LONG COVID

On 7 January 2020, the virus that causes coronavirus disease 2019 (COVID-19) was confirmed as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The virus was first identified in Wuhan, China in late 2019 before rapidly spreading across the world.

Most people who get COVID-19, recover fully within a few weeks. However, some people continue to have symptoms for longer than expected. These symptoms vary in their severity.

 For more information on COVID-19 please visit our COVID-19 Frequently Asked Questions.

Patients who have had COVID-19 but who still have symptoms one month after the initial illness, may have Long COVID.

Many different names have been used when individuals have symptoms that persist, which include “Long-COVID”, “Long Haulers”, “Chronic COVID-19”, “Post-COVID-19 Syndrome”, “Post-COVID-19 Condition”  and “Post-Acute Sequelae of SARS-CoV-2 infection” or “PASC”.

There is currently no internationally accepted definition for Long-COVID, however, the US Centers for Disease Prevention and Control (CDC) describes post-COVID conditions as a wide range of new, returning or ongoing health problems people can experience four or more weeks after SARS-CoV-2 infection.

The World Health Organization is currently finalizing the name and definition of this condition. Once confirmed, the page will be updated accordingly.

Doctors and scientists are still trying to understand why some patients develop Long COVID. Presently it is believed that as many as 1 in 10 people who become ill with COVID-19 have not recovered fully when followed up 9 months after their acute illness.

It is thought that the ongoing symptoms or the development of symptoms after the initial illness may be due to the damage that occurred in the body when patients first became ill with COVID-19. Patients who become ill with COVID-19 may have damage to their lungs, heart and brain, but other organs in the body may have been affected too, which can result in a wide variety of  symptoms. Long COVID may be a result of damage caused by the body’s own immune response to the virus during the initial illness as well as the damage caused by the virus itself. However, there isn’t enough evidence for now and we do not fully understand the reason people develop Long COVID.

Importantly, patients  who contracted COVID-19 cannot spread the virus once they have completed the period of initial infection – usually 10 days after the onset of symptoms or the date of the positive SARS-CoV-2 test. Patients who suffer from Long COVID cannot give another person COVID-19 or Long COVID.

It is important to remember that some patients can be re-infected with COVID-19. For this reason, if a patient became ill, had a positive COVID-19 test, recovered fully and then started to develop symptoms again, they should be retested for COVID-19.

It is unknown how many people suffer from Long COVID, but any COVID-19 patient can be affected, including those who experienced mild symptoms and those who had severe disease and were treated in hospital.

We are not yet sure who is most at risk for developing Long COVID, however there are certain groups which appear to be at greater risk:

  • Elderly
  • Women
  • People who have more symptoms when they are initially ill with COVID-19
  • People with pre-existing clinical depression
  • People who have obesity (Body mass index greater than 30 kg/m2)
  • People with asthma
  • People who had severe COVID-19 that had to be treated in hospital

Patients may present with a remarkably wide range of new or persistent symptoms following COVID-19 illness, including the following most commonly reported symptoms:

  • Severe tiredness/fatigue
  • Shortness of breath
  • Ongoing cough
  • Chest pain or heaviness
  • Joint pain or swelling

Other symptoms include:

  • Difficulty concentrating or “brain fog”
  • Muscle pain
  • Headache
  • Fever that comes and goes
  • Heart beating out of your chest/palpitations
  • Loss of smell or taste
  • Difficulty exercising
  • Dizziness/vertigo
  • Ringing in your ears/tinnitus
  • Numbness in the hand or feet/peripheral neuropathy
  • Skin rash
  • Nervousness/anxiety
  • Feeling sad/depression

There is no way to test a patient for Long COVID.

A diagnosis of Long COVID should only be made by a doctor or a nurse after a thorough history and examination to exclude other causes of the symptoms. Other causes for symptoms may include:

  • Other viral respiratory infections
  • Bacterial pneumonia
  • Tuberculosis
  • Worsening symptoms relating to underlying comorbidities such as diabetes and hypertension
  • Depression and anxiety disorders

Patients who should be considered to have Long COVID:

  • Patients who were diagnosed with COVID-19 by means of a positive COVID-19 test, who have ongoing symptoms for more than 4 weeks after the acute illness that cannot be explained by another diagnosis.
  • Patients who have new or persistent symptoms, after they had a COVID-like illness even if they had not tested positive for COVID-19 may be considered, provided any other potential causes have been excluded.

There are many different viruses and infections that can cause symptoms similar to COVID-19 and Long COVID, so it is important to look for other conditions before making a diagnosis of Long COVID.

It is hard for doctors to predict when symptoms will improve, since it differs from patient to patient. The recovery will depend on the patient’s age, overall health, and how severe the COVID-19 symptoms are. Some symptoms, for instance severe tiredness, might continue even while other symptoms  improve or go away entirely.

Patients need to know that they are not alone and research has found that most symptoms, if not all, will go away with time. However, patients with troublesome symptoms or with symptoms that fail to resolve in 6-8 weeks should visit their nearest doctor or clinic.

Every Long COVID patient is different, as such, every patient will need  treatment specific to their symptoms which can be managed by their family doctor or clinic. There are no drugs to prevent Long COVID . Long COVID is not a contraindication to vaccination, and COVID-19 vaccination may even sometimes improve Long COVID symptoms.

Long COVID is treated by slow stepwise rehabilitation and  appropriate management of symptoms.

Sudden onset severe acute symptoms such as severe chest pain, or difficulty breathing are not typical of Long COVID, and patients should go to their nearest clinic or hospital as soon as possible.

For non-life-threatening conditions, treatment includes over the counter medication for pain, advice on self-treatment strategies, caregiver support and education,  support groups, stress management, stigma management and lifestyle changes (including a healthy diet and nutrition, graded exercise and return to normal activity over an adequate period of time).

Due to the many different symptoms that patients with Long COVID may have, they may need a team of health care workers to help relieve their symptoms. This team may include:

  • Primary Care Clinicians (family doctors or GPs that are trained to help with general medical problems)
  • Specialist Clinicians (specialist doctors focused on different organ systems relating to different symptoms)
  • Occupational therapists (help people to participate in the activities of everyday life)
  • Rehabilitation medicine specialists (doctor specially trained to assess and provide treatments to patients with complex disabling conditions)
  • Physiotherapists (help treat disease, injury, or deformity by physical methods such as massage, heat treatment and exercise)
  • Mental health care practitioners (includes psychologists and psychiatrists trained to help with anxiety, depression and other mental health conditions).

Depending on the specific problems, home management strategies may include the following :

  • Severe Tiredness/Fatigue is considered the most difficult symptom to manage.
    • You should try to carefully pace yourself and set realistic goals.
    • Starting with low intensity exercises and gradually increase exercise intensity in a step-wise manner may be useful in some patients.
    • You should plan to do important tasks when you expect to have the most energy, typically in the morning and take breaks throughout the day as needed.
    • Think about what tasks and activities are most important each day, so you don’t use more energy than you need to.
    • Tiredness can be influenced by pain, diet, sleep patterns, physical activity, cognitive activities, etc. and you should address all these factors that contribute to managing your fatigue.
  • If you are not sleeping well, improving your “sleep hygiene” can help.
    • This involves going to bed and getting up at the same time each day, avoiding caffeine and alcohol late in the day, and not looking at mobile devices or screens before going to bed.
  • Pain, aches and fevers should be treated with simple pain killers as required.
    • If you have pain and fever, talk to your pharmacist or doctor about what could work for you.
  • Loss of smell is concerning but it is important to know that this will return with time.
    • Practising with different scents/smells can help with recovery.
    • Lemon and orange skin, nutmeg, clove, mint, eucalyptus, ground coffee, coconut and vanilla can be used. 
  • If you have a chronic cough or shortness of breath you may benefit from breathing control exercises and respiratory physiotherapy.
    • If your symptoms are debilitating and you struggle to return to your previous function, you should visit your doctor.
  • Athletes and patients in physically demanding jobs who have been formally diagnosed with COVID myocarditis or heart disease should avoid rigorous exercise or labour for a period of time and should be assessed by a specialist physician or cardiologist before return to previous levels of activity.
  • In addition to the general physical limitations that occur as a result of Long COVID, the psychological aspect of the disease process should not be overlooked.
    • You may be at risk for anxiety and depression and if you are concerned, you should follow up with your local doctor or clinic for further assistance.
    • You may experience some symptoms associated with post-traumatic stress disorder or PTSD as listed below:
      • Being easily startled or frightened
      • Always being on guard for danger
      • Self-destructive behaviour, such as drinking too much or driving too fast
      • Trouble sleeping
      • Trouble concentrating
      • Irritability, angry outbursts or aggressive behaviour
      • Overwhelming guilt or shame
    • If you show signs of post-traumatic stress disorder (typically occurring in those who developed severe disease requiring ICU), anxiety and/or depression, you should be appropriately referred to a psychologist and/or psychiatrist.
    • You should look to join or form a support group for people suffering with Long COVID.
      • These support groups can help you meet other people like you who are also affected by Long COVID as well as teach others about your condition.
    • You may have lost your job because of tiredness and fatigue so you can be referred to social workers and seek access to social relief funds.
    • You should try eat a healthy diet with that contains important vitamins and minerals, however, additional vitamin and mineral supplements have not been shown to reduce the risk of acute SARS-CoV-2 infection or improve Long COVID symptoms.
    • You should take the COVID-19 vaccine as it will protect you from being infected again and having severe disease or dying; and it may improve your Long COVID symptoms.

If you feel that your symptoms are becoming worse or are not subsiding, please visit your nearest doctor or clinic for further assistance.

Fatigue is common, and can persist for a few weeks into your recovery. But if you had COVID-19 and continue to have bothersome symptoms (such as severe fatigue, or chest discomfort or shortness of breath) after 2 to 3 weeks, visit your GP. You should also make an appointment with your GP if you start to feel worse or develop any new symptoms.

Depending on your symptoms, you might need tests. This will help your doctor better understand what is causing your symptoms and whether you need treatment.

The only way to avoid Long COVID is to avoid getting COVID-19. It is true that most people who are infected will not get very sick. But it is impossible to know who will recover quickly and who will have persistent symptoms.

The best way to prevent COVID-19 is to get vaccinated. In addition to protecting yourself, getting the vaccine will also help protect other people, including those who are at higher risk of getting very sick or dying. Vaccination does not worsen Long COVID symptoms, and a small study suggested that vaccination might even lead to a small improvement in some symptoms.

People who are still waiting to be vaccinated can lower their risk through social distancing, wearing face masks in public and washing their hands often.

Long COVID is receiving more attention and is being seen as more of a priority across the world. There are many researchers looking to better understand what causes Long COVID, how it will affect patients, how long these symptoms will take to go away and most importantly, how to prevent and treat its effects.

Here are some key messages:

  • You are not alone – as many as 1 in 10 COVID-19 patients may develop Long COVID.
  • Long COVID is a real phenomenon even though we don’t understand it very well.
  • The most common symptoms are:
    • Severe tiredness/fatigue
    • Shortness of breath
    • Ongoing cough
    • Chest pain or heaviness
    • Joint pain or swelling
  • These symptoms appear to improve over time.
  • COVID vaccinations do not worsen Long COVID symptoms, and patients with Long COVID are encouraged to get vaccinated to prevent re-infection.
  • Managing your Long COVID may include:
    • Graded, stepwise return to daily activities including work and exercise.
    • Healthy sleep.
    • Healthy diet.
    • Symptom control (including pain management).

Ensuring other medical conditions are well-controlled including HIV, tuberculosis, anaemia, diabetes mellitus and mental health issues so that they don’t contribute to ongoing symptoms.