Long COVID
For most people COVID-19 is over in two or three weeks. For some it is not: the cough and the fever go, and the exhaustion, the breathlessness and the…
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Medicines commonly prescribed for Long COVID
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: SUPPOSITORY, 600 mg paracetamolActive substance: paracetamolManufacturer: Laboratorios Almirall S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 325 mgActive substance: paracetamolManufacturer: Laboratorios Cinfa S.A.Prescription not requiredDosage form: CAPSULE, 90 mgActive substance: duloxetineManufacturer: Newline Pharma S.L.U.Prescription required
For most people COVID-19 is over in two or three weeks. For some it is not: the cough and the fever go, and the exhaustion, the breathlessness and the inability to think clearly stay for months. This condition exists, it has been described, and it amounts to neither weakness of character nor anxiety. There is still no medicine that removes it, but there is something that works better than hunting for a miracle cure: understanding how it behaves, ruling out other illnesses, and getting the pacing of effort right. Getting that last part wrong can set a person back by months, which is why it has a section of its own here.
What counts as long COVID
The term covers complaints that continue, or first appear, a month after infection and are not explained by another diagnosis. If they last beyond three months, the picture is usually called post-COVID syndrome. The exact interval matters less than two conditions: a link with the infection, and the absence of another explanation. The second is always checked, because otherwise anaemia or an underactive thyroid is easily mistaken for long COVID.
A few things are worth knowing in advance. The severity of the acute illness barely predicts what follows: long COVID often develops after an infection that was shrugged off without any admission to hospital. Children and teenagers get it too. Being vaccinated before infection lowers the likelihood, though it does not remove it altogether. And most importantly: in most people the condition gradually improves, only it does so not in a straight line but in waves, with setbacks, which is easily read as getting worse.
What it feels like
The set of complaints differs from person to person and shifts even within a week. The commonest are:
- Draining fatigue, out of all proportion to what was done and not lifted by sleep.
- Breathlessness on effort that used to be easy, and a sense of not being able to fill the chest.
- Brain fog: absent-mindedness, words that will not come, an inability to hold several things in mind at once, slowed reading.
- Palpitations and light-headedness on standing, vision greying out, feeling unwell when upright.
- Muscle and joint pain, headaches, tingling and numbness.
- Insomnia in the middle of complete exhaustion, and waking unrefreshed.
- Changes in smell and taste, including distortions in which familiar food smells of rot or chemicals.
- Cough, chest pain, sore throat, ringing in the ears.
- Nausea, abdominal pain, looser stools, loss of appetite.
- Hair loss, rashes, heightened sensitivity to light and noise.
- Anxiety and low mood — both as a problem in their own right and as an understandable reaction to all of the above.
Palpitations and light-headedness on standing deserve a mention of their own: these are not "nerves" but a disturbance of blood vessel tone that can be recognised and treated. A pulse measured lying down and again after a few minutes standing often says more than a long work-up, and simple things help — more fluid and more salt, compression stockings, standing up slowly, and avoiding long periods of standing still.
The main rule: do not pay for the good days
A substantial proportion of people with long COVID have a feature that inverts the usual logic of recovery. The deterioration comes not during the effort but hours or a day afterwards, and it lasts for days. Because of that delay the connection is missed: someone feels better, does the cleaning and goes shopping, and the next day is flat out in bed blaming anything except yesterday.
From this follows the essential point. The familiar advice to build activity up gradually and push through does not help with this pattern; it does harm, leading to ever deeper crashes. The opposite works: stay noticeably below your ceiling, spread tasks across the week, alternate activity with genuine rest, and do not spend a good day all at once. Effort is not only physical: conversation, screens, noisy places and strong emotion draw on the same reserve.
The practical way to find the boundary is a diary in which each day's activity sits alongside how you felt for the two days after. Within a few weeks the pattern becomes visible, and what is most sorely missing appears: predictability. Activity can be increased, but in tiny steps, starting from the level after which no crash follows, and guided by how you are rather than by the calendar.
What must be ruled out, and how it is investigated
The diagnosis is not made on one feature but on the whole picture, and an obligatory part of it is making sure this is not another illness. Breathlessness and fatigue accompany anaemia, an underactive thyroid, diabetes, heart disease, sleep apnoea, and vitamin D or B12 deficiency. All of those are treatable, and it would be a shame to miss them.
- Questions about how you were before, how the infection went, and how the complaints shift from day to day.
- Blood tests: full blood count, inflammatory markers, glucose, thyroid, kidney and liver, ferritin, vitamins.
- Blood pressure and pulse lying and standing, oxygen saturation, including after a small effort.
- An electrocardiogram and, if needed, a chest X-ray and an echocardiogram.
- Assessment of mood and sleep: without that the picture is incomplete.
Normal results do not overturn the diagnosis and do not mean the complaints are invented. They mean exactly one thing: the dangerous possibilities are excluded and recovery can be got on with.
When urgent help is needed
Long COVID should not produce acute events, so acute events are not put down to it. Call an ambulance (in European countries, the single number 112) for sudden severe breathlessness, chest pain — particularly crushing pain spreading to the arm or jaw — coughing up blood, fainting, or confusion.
Separately: pain and swelling in one calf, especially together with breathlessness, may be a clot, and the tendency to clotting persists for some time after COVID-19. That is not something to watch; it needs to be looked at immediately. On the same day, though without an ambulance, see a doctor for new breathlessness at rest, a fever lasting more than a few days, or rapid weight loss.
What helps
There is no universal treatment, but the range of measures that work is wide, and they are matched to the particular complaints.
- Breathing retraining. A very common and very correctable cause of breathlessness is a disordered breathing pattern: fast, shallow, from the top of the chest. Work with a physiotherapist restores calm breathing from the abdomen and often clears the breathlessness in lungs that are perfectly sound.
- Supervised rehabilitation built around tolerance rather than around a training plan. Where effort brings on crashes, the aim is stability, not personal bests.
- Smell training: sniffing a few strong scents daily over months — a dull method with proven benefit.
- Managing brain fog: lists, one thing at a time, quiet, and breaks taken before the tiredness arrives rather than after.
- Sleep and mood. A fixed waking time, an unloaded evening and, where needed, psychological support — needed not because the illness is "in the head" but because months of illness are heavy.
- Treating what comes with it: blood pressure, palpitations, pain, reflux, migraine. Painkillers are taken in short courses and discussed with a doctor.
And what is not worth doing. A whole industry of expensive procedures has grown up around long COVID: blood washing, vitamin drips, ozone, courses of "immune modulators". None has shown any benefit, the money and energy they consume are considerable, and some of them are not harmless. Before paying, ask your doctor what is actually known about the method.
Living and working with it
Recovery takes months in most people and longer in some, and it moves unevenly. It makes sense to plan the coming weeks rather than a cure by a fixed date.
With work it is almost always better to negotiate than to be heroic: a phased return, reduced hours, breaks, working from home, moving the hardest tasks into the best part of the day. Going straight back to full time is the commonest cause of a crash and a second period of sick leave. Children and teenagers need the same allowances at school: a shortened day, temporary exemption from sport, extra time for written work.
Tell those close to you plainly that seeming well today does not mean being better; from the outside this is not obvious, and that is why it stings. And drive only when you trust your reactions: brain fog and sudden light-headedness are not compatible with being at the wheel.
Online consultation
This is exactly the subject where a remote appointment fits almost perfectly: travelling to a clinic with draining fatigue is an ordeal in itself, whereas talking and going through blood tests need nothing but a connection. At the first appointment the doctor will sort the complaints into groups, arrange the tests that exclude other causes, and explain the results. Then comes the most useful part: matching the level of activity to your pattern of crashes, going through the diary, working on palpitations on standing, on sleep, on brain fog and on mood. Online it is convenient to work out what to ask an employer for and how to word it, to check the safety of the medicines and supplements you are taking, and to weigh up soberly the latest expensive method someone has offered you. Follow-up matters more here than a single visit: the complaints change, and the plan changes with them. The acute situations in the urgent section are not dealt with online — for those, call an ambulance.
This material is for information only and does not replace medical advice.
Consult with a doctor about Long COVID
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Long COVID
Discuss your symptoms and possible next steps for Long COVID with a doctor online.
