When Long COVID Makes You Extra Thirsty
Among the many symptoms that have been reported by people experiencing Long COVID, one of the more recent is an unusual level of thirst. This could mean that the feeling of thirst may keep getting stronger and last longer than usual. Or that even drinking lots of water—the healthiest thirst-quencher of all—doesn’t do the trick.
Stuart Katz, MD, a cardiologist and the Helen L. and Martin S. Kimmel Professor of Advanced Cardiac Therapeutics at New York University Grossman School of Medicine, is a researcher whose Long COVID symptoms lasted for nearly a year. During that time, he began experiencing symptoms of COVID-associated thirst following his initial SARS-CoV-2 infection in December 2020. Dr. Katz says that the excessive thirstiness and other Long COVID symptoms have taken a toll on his quality of life.
He is not alone. A 2023 study published in JAMA found that excessive thirst was one of 12 symptoms most commonly seen in patients with Long COVID. This study is part of a larger research effort called the National Institutes of Health’s Researching COVID to Enhance Recovery (RECOVER) Initiative. Using self-reported data from approximately 10,000 Long COVID patients across 85 sites in 33 U.S. states and Washington, D.C., and Puerto Rico, the scientists found that 40% reported thirst. In addition to his own experience with Long COVID, Dr. Katz is a RECOVER investigator.
The physiological processes that cause excessive thirst in Long COVID remain unknown. One hypothesis, which Dr. Katz believes should be investigated with experimental studies, proposes that angiotensin II (an endocrine hormone that stimulates thirst) may play a role. SARS-CoV-2 enters cells through a receptor on the cell membrane that also interacts with angiotensin II. A connection may exist between the way in which SARS-CoV-2 enters cells and the lasting symptom of thirst in Long COVID patients, Dr. Katz explains. But more data is needed to establish such a link.
Currently, there are no proven treatments for excessive thirst among patients with Long COVID. In some cases, like Dr. Katz’s, the symptom resolves on its own over time. However, drinking too much water may pose some risk, such as excess urine production or low blood sodium, he warns. Dr. Katz instead recommends consuming ice chips or sucking candy, which has helped some of his patients with heart failure—a condition that can also cause increased thirst. Until more is known, thirst remains a challenge and mystery for scientists and patients alike.
Dr. Katz is using his own experience as a force for good. “My personal experience with Long COVID remains fresh in my mind,” he told me recently. “It provides a strong motivation to complete the scientific work of RECOVER with the hope to better understand what happened to me and how better to help the millions of patients still suffering with Long COVID symptoms.”
Tyler Harvey is an MD/PhD candidate at Yale School of Medicine
The last word from Lisa Sanders, MD:
Thirst is one of the strongest of all human motivations—stronger even than hunger. And with good reason. Those who teach wilderness survival refer to the “rule of 3,” which says that a person can live for 3 minutes without air (oxygen), 3 days without water, and 3 weeks without food. Angiotensin II is sometimes known as the thirst hormone. Its release from the kidney triggers the drive to drink. That this is one of the symptoms of Long COVID is yet more evidence of how widespread this virus can travel in the body: lung, heart, brain, and kidneys.
Last year, researchers proposed a group of 12 key symptoms indicative of and possibly diagnostic of Long COVID. Although this tool was not intended to be used for clinical diagnostic purposes, it allowed researchers to assign a point value to each symptom, based on its frequency. They propose that the probability of Long COVID is higher in those who score a total of 12 points once all the symptoms were added up. The 12 symptoms and their points are:
- Loss of smell or taste: 8 points
- Post-exertional malaise: 7 points
- Chronic cough: 4 points
- Brain fog: 3 points
- Thirst: 3 points
- Heart palpitations: 2 points
- Chest pain: 2 points
- Fatigue: 1 point
- Dizziness: 1 point
- Gastrointestinal symptoms: 1 point
- Issues with sexual desire or capacity: 1 point
- Abnormal movements (including tremors, slowed movements, rigidity, or sudden, unintended and uncontrollable jerky movements): 1 point
I have seen patients who I was certain had Long COVID and who didn’t reach a score of 12, but I think this may be a useful tool for further research. Indeed, thirst is one of the 12 symptoms—so it’s very common in this population.
Read other installments of Long COVID Dispatches here.
If you’d like to share your experience with Long COVID for possible use in this blog (under a pseudonym), write to us at: LongCovidDispatches@yale.edu. It may appear, space permitting, in a future post.
Information provided in Yale Medicine content is for general informational purposes only. It should never be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider for any questions you have regarding a medical condition.
