVID-19 have been shown to remain infectious up to 10 days from symptom onset; for people with more severe COVID infection or those who are moderately or severely immunocompromised, that period extends to 20 days or potentially longer.

Symptom onset is an essential part of determining when to begin isolation. However, if you're near the end of your isolation period and symptoms are still present but improving—especially if you have been fever-free for 24 hours—you're likely in the clear from spreading the virus.

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. Prolonged positive antibody testing doesn't necessarily indicate transmission risk unless you are immunocompromised. If that is the case, you should consult with a healthcare provider.

Related: Stomach Flu vs. COVID-19: Here's How To Tell the Difference

Is a Cough a Sign of Long COVID?

Long COVID, or post-COVID conditions (PCC), can include a wide range of new, returning, or ongoing health symptoms that people experience after being infected with SARS-CoV-2. These symptoms last for at least three months from the onset of a COVID-19 infection. Symptoms can affect any bodily system, including respiratory, digestive, cardiovascular, and neurological. However, there's no official medical test for long COVID, making it a difficult condition to diagnose.

Cough is one of the most common long-lasting symptoms of COVID. One study of about 8,600 adults with long COVID found that about 33% of people experienced chronic cough at least six months after symptom onset.

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."

Possible complications of a persistent cough after COVID-19 include:

• Interstitial lung disease: This is a group of conditions that cause lung scarring and shortness of breath. Interstitial lung disease might also cause persistent coughing.

• Autoimmune conditions: Reduction in immune cells can trigger an autoimmune response, causing your immune system to attack healthy cells, tissues, or organs.

• Asthma: Any viral respiratory infection, including COVID, could trigger asthma. Symptoms can include cough, dyspnea (shortness of breath), chest tightness, and/or wheezing, even in those without prior asthma or those with a remote history of asthma.

Related: Why Is It So Difficult for Long COVID Patients to Get Diagnosed and Treated?

How to Treat a Lingering Cough After COVID-19

There is no specific treatment for a lingering cough after COVID. As with any cough, staying hydrated helps your body clear mucus and promotes healing. Other basic remedies include:

• Using a humidifier

• Taking a hot and steamy shower

• Consuming honey or cough drops as needed

Exercise can also be helpful in the healing process. Exercise brings more blood flow to your lungs, helping healthier areas of your lungs compensate for damaged areas. Talk to your healthcare provider about which types of exercise might be beneficial.

The goal is to reduce the cough reflex. Other possible treatments include medications, like inhaled corticosteroids, which reduce the cough reflex, airway inflammation, or mucus secretion.

When to Seek Medical Attention

A persistent cough might be a sign of another infection. The infection might be viral (e.g., influenza) or bacterial (e.g., pneumonia).

You may want to seek advice from a healthcare provider if:

• The cough hasn't gone away or started to get better a month after having COVID-19

• The cough changes or gets worse

• You develop symptoms like a fever, increased shortness of breath, or chest pain/chest tightness
  

A Quick Review

Coughing is your body's way of clearing infection, but a chronic cough can be due to inflammation. A lingering cough after COVID-19 is possible, but it's not usually a cause for concern. It might also not even be related to COVID.

Seek medical attention if your cough persists for more than a month, if it changes or gets worse, or if you develop new symptoms. Treatment can reduce your risk of possible complications and chronic conditions.

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