Long COVID: What we know so far

Although we’re pretty familiar with the short term symptoms of COVID-19, we’re still finding out more about its longer term effects. In this blog, our Artificial Intelligence clinician and GP, Dr Kimya Tarr, summarises what we know so far and where you can find support for long COVID.

What is long COVID?

Long COVID is a term being used to describe illness in people who have symptoms that go on for weeks or months after they caught the infection¹.

Data from the UK COVID Symptom Study app suggests that while most people recover from COVID-19 within two weeks, one in ten people may still have symptoms beyond three weeks, and a smaller proportion for months².

A US study, found that only 65% of people had returned to their previous level of health 14-21 days after a positive test.

Why do some people go on to have long COVID?

It’s not currently known why some people are more prone to long COVID and why some people’s recovery is prolonged.

One theory is that ongoing symptoms may be caused by the body’s response to the virus persisting even after the initial illness (which may have been mild)⁴. But it’s important to note that people with long COVID are not thought to be infectious, unless they have caught the virus again⁵.

While children can be affected, it’s more common in adults. There’s some evidence to suggest that some people may be at greater risk of developing long COVID⁶, in particular:

• older adults
• women
• people with pre-existing asthma
• people with a greater number of initial symptoms in the first week of their initial illness

What are the common symptoms of long COVID?

Based on research studies and patient surveys, over 200 symptoms of long COVID have been reported to date⁷.

Long COVID symptoms can vary from person to person and are wide ranging. They can affect different parts of the body, can fluctuate and change in nature over time.

The most commonly reported symptoms include:

Symptoms related to the brain and nerve endings such as:

• ‘Brain fog’ (problems concentrating or slowed thinking)
• Memory loss
• Headaches
• Insomnia (problems sleeping)
• Pins and needles or numbness in the body’s extremities such as the hands, feet or arms
• Dizziness
• Delirium (sudden confusion), in older people

Symptoms related to the ears, nose and throat such as:

• Tinnitus (the sensation of ringing or buzzing in the ears)
• Earache
• Sore throat
• Vertigo (spinning sensation)
• Loss of, or change in sense of taste or smell

Symptoms related to the heart such as:

• Chest tightness
• Chest pain
• Palpitations (heartbeats that suddenly become more noticeable)

Symptoms related to the lungs such as:

• Shortness of breath
• Cough, which can be both dry or with mucus

Symptoms related to the gut such as:

• Abdominal pain (stomach ache)
• Nausea
• Diarrhoea
• Weight loss and reduced appetite, in older people

Symptoms related to the muscles and joints such as:

• Joint pain, for example back, rib or neck pain
• Muscle pain

Symptoms related to the skin such as:

• Rashes, which may look like hives, prickly heat or chilblains⁸

Other symptoms such as:

• Fatigue (feeling tired), which can range from mild fatigue to extreme exhaustion
• Fever
• Mental health problems such as depression or anxiety⁹

How long can it take to recover from long COVID?

Recovery time is different for everyone but for most people, symptoms will resolve by 12 weeks9. Most people with long COVID will be able to continue life as normal, but for a small number, their mental and physical health may be severely affected to the point where their symptoms limit their ability to engage in work and family activities.

Speaking to a healthcare professional about your symptoms

If you’re worried about new, ongoing or worsening symptoms, especially if you’ve had them for more than 4 weeks after the start of suspected or confirmed COVID-19, speak to a clinician⁹.

If you’re experiencing symptoms such as worsening breathlessness, unexplained chest pain, new confusion or new weakness in the face, arms or legs, seek urgent medical attention as this could be a sign of something serious⁴.

Clinical tests are not always needed to diagnose long COVID, but they may be used to rule out other causes of your symptoms. Blood tests, chest x-rays, blood pressure and heart rate are some of the tests that may be requested. Your doctor will give you tips to help you monitor and manage your physical symptoms at home, and offer you mental health support if needed. Other therapies may be offered depending on your symptoms. Referral to specialist rehabilitation services are not needed for most people, but depending on where you live, may be an option to help you recover⁴.

Useful resources for long COVID

The following websites are useful resources for people that have long COVID or are interested in finding out more:

• Asthma UK and British Lung Foundation. Post-COVID hub. https://www.post-covid.org.uk/
• NHS Your COVID Recovery https://www.yourcovidrecovery.nhs.uk/
• Facebook. Long COVID Support Group. https://www.facebook.com/group...
• Royal College of Occupational Therapists. How to conserve your energy: Practical advice for people during and after having COVID-19. https://www.rcot.co.uk/conserving-energy
• CDC. Long term effects of COVID-19 https://www.cdc.gov/coronaviru...

References:

1. nhs.uk. 2021. Long-term effects of coronavirus (long COVID). [online] Available at: <; [Accessed 4 March 2021].
2. COVID Symptom Study, 2020. How long does COVID last?. Available from: https://covid.joinzoe.com/post/covid-long-term [Accessed 22 January 2021].
3. Tenforde, M.W., Kim, S.S., Lindsell, C.J., et al, 2020. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR), 69(30), 993-998. http://dx.doi.org/10.15585/mmwr.mm6930e1
4. Greenhalgh, T., Knight, M., A'Court, C., Buxton, M., & Husain, L., 2020. Management of post-acute covid-19 in primary care. BMJ (Clinical research ed.), 370, m3026. https://doi.org/10.1136/bmj.m3026
5. Cevik, M., Tate, M., Lloyd, O., Maraolo, A.E., Schafers, J., & Ho A., 2020. SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis. The Lancet Microbe, 2(1), e13-e22.https://doi.org/10.1016/S2666-5247(20)30172-5
6. National Institute for Health and Care Excellence, 2020. COVID-19 rapid guideline: managing the long-term effects of COVID-19 (NG188) evidence review 1: risk factors. Available from: https://www.nice.org.uk/guidance/ng188/evidence/evidence-review-1-risk-factors-pdf-8957625373 [Accessed 23 January 2021].
7. Patient Led Research For COVID-19, 2020. Report: What Does COVID-19 Recovery Actually Look Like? An Analysis of the Prolonged COVID-19 Symptoms Survey by Patient-Led Research Team. Available from: https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ [Accessed 22 January 2021].
8. COVID Symptom Study, 2020. Skin rash should be considered as a fourth key sign of COVID-19 . Available from: https://covid.joinzoe.com/us-post/skin-rash-covid [Accessed 23 January 2021].
9. National Institute for Health and Care Excellence, 2020. COVID-19 rapid guideline: managing the long-term effects of COVID-19 (NG188). Available from: https://www.nice.org.uk/guidance/ng188/evidence/evidence-review-1-risk-factors-pdf-8957625373 [Accessed 23 January 2021].