text: Confronting COVID 19 associated cough and the post COVID syndrome role of viral neurotropism neuroinflammation and neuroimmune responses Cough is one of the most common presenting symptoms of COVID 19 along with fever and loss of taste and smell Cough can persist for weeks or months after SARS CoV 2 infection often accompanied by chronic fatigue cognitive impairment dyspnoea or pain a collection of long term effects referred to as the post COVID syndrome or long COVID We hypothesise that the pathways of neurotropism neuroinflammation and neuroimmunomodulation through the vagal sensory nerves which are implicated in SARS CoV 2 infection lead to a cough hypersensitivity state The post COVID syndrome might also result from neuroinflammatory events in the brain We highlight gaps in understanding of the mechanisms of acute and chronic COVID 19 associated cough and post COVID syndrome consider potential ways to reduce the effect of COVID 19 by controlling cough and suggest future directions for research and clinical practice Although neuromodulators such as gabapentin or opioids might be considered for acute and chronic COVID 19 cough we discuss the possible mechanisms of COVID 19 associated cough and the promise of new anti inflammatories or neuromodulators that might successfully target both the cough of COVID 19 and the post COVID syndrome 