Recognising and dealing with ‘long Covid’


UNPREDICTABLE The symptoms of long Covid are varied and overlap one another; the intensity can fluctuate significantly over time and can affect any system within the body.

Andrew O'Brien

It was suggested to me recently that I consider writing a piece about ‘long Covid’. Then I heard the rumblings from the UK about vaccines not working against the Indian variant and now I’m wondering if this Covid nonsense hasn’t been ‘long’ enough already, thank you very much. But it’s out there, another new condition to add to our list of afflictions.
Long Covid is described as the presence of signs and symptoms that develop during or following an infection consistent with Covid-19, which continue for 12 weeks or more and are not explained by an alternative diagnosis. This can include ongoing symptomatic Covid-19 which lasts from four to 12 weeks and ‘Post-Covid Syndrome’ which continues beyond 12 weeks. At this stage, not an enormous amount is known about who is at risk of long Covid, and why, or indeed about the ideal management and treatment, but we will look at what we do know.
The symptoms of long Covid are varied and overlap one another; the intensity can fluctuate significantly over time and can affect any system within the body. So far symptoms have been described in the respiratory, cardiovascular, gastrointestinal, reproductive, genitourinary, endocrine, renal, dermatologic, musculoskeletal, neurological, neuropsychiatric, immunological, ophthalmic, and audiological systems. Hands up anyone I’ve forgotten!
The most reported symptoms of long Covid are fatigue, post-exercise malaise and cognitive dysfunction. Symptoms tend to follow a cycle of remission and relapse, where sufferers may be relatively well before relapsing. The most common relapse triggers have been reported as physical or mental activity and stress.
It seems anyone who had either mild or severe Covid-19 is at risk of developing longer term problems, regardless of whether they were hospitalised or able to manage at home. One study in the UK found that almost 30 percent of people who had been hospitalised with Covid-19 had to be readmitted within a few months. While a Russian group found that almost half of patients who had been admitted to hospital with confirmed Covid-19 were still experiencing at least one symptom six months later with fatigue, shortness of breath and confusion the main complaints.

Specialist clinics
The NHS announced in October that it would open specialist long Covid clinics across the UK, where patients would undergo physical, cognitive and psychological assessments to establish just how significant and wide-ranging their symptoms are before starting a rehab programme. Obviously, each of those components could have pre-existing issues, but are likely to have worsened, making this a very complex issue.
The biggest challenge for anyone experiencing long Covid, and for the healthcare teams looking after those people, is working out a rehabilitation plan. The research is still trying to catch up with what is a very new condition, and some of what may have seemed logical may have negative effects. As mentioned above, the most common triggers for symptoms are physical or mental activity and stress, but surely the best was to rehabilitate someone from a significant illness is with gradual exercise?
Currently teams are analysing the risk-reward balance of using exercise, trying to work out how much is too much on a case-by-case basis. There is also the issue of post-exercise malaise to consider, where the patient experiences an exacerbation of multiple symptoms beyond the level that could be considered normal fatigue and often lasting for days or weeks. At present the advice is to start with very gentle exercise and increase gradually as symptoms allow.
The NHS has an excellent website called ‘Your Covid Recovery’ that looks at each system that may be affected and offers tips to both patients and their families to assist in their recovery. If you need more information, the best place to start is with your GP.
In the meantime, let’s just hope this doesn’t last much longer.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at