Long Covid

Overview

Most people with COVID-19 will recover completely within a few weeks. However, some people may keep experiencing symptoms for several weeks or months after their infection.

People who have a longer recovery period can experience:

• ongoing symptoms in the medium term (from 4 to 12 weeks from first getting COVID-19)
• longer term symptoms (from 12 weeks or more from first getting COVID-19). This is called ‘long COVID’ or post COVID-19 condition

Long COVID can affect nearly all parts of the body with multiple and varied symptoms. These symptoms can be persistent, but come and go over time and have a negative impact on daily life.

Phases of Long COVID

Long COVID can manifest in two main phases:

• Medium-term symptoms. These occur from 4 to 12 weeks from the onset of COVID-19 and may not necessarily continue beyond this period.
• Long-term symptoms. Known as long COVID, these symptoms extend beyond 12 weeks from the initial COVID-19 infection and can be intermittent or continuous.

Symptoms of Long COVID

Long COVID can affect various body systems, leading to a wide range of symptoms which may fluctuate over time:

• General symptoms. Persistent fatigue, low-grade fever, and changes in appetite which may lead to weight loss.
• Respiratory and cardiovascular symptoms. Shortness of breath, heart palpitations, chest pain or tightness, and ongoing cough.
• Neurological symptoms. Problems with memory and concentration, headaches, and sleep disturbances.
• Sensory changes. Altered taste and smell.
• Musculoskeletal symptoms. Joint and muscle pain, and sensations such as numbness or "pins and needles."
• Mental health. Mood changes, including symptoms of anxiety, depression, and increased stress.
• Other symptoms. Skin rash and hoarse voice.

These symptoms are not only persistent but can also severely impact the ability to perform daily activities, including work and household chores.

Long-term Health Consequences

In some cases, long COVID may lead to the development of new, chronic conditions affecting the heart, kidneys, nervous system, or endocrine systems such as diabetes. The full spectrum of long COVID is still under investigation as it is a relatively new condition in the medical community.

Management and Treatment

Due to the complex and varied nature of long COVID, management strategies are personalized. They often involve:

• Symptomatic treatments. Addressing specific symptoms such as pain, respiratory difficulties, or sleep disturbances with appropriate medications or therapies.
• Rehabilitation. Tailored programs to improve physical and mental stamina and overall well-being.
• Regular monitoring. Ongoing assessments to understand the evolving nature of the condition and adjust treatments accordingly.

It is crucial for anyone experiencing persistent or new symptoms after a COVID-19 infection to seek medical advice. A healthcare provider can offer guidance and support, and coordinate care tailored to individual needs.

Continued Research and Understanding

As health experts continue to study long COVID, more information will likely emerge on how best to treat and manage it. Patients and healthcare providers are encouraged to stay informed through reliable sources and engage in open discussions about symptom management and recovery expectations.

Symptoms

Recovery from COVID-19 varies significantly from person to person, influenced by the severity of the disease, individual health backgrounds, and the presence of any pre-existing conditions. While some individuals may experience a swift recovery within days or weeks, others might face a prolonged recovery period lasting months, especially if they had severe symptoms.

Monitoring and Managing Recovery

It's essential to maintain ongoing communication with your healthcare provider throughout your recovery process. Regular check-ups are crucial to monitor your recovery progress and manage any persistent or new symptoms that arise. Your doctor can also adjust or recommend medications to address specific symptoms or complications.

Symptoms During COVID-19 Recovery

As you recover from COVID-19, you might experience a range of symptoms that can affect different parts of your body and impact your overall well-being. Here are some of the symptoms that you may encounter:

Common Symptoms

• Fatigue. This is one of the most frequently reported symptoms and can range from mild to severe, often hindering daily activities.
• Respiratory Issues. Persistent cough and breathlessness may continue, even after other symptoms have subsided.
• Pain. You may experience joint or muscle pain and chest pain, which can fluctuate in intensity.
• Sensory Changes. Alterations in taste or smell are common and can persist for weeks.
• Mental Health. Many individuals report feelings of anxiety and low mood during their recovery period, which can be addressed through support from healthcare professionals.

Less Common Symptoms

• Fever. Some may continue to experience low-grade fevers as they recover.
• Neurological Symptoms. Headaches, memory difficulties, and confusion can occur, reflecting the potential impact of COVID-19 on neurological health.
• Physical Weakness. Muscle pain and weakness may be prominent, especially if the illness was severe.
• Gastrointestinal Issues. Problems with stomach and digestion may persist, including discomfort and irregularities.
• Skin Manifestations. Rashes and other skin symptoms can appear or persist.

Managing Recovery Symptoms

Effective management of post-COVID symptoms may involve:

• Rest. Ensuring adequate rest is vital for recovery, especially to combat fatigue and restore energy levels.
• Physical Therapy. For muscle weakness and joint pain, physical therapy can be beneficial.
• Nutrition. A balanced diet rich in vitamins and minerals supports immune system function and overall health.
• Hydration. Keeping hydrated helps manage fever and supports overall bodily functions.
• Mental Health Support. Addressing anxiety, depression, or low mood through counseling or therapy can be crucial for mental and emotional well-being.

What to Expect in the Long Term

It's important to recognize that recovery timelines can vary widely. Most people gradually see an improvement in their symptoms and return to their pre-COVID health. However, a subset of individuals might experience lingering effects known as long COVID, characterized by persistent symptoms that can last for months.

As research into COVID-19 continues, more will be understood about the long-term impacts and the best practices for treatment and recovery. Regular follow-ups with your healthcare provider are essential to adapt recovery plans as new information becomes available and as your condition evolves. If you or someone you know is recovering from COVID-19, prioritizing care and monitoring symptoms is key to a successful recovery.

Diagnosis

Long COVID, characterized by persistent symptoms following a COVID-19 infection, lacks a singular diagnostic test. Instead, healthcare providers may recommend a series of tests to better understand the symptoms and exclude other potential causes.

Diagnostic Tests for Long COVID

To gain a comprehensive understanding of your health status and rule out other conditions, your doctor might order various tests, including:

• Blood Test. To check for ongoing inflammation or other markers that might explain fatigue or lingering symptoms.
• Heart Rate and Blood Pressure Checks. To assess cardiovascular function, which can be affected by COVID-19.
• Electrocardiogram (ECG). To detect any abnormalities in the heart's rhythm and structure.
• Chest X-Ray. To visualize the lungs and check for signs of lasting pulmonary issues.
• Pulse Oximetry. A non-invasive test to measure your blood oxygen levels, especially important if you're experiencing breathlessness.
• Exercise Tolerance Tests. Such as the sit-to-stand test, which can help evaluate your physical endurance and how quickly you fatigue.

Long COVID and Fatigue

Fatigue is the most commonly reported symptom of long COVID, persisting for months beyond the initial infection and significantly impacting daily activities.

Characteristics of Long COVID Fatigue

Fatigue in long COVID can manifest in several ways:

• Routine tasks, such as household chores or climbing stairs, may become unusually exhausting.
• Work-related activities might lead to disproportionate tiredness compared to before the infection.
• Engaging in multiple activities or consecutive days of exertion can result in overwhelming fatigue.

For tips on managing fatigue related to long COVID, resources such as the long COVID recovery guide can be beneficial.

Approaches to Exercise Intolerance in Long COVID

Exercise intolerance is a notable challenge, with some patients experiencing significant symptoms such as:

• Tachycardia. An abnormally fast heart rate during rest and exacerbated by physical activity.
• Post-Exertional Malaise. Extreme fatigue following physical activities, lasting several days.

Management Strategies

• Medication. Beta-blockers may be prescribed to manage symptoms like tachycardia, helping to stabilize the heart rate during activities.
• Paced Exercise. Gradual and controlled exercise, avoiding the "boom and bust" cycle, is critical. Starting slowly and only increasing the intensity if it doesn't exacerbate symptoms can help manage long COVID effectively.
• Specialized Guidance. Healthcare professionals like cardiologists and respiratory specialists may provide tailored advice based on individual symptoms and recovery progress.

Managing fatigue after exercise

Dr. Robert Bell, a cardiologist at University College London Hospital (UCLH), has been co-managing Covid clinics with his respiratory colleagues for over a year, focusing on patients who exhibit "exercise intolerance." He observes that many of these patients experience significantly increased heart rates (tachycardia) during exercise, leading to extreme fatigue afterward. Dr. Bell describes, "These individuals typically have resting heart rates around 100 beats per minute without activity, which can surge to 140, 150, or even 180 during physical exertion, leaving them profoundly exhausted for days."

He has discovered that beta blockers, which slow the heart rate, are effective in managing these symptoms for some patients. Dr. Bell notes that these patients are often young, predominantly women in their forties who are otherwise healthy and active. Effective symptom control allows them to interrupt the debilitating cycle of fatigue and regain their fitness.

Dr. Claire Steves, Senior Clinical Lecturer at King’s College, emphasizes the importance of cautious exercise regimens for individuals with long Covid, noting that while physical activity can be beneficial, it must be carefully paced to avoid exacerbating symptoms. She explains, "Many with long Covid experience a 'boom and bust' cycle—overexerting one day can lead to days of recovery. By adopting a paced approach and gradually increasing activity as tolerated, we can avoid this cycle." Dr. Steves is involved in developing online tools and resources designed to help individuals customize and pace their recovery activities to meet their specific needs and capacities effectively.

Treatment

Managing Long COVID

Long COVID, characterized by persistent symptoms after recovering from an acute COVID-19 infection, lacks a uniform treatment approach. Management strategies are tailored to individual symptoms and may require trial and error to identify effective therapies.

Treatment Options for Long COVID

• Medication. Healthcare providers may prescribe medications to address specific symptoms such as cough, headaches, anxiety, and depression. If a specific underlying condition, such as blood clots, is identified as contributing to long COVID symptoms, targeted treatments may be utilized.
• Stellate Ganglion Block and Olfactory Retraining. These treatments can be employed to potentially restore the sense of smell and taste. A stellate ganglion block involves an injection that numbs certain nerves in the neck, potentially affecting sensory perception. Olfactory retraining therapy involves exposure to familiar scents to help retrain the brain's recognition of smells.
• Physical Therapy. This can include exercises, massage, and other therapeutic interventions designed to address pain and mobility issues, helping to improve overall physical function.
• Pulmonary Rehabilitation. This specialized program combines exercise and education to help patients improve their breathing and manage respiratory symptoms effectively at home.
• Counseling. Psychological support through counseling can be crucial for managing the emotional and psychological challenges posed by chronic or severe illness.