What is the latest advice on long COVID symptoms and treatment?

The term 'long COVID' may have only been coined last year, but with 1.1 million people in the UK now thought to be living with the illness, there is an urgent need for new expert advice.

It is only a year since 'long COVID' appeared in the public consciousness. Now it is thought that 10% of all people diagnosed with COVID-19 will go on to have long-term symptoms.

The size of the problem

While the National Institute for Health and Care Excellence (NICE) defines long COVID as symptoms persisting for four weeks or more, there is huge variability between the length and severity of symptoms people experience. According to a report from the Office for National Statistics in October 2021:

  • 1.1 million people have long COVID symptoms in the UK.
  • 2 in 3 say their symptoms have an impact on their day-to-day activities.
  • Over 3 in 4 have ongoing symptoms at least 12 weeks after their symptoms began.
  • More than 1 in 3 have had symptoms for over a year.

What is long COVID?

Even defining what constitutes long COVID has proved something of a challenge - the National Institute of Health Research suggests it may be not one syndrome but four, resulting from various combinations of:

  • Debility as a result of Intensive Care Unit admission for the most seriously unwell.
  • Organ damage.
  • A postviral syndrome with overlaps with ME/CFS.
  • A new condition unknown until the pandemic.

Healthcare professionals have been faced with the difficulty of diagnosing and treating long COVID, which is by nature a 'complex, multi-system illness'. Resulting from a COVID-19 infection, long COVID can cause a wide range of persistent symptoms. These symptoms can appear weeks to months after the initial COVID-19 infection and can even disappear for periods at a time.

The trouble is that these characteristics make long COVID hard to predict. But healthcare experts have identified an 'urgent need' to improve the available advice. A recent 2021 consensus of 33 experts on the management of long COVID examined the warning signs, treatment options and long-term effects on patients.

When should I suspect long COVID?

If after four weeks of contracting COVID-19 you continue to experience new or fluctuating symptoms, then you may have long COVID. Some of the main symptoms highlighted by the expert panel include:

If you have any of the above symptoms, don't panic. Many of these symptoms on their own are quite common and this does not mean that you have long COVID or any other serious illness. However, you should consult your GP who will be able to identify any health problems and provide the right care.

How will you be diagnosed?

Your GP will only diagnose you with long COVID once other illnesses have been ruled out. Such a wide range of symptoms could be signs of a number of conditions. These include, but are not limited to:

  • Respiratory and lung conditions.
  • Heart health.
  • Blood clots.
  • Nervous system dysfunctions.
  • Immune system problems.
  • Arthritis.

Don't be surprised if your GP carries out a few tests to check for any of the above. It's important that other health issues are either found or dismissed so that you can receive the most appropriate and effective treatment.

Treatment plans and support

If you have been diagnosed with long COVID, there are a number of treatments options.

In the 2021 consensus on long COVID management, experts have outlined the main types of treatment available. The right treatment for you will entirely depend on your symptoms and any perceived conditions linked with long COVID. Your GP will advise you of the best course of action, based upon your own personal symptoms.

If you live in England, you may be referred to a COVID assessment clinic. Here, you will receive specialist care and support for long COVID from experts who will create a personal treatment plan based on your specific needs.

Alongside a wealth of information on COVID recovery, the NHS is now providing a digital COVID recovery programme. It includes an 'ask the healthcare professional' feature which allows you to ask local healthcare experts questions.

Treatments and adjustments at home

Depending on your symptoms, your GP or healthcare professional may recommend treatments and adjustments you can do at home.

Reducing palpitations

Tackling ongoing fatigue

  • Eat well.
  • Get a good night's sleep.
  • Try relaxation techniques.
  • Delegate tasks to others when your energy is particularly low.
  • Pace yourself. One of the features of ME/CFS which is also seen in long COVID is a 'boom and bust' pattern, where overdoing activity when you feel less ill is followed by worsening exhaustion. Build up activity slowly and don't be tempted to overdo it.

Managing breathlessness

  • Pace and break up activities.
  • Exercise in short bouts with frequent rests.
  • Don't completely stop doing things that make you breathless, as muscles will get weaker and make the problem worse.

Improving a persistent cough

  • Practise controlled breathing exercises and gentle breathing through your nose.
  • Close your mouth and swallow.
  • Stay hydrated.
  • Suck lozenges or boiled sweets.
  • Keep an upright posture where possible.
  • Steam inhalation.

Helping a lost sense of taste and smell

  • Keep your mouth clean and healthy with frequent brushing.
  • Rinse your mouth with water if it feels dry and avoid alcohol-based mouthwashes.
  • Experiment with different flavours and add strong flavours or marinades.
  • Choose foods with low salt content.

Treating painful swallowing

  • Sit upright when eating and drinking and have small mouthfuls.
  • Keep your mouth clean and healthy with regular tooth brushing.

Easing joint and muscle problems

  • Do strength and flexibility exercises with frequent rests (unless otherwise advised).
  • Keep up general physical activity (like housework and gardening).
  • Change your position frequently.
  • Take over-the-counter painkillers.

Reducing headaches

  • Take ibuprofen or paracetamol (ideally limited to within three days a week).
  • Avoid too much alcohol.
  • Have a good sleep routine.
  • Practise relaxation techniques.

Medications and prescriptions

Your GP may feel it necessary to prescribe drugs for a number of symptoms:

  • Cardiovascular conditions, including beta-blockers to slow down your heart rate and ACE inhibitors and angiotensin receptor blockers for high blood pressure.
  • Respiratory and lung conditions, including antibiotics or steroids for coughs and inhalers for breathlessness.
  • Headaches and migraines.
  • Poor mental health, antidepressants.

Specialist services and therapies

After diagnosing a condition that has resulted from long COVID, your GP may decide to refer you to a service that specialises in that area.

Developed immune system problems

  • Dieticians for advice on eating and drinking habits.
  • Allergy and immunology specialists for diagnosis and treatment of specific needs.

Breathlessness

  • Specialist physiotherapists for controlled breathing.
  • Alternative therapies like meditation and pranayama.

Mental health

  • Psychological 'talking' therapies to treat anxiety.
  • Counselling for depression.

Persistent coughs

  • Physiotherapy for positions and techniques that stop coughing.

Joint and muscle conditions

  • Physiotherapy for exercises to aid recovery.

Memory or concentration issues (cognitive rehabilitation)

  • Occupational therapists and psychologists for cognitive rehabilitation.

Mental health treatment

It is important that you flag any feelings of stress, anxiety or low moods with your GP. They will be able to carry out an assessment of your mental health and talk you through the support options available.

Although long COVID itself is relatively new, there is a known link between long-term, debilitating diseases and mental health issues. A 2019 report by BMC Public Health found this figure to be as high as 36.6%. Healthcare professionals recognise the risks of poor mental health with long COVID patients and can provide support.

Guidance is also now in place to support the return-to-work process which includes written advice for both employers and employees. The 'COVID-19 return to work guide for recovering workers' is an example of the efforts being made by the medical profession to help long COVID patients continue to live their lives.

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