What is long COVID?

Post COVID-19 Syndrome is also called long COVID. It describes the signs and symptoms that develop during or following
an infection consistent with COVID-19, which continue for more than 12 weeks and are not explained by an alternative diagnosis.

The condition usually presents with clusters of symptoms, often overlapping, which may change over time and can affect any system within your body.

The severity of your illness after catching COVID-19 does not indicate whether you will go on to develop long COVID. In other words, you may have a mild dose of COVID-19 and then develop long COVID. Or, you may have been severely ill with COVID-19 and then suffer no longer term after effects.

How long does it take to recover from Long COVID? 

Most people who get symptoms of COVID resolve within 4 weeks. However, for some recovery from coronavirus can take longer. The length of time will vary from person to person. It’s important not to compare yourself to others. The symptoms can also vary, so not everyone is affected in the same way.

Depending on how long you have ongoing COVID symptoms for, it can be called one of 2 things:

• Ongoing symptomatic COVID
  This is where your symptoms continue for more than 4 weeks. If your symptoms last for longer than 12 weeks, it will then be called;
• Post-COVID Syndrome
  This is where your ongoing symptoms continue for longer than 12 weeks and cannot be explained by any other condition.

Commonly reported symptoms

There are a broad spectrum of symptoms that you may or may not experience with long COVID. These are the most common ones you may experience:

Musculoskeletal Symptoms

• Joint pain
• Muscle pain

Respiratory and Cardiovascular Symptoms 

• Breathlessness
• Cough
• Chest tightness
• Chest pain
• Palpitations

General Symptoms

• Fatigue/ Sleep disturbance/ insomnia
• Fever
• Pain

Neurological Symptoms

• Cognitive impairment (‘brain fog’, loss of concentration or memory issues)
• Headache
• Sleep disturbance
• Pins and needles or numbness
• Dizziness
• Delirium (in older people)

In addition to these symptoms, you may find yourself with issues with:

• Mental wellbeing 
• Slow recovery in returning to activity/exercise
• Breathlessness & Anxiety

Fatigue

• During your recovery from any illness, including coronavirus, you may experience fatigue. Fatigue affects what you’re able to do.
• You use energy for concentration, attention, problem solving, talking and making decisions. Fatigue means you have less physical, mental and emotional energy to do these daily activities.
• There are ways to help you manage fatigue.

Breathlessness

• After an illness you may find you have difficulty catching your breath and feel short of breath more easily. This is called breathlessness. This can happen if you’ve had coronavirus, even if you have not needed to stay in hospital.
• This can be a scary feeling but there are several things you can do to reduce breathlessness.

Sleep problems 

• During any illness it’s common to sleep more as your body fights the infection. While you’re recovering, it’s also common to have disturbed sleep patterns. You may struggle to get back into a good routine.

Low mood and depression

• Being unwell can have an impact on your mental health.
• Reach out to family and friends and speak with them on the phone if you’re not able to see them face to face.

Anxiety 

Everyone experiences anxiety at some time in their life. It’s a normal reaction when we’re in danger or under threat. Anxiety can start when we don’t feel in control. Experiencing a stressful event like having coronavirus or a stay in hospital can cause anxiety. You may worry this will happen again and this can make you feel more anxious about the future. This is a normal reaction.

Symptoms of anxiety

Anxiety affects people in different ways. You may have:

• trouble sleeping
• difficulty concentrating
• difficulty remembering things
• changes in mood
• flashbacks
• more breathlessness
• rapid shallow breathing
• difficulty slowing your breathing down

Coughs

Coughing is the body’s way of protecting our lungs and getting rid of things that irritate them. This is a normal and important function.

Some viral infections can leave us with a dry cough because our lungs have been irritated. This should gradually disappear during the course of your recovery. It’s not clear how long after coronavirus you may have a cough and it can be frustrating at times.

A dry cough is one of the most common coronavirus symptoms, but some people may have a cough with phlegm (thick mucus).

It can be difficult to control your cough but there are a few ways to help.

Is there anything I can do to help recovery? 

Fatigue: 

1: Plan your day

Try to break your day into small parts and set easy goals to begin with. Rest between activities and only do what you feel able to do.

You can keep a daily activity diary, where you write down each activity you’ve completed. This lets you track your energy levels and avoid activities that cause setbacks.

Remember to include mental and emotional activities in your activity diary. This can help you plan ahead and prioritise what is important to you.

2: Pace yourself

Try to avoid doing lots of things one day and then nothing the next few days. Instead, pace yourself and spread out what you’re doing during the week. It’s normal for your energy levels to be different on different days.

If you feel more tired and unwell when you try to build up your activity, do not keep increasing it. Instead, work with what you’re able to do without increasing your fatigue. If this continues longer-term, speak to your GP for advice.

3: Move around

It’s important to avoid sitting in one position for too long. Get up each hour to have a stretch or get a glass of water.

Remember to use any walking aids you need.

Breathlessness

1: Position to ease breathlessness

Using a different position will allow your breathing muscles to work better and help you to feel less short of breath. You might find one position works best for you. Feelings of panic will often make your breathlessness worse. So, trying to relax in your preferred position will also help.

Lying on your front (prone lying) can help reduce breathlessness if you’re recovering from coronavirus. Adding pillows under your chest or pelvis may make this position more comfortable. Only use this position if you feel comfortable and it helps your breathing.

2: Techniques to reduce breathlessness

Breathing control

1. Sit in a relaxed position in a chair with your back well supported.
2. Place one hand on your tummy.
3. Slowly take a deep breath in through your nose.
4. As you breathe in, allow your tummy to rise up.
5. As you breathe out slowly, feel your tummy relax down.

This may take some practice but can be very useful to help reduce breathlessness.

Pursed lip breathing

This can be useful to control breathlessness when you’re walking or being more active.

Take a breath in through your nose. Gently breathe out through your mouth with your lips pursed, just like when you’re whistling or blowing out a candle. Try to breathe out for longer than you breathe in.

Blow as you go

Breathe in before you start to move, then breathe out when you’re making a big effort, such as bending down, lifting something heavy or going up stairs.

If you find your breathlessness is not improving, contact your GP.

Take a look at this video from our team, with some breathing exercises you can try.

Coughs

1: Ways to help a dry cough

Keep yourself well hydrated by drinking small sips of water throughout the day. If you feel yourself starting to cough, take small sips of liquid. You may only need a few sips or you might need to have many to help control coughing. This can soothe your throat. Sucking a sugary sweet may also help.

If you don’t have a drink near you, try swallowing repeatedly if you have a cough. This can work in a similar way to sipping water.

You can drink a warm drink, such as honey and lemon, to help soothe your throat.

Steam inhalations can help to add moisture to your throat and nose. Pour hot water into a bowl and then put your head over the bowl. If comfortable, cover your head and bowl with a towel. You don’t need to add anything, the steam alone is sufficient.

If you have a runny nose, blow your nose if required. Try not to sniff.

If you cough when you go to bed, consider using the position discussed above to ease your breathing.

Avoid things that make you cough, for example:

• smoking
• smoky atmospheres
• air fresheners
• strong smelling candles
• strong perfumes or deodorants

2: Ways to help a cough with phlegm

If your cough has some phlegm (mucus, sputum), you should:

• stay hydrated
• inhale steam
• try lying on either side as flat as you can to help drain the phlegm
• try moving around to help to move the phlegm
• try the breathing control technique described above if you move to an area with a different temperature
• try to breathe in through your nose – breathing in through your mouth can make you cough more

If your cough is not improving, speak to your GP for advice.

Read further information about coughs

Pain

There are ways to manage pain that you may experience following coronavirus. For example, you can:

• plan the things you need to do each day to help you keep on top of your pain
• pace yourself – if your pain is stopping you completing a task you can try again later
• try to relax – this can be hard, but finding something which relaxes you will reduce the stress of pain
• take regular enjoyable exercise – even a small amount, like going for a walk, will make you feel better and keep your muscles and joints strong
• take prescribed pain medicine as instructed
• talk to others – such as family and friends – about pain you’re experiencing and why you may need to do things differently at the moment
• do things you enjoy – this makes you feel good and can reduce pain

If you are looking for support in getting back to activity after COVID, then this is something we can help with. Give us a call to find out more.

Sleep problems

You can help get back to a better sleeping pattern by:

• having a comfortable bedroom temperature
• making sure your bedroom is dark – blackout blinds can help
• taking time to relax later in the evening
• getting ready for bed at the same time each night
• avoiding screens – like phones or laptops – for at least 2 hours before bed
• trying to get up at roughly the same time every day
• avoiding caffeinated drinks – like tea and coffee – before bed
• trying not to snack or eat a large meal late in the evening
• setting aside time during the day to write down any worries you have
• discussing your worries with family and friends if you feel able
• keeping a ‘sleep diary’ to help you work out what helps and what doesn’t help you get a good night’s sleep
• If you can’t get to sleep within half an hour of going to bed, get up and relax in another room until you feel tired again.
• If you’re feeling very tired during the day and are struggling to stay awake, a 30 minute ‘power nap’ can help. It shouldn’t affect your sleep at night as long as it’s not too late in the day.

Low mood and depression

If you feel you need more help with your mental health, you can:

• Take a look at these mental wellbeing resources
• Read further information about low mood and depression
• Visit clearyourhead.scot
• Phone Breathing Space on 0800 83 85 87 – weekdays from 6.00pm to 2.00am and at weekends from Friday 6.00pm to Monday 6.00am

Returning to work

The longer-term effects of coronavirus will be different for everyone. Your return to work will depend on:

• how you’re feeling
• the type of job you do
• the level of flexibility offered by your employer

It’s important that you work with your employer to manage your return to work. Some people will need a phased return to work following recovery from coronavirus. A phased return means you gradually build up your hours and days at work.

Where available, take advice from your Occupational Health department. Or, talk to your line manager.

If you’re self-employed, try and pace yourself, especially if you’re fatigued. Try not to return to work too quickly following your illness.

When you return to work, you may find yourself feeling more tired. This is normal. During this time, it’s important that you try and pace yourself both at work and at home.

RESOURCES: 

Further information about fatigue

• Coping with fatigue
• Royal College of Occupational Therapists: Recovering from COVID-19: Post viral-fatigue and conserving energy
• Thistle Foundation: support for people experiencing post-viral fatigue syndrome as a result of COVID-19
• Chartered Society of Physiotherapy: Covid recovery activity planner

Further information about pain

There are many organisations that provide resources and information for people with pain.

• Pain Concern
• Pain Association
• Versus Arthritis
• Action on Pain
• Pain Toolkit
• Tame the Beast
• Live Well with Pain
• British Pain Society

Further information about returning to work

• Society of Occupational Medicine: COVID-19 Return to work guide for recovering workers (PDF, 2.1 MB)
• Citizens Advice Scotland
• Money Advice Scotland
• Working Health Services Scotland
• Acas (the Advisory, Conciliation and Arbitration Service): COVID-19 advice for employers and employees

Access the Long Covid Rehab Booklet here.