What is long COVID and do you have it?

Around 10% of people have a slow recovery from COVID-19 infection that lasts longer than 3 weeks (UK COVID symptom study). Most people will recover within 12 weeks. People who do not recover within this time-frame may have Long COVID if their symptoms are not explained by another illness.

The likelihood of developing long COVID is not linked to any particular symptoms, the severity of the initial illness or if hospital admission was needed. The symptoms of long COVID can affect any part of your body and can change over time.

What causes long COVID?

The short answer is that we do not know what causes long COVID to occur. We do know that similar symptoms have been found in patients suffering from other coronaviruses such as SARS and MERS.

There are likely to be a number of causes of long COVID rather than just one in particular. These include a persistently high viral load, inflammatory or immune reactions, physical weakness and psychological factors such as PTSD.

For people who continue to suffer symptoms, the NHS has a great website to advise on symptom management.

What are the symptoms of long COVID?

General non-specific symptoms

• Tiredness
• Fever
• Pain

Fatigue

Tiredness can occur after any severe infection as the body recovers. For example post-viral fatigue is fairly common.

The tiredness in long COVID can be severe and be similar to that in Chronic Fatigue Syndrome and ME (Myalgic Encephalitis).

Psychological symptoms

• Anxiety
• Low mood
• Depression
• Poor sleep
• PTSD occurs in a minority of people, often healthcare workers.

Persistent chest symptoms

• Persistent cough
• Breathlessness

Blood clots

Having a COVID-19 infection increases the risk of blood clots. This might present with breathing difficulties, chest pain, or palpitations.

Heart symptoms

20% of people admitted with COVID-19 have obvious heart involvement, but probably a greater proportion have undetected heart involvement. Symptoms include:

• Chest tightness
• Chest pain
• Palpitations

Neurological symptoms

• Brain fog, loss of concentration
• Headache
• Sleep disturbance
• Pins and needles in arms or legs
• Dizziness
• Stroke
• Seizures
• Encephalitis
• Cranial nerve neuropathy

Older people

• Loss of muscle mass and weakness
• Reduced appetite and malnutrition
• Depression
• Delirium
• Chronic pain

Other symptoms

• Musculoskeletal: joint and muscle pain
• Gastrointestinal: abdominal pain, nausea, diarrhoea
• ENT: tinnitus, earache, sore throat, dizziness, loss of taste/smell
• Skin rashes

Which symptoms need urgent attention?

You should seek urgent medical attention if they have the following symptoms:

• shortness of breath
• chest pain
• severe psychological distress or ideas of self-harm
• severely ill child

What should you do if you suspect you have long COVID?

You should seek medical advice and discuss the nature of your symptoms with the doctor. The first thing of course is that you should have a history of having COVID-19 infection, or have had symptoms that were suspicious of a COVID-19 infection.

Long COVID is a diagnosis of exclusion. That means that other serious medical problems should be excluded before assuming that the cause is long COVID.

A relevant examination should be done according to the symptoms and may include the pulse, blood pressure and oxygen levels. Tests may also be useful to make a diagnosis and can include blood and urine tests, chest x-ray and ECG.

Take home message

Symptoms of long COVID can affect virtually any part of the body or more than one body part at a time. The condition my fluctuate and last for long periods of time.

We are just beginning to see these cases for the first time and therefore have limited experience of what treatments might work. Most of the evidence currently comes from consensus of medical professionals or individual cases that they have seen.

Long COVID is a diagnosis of exclusion so other medical problems need to searched for. You should not automatically assume that your symptoms are due to long COVID as they may be due to another problem. That is why it is important to discuss the problem with an experienced medical professional and why a number of tests may have to be done to arrive at a diagnosis.