Long Covid
1. Introduction
Long Covid is a term to describe the effects of Covid-19 that continue for weeks or months beyond the initial illness. The health watchdog the National Institute for Health and Care Excellence (NICE) defines long Covid as lasting for more than 12 weeks, although some people consider symptoms that last more than eight weeks to be long Covid.
Other names that have been used for the condition include post-acute Covid-19 syndrome, post-Covid-19 syndrome, chronic Covid syndrome (CCS), post-acute sequelae of SARS-CoV-2 infections (PASC). Please note that long Covid is still a newly emerging condition and as such research and guidance are changing on a daily basis. We will do our best to keep this information as up-to-date as possible.
Frequently Asked Questions
- Long Covid is a term to describe the effects of Covid-19 that continue for weeks or months beyond the initial illness.
- Fairly common.
- 1 in 10 people (10%) (of those diagnosed with Covid-19) still have symptoms at 12 weeks post-covid infection.
- No.
- Many people are concerned when they are experiencing these symptoms due to the lack of knowledge around the condition. However, the medical profession is sharing information on a daily basis and knowledge into the symptoms and treatments are progressing daily.
- Recent research is showing most sufferers recover over time, albeit slowly.
- The only risk factor is having suffered from an acute Covid-19 infection of any severity. No other risk factors have been conclusively identified.
- Cough.
- Breathlessness.
- Fatigue.
- Memory and concentration difficulties.
- Chest pain.
- Speak with your GP and health professionals, don’t be afraid to seek help.
• Currently there are a lot of unknowns about long Covid. Although the process can be slow, most people are appearing to recover in time with the appropriate support.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
Symptoms of long Covid are varied and still emerging (1-4). Due to the many different body systems affected – respiratory, cardiac, vascular and digestive to name a few – long Covid is classified as a multi-system disease by the medical profession (4).
- Chest pain/tightness.
- Breathlessness.
- Fatigue.
- Cognitive impairment (poor concentration, difficulties multi-tasking, poor short-term memory).
- Paraesthesia (pins and needles).
- Muscle and joint pain.
- Low grade fever.
- Cough.
- Dizziness.
- Tachycardia (racing heart rate).
- Palpitations.
- Headaches.
- Tinnitus, earache.
- Weakness.
- Gastrointestinal upset – feeling sick, diarrhoea, stomach ache.
- Skin rashes.
It is usual after a significant virus to have some lingering symptoms, so some general guidelines have been put together based upon knowledge of other similar conditions to provide an indication of what is expected in a “normal” recovery.
- 4 weeks – most of the chest pain and phlegm should have reduced.
- 6 weeks – cough and breathlessness should have reduced.
- 3 months – most symptoms should have settled but tiredness may still be present.
- 6 months – all symptoms should have settled (2).
3. Causes
A number of theories currently exist around the cause of long Covid, however, as this illness is still in its infancy, research and understanding are underway, but conclusive findings are not yet possible.
4. Risk Factors
Long Covid has been noted following all severities of the initial illness (1, 3). There have been no conclusive findings regarding any specific risk factors for developing long Covid.
5. Prevalence
1 in 10 people (10%) still have symptoms at 12 weeks post-Covid infection (4, 5). This indicates a considerable number of people will be suffering from long Covid symptoms.
6. Assessment & Diagnosis
Long Covid is classified as ongoing symptoms post 12 weeks after infection of Covid-19 (3, 5). The first point of contact is often with the GP. It has been noted that older adults and those who have received hospital care more frequently contact their GP after Covid-19 infection (6). However, these are not the only people who suffer from long Covid; there are no common risk factors meaning it affects all ages, genders and the severity of the initial infection does not matter.
The main message from the health service is to seek help if you are concerned about symptoms or if things are not improving (2). When suffering from ongoing symptoms, you may need to undergo further tests to ensure any complications from the initial Covid-19 infection or other illnesses are ruled out (1, 4).
Long Covid clinics are now being set up around the country via the NHS and several providers, including Pure Physiotherapy, now have dedicated Covid rehabilitation services.
7. Self-Management
There are many useful resources emerging (some are listed at the end of this article) to assist with self-management of post-Covid symptoms. As long Covid still has a number of unknowns, anxiety relating to the condition is common and being able to access the information available can assist with reassurance. Support groups can also be useful, especially in reducing the feeling of isolation if you do not know any other sufferers; a number of these now exist online and on social media.
We have produced some information leaflets to assist with self-management of different symptoms of long Covid. We do recommend that you discuss your symptoms and management with a healthcare professional to ensure you are safe to self-manage your symptoms.
Pulse oximetry (measuring the oxygen levels in your blood) can be useful for reassurance and management at home and has been shown not to increase anxiety (4). A pulse oximeter measures the oxygen level in the blood. Pulse oximeters are now available to purchase fairly cheaply, however, please be aware that applications utilising a phone camera are not accurate and should not be used. Normal readings would be >96%. If readings persistently drop below 96% speak to your GP; if your reading goes below 92%, please seek immediate healthcare advice.
8. Rehabilitation
Any post-Covid treatment needs to be individualised; long Covid is not ‘one size fits all’ (5). It is encouraging that more recent studies are showing that patients are recovering with the correct support, however, the correct support remains very much debated.
As of now, the best guidance is rest, symptomatic treatment using multi-discipline support where needed (this may be a mix of doctors, physiotherapists, occupational therapists, psychologists), and a very gradual increase in activity (4). One of the main challenges is difficulty adapting to the reduced function in the early stages. People often try to manage their symptoms whilst pushing through to try and maintain previous levels of activity/exercise risking a relapse in symptoms (7).
Currently, the guidance is that exercise and/or increasing activity should be undertaken cautiously (4). Return to exercise after Covid-19 and return to exercise with long Covid are two different topics. After Covid-19, it is recommended seven symptom-free days as a minimum before return to exercise (8). However, long Covid sufferers have ongoing symptoms and therefore return to exercise needs to be planned, ongoing complications ruled out and utilise a symptom-related outcome measure to monitor and track progress. An activity would not be measured by time, distance or repetitions, but based upon the score the suffering rates themselves on the scale. Ideally, the main symptom would be utilised if appropriate, so this may be breathlessness, fatigue or heart rate as examples.
Pure Physiotherapy has developed a specific post-Covid rehabilitation service. Our aim is that a fully individualised approach is taken and we have invested in a specific kit to be able to carefully monitor and review individuals over time. We will work with the individual to identify their goals and then work out the best way to move towards these based on their specific symptoms. We have useful links with other healthcare professionals to be able to provide a holistic approach to the rehabilitation process, referring and working alongside as necessary.
9. Long Covid
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
10. Return to Sport / Normal life
The majority of people who suffer a Covid infection will recover with time. Many people will recover rapidly after initial infection and return to normal life after a few weeks, for those with ongoing symptoms this can take months or even years. The main advice is to pace yourself and initially work on functional tasks in your daily life before working on a return to sport. There are a number of different ways to be able to self-monitor your return such as heart rate and breathing. Our Covid service can assist with guiding you through your recovery.
11. Other Treatment Options
There is currently a lot of research occurring around treatment options with covid. Treatments are often based on similar existing conditions and then applied to the covid symptoms. Our advice is to speak with your GP, long covid clinic, or give us a call for a chat around our rehabilitation services and other members of the multi-disciplinary team that may be able to assist.
12. Links for Further Reading
Covid-19: the Road to Recovery (csp.org.uk)
Your COVID Recovery | Supporting your recovery after COVID-19
Post-COVID HUB – By Asthma UK and British Lung Foundation (post-covid.org.uk)
Support for Rehabilitation Self-Management after COVID-19-Related Illness (who.int)
Recovering from COVID-19: Post viral-fatigue and conserving energy – RCOT
Long Covid Physio: Website is for everybody living with Long COVID
References
- Taylor, Anna K, et al. (2021). ‘Reluctant pioneer’: A Qualitative study of doctors’ experiences as patients with long COVID. Health Expect.
- NHS. (2021). Your Covid Recovery. https://www.yourcovidrecovery.nhs.uk/.
- NICE. (2020). COVID-19 rapid guideline: managing the long-term effects of COVID-19. s.l. : National Institute for Health and Care Excellence.
- Trisha, et al. (2020). Management of post-acute covid-19 in primary care. Greenhalgh British Medical Journal. 370.
- Gorna, Robin, et al. (2020). Long COVID guidelines need to reflect lived experience. The Lancet. 397.
- Broughan, John Michael, et al. (2021). General practice attendances among patients attending a post-COVID-19 clinic: A pilot study. British Journal of General Practice.
- Humphreys, Helen, et al. (2021). Long COVID and the role of physical activity: a qualitative study. British Medical Journal. 11.
- Salman, David, et al. (2021). Returning to physical activity after covid-19. British Medical Journal.
- The Lancer Neurology. (2021). Long COVID: understanding the neurological effects The Lancet Neurology. 20.
- Norton, Alice, et al. (2021). Long COVID: tackling a multifaceted condition requires a multidisciplinary approach. The Lancet.
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