Many factors influence the range in recovery from COVID-19, some are predictable if they relate to other health conditions or age, and some are unpredictable and we can’t say why some suffer severe or ongoing symptoms. Most of us know someone who has no symptoms but tests positive. Others have a prolonged recovery due to complications such as clots or strokes or heart attacks. Those who required intensive care unit support whilst they had COVID-19, and needed intubation or ventilation, will also take a long time to recover. Research shows that most people have made a full recovery 12 weeks after they get initial symptoms. A cough from any infection – viral or bacterial – can persist for up to 3 weeks and doesn’t warrant further investigations if you’re otherwise well and have no underlying lung conditions. We would expect your cough to be getting better in this time, though. Similarly, a sore throat usually lasts about 7 days from any viral infection, including COVID, and fevers should have resolved within the first few days. Some people are left in the middle, where a few weeks later, they still have a bit of a cough or chest tightness, or going back to work or studies feels very effortful, and they’re not back to full strength. Many report symptoms waxing in waning, where a week or two after initial symptoms, they think they’re recovered, and then suffer a day where they feel set back by symptoms again.
Long COVID, or post-COVID syndrome as it’s now termed, typically lasts for longer than 12 weeks but if you are worried that your symptoms are prolonging or affecting your daily activity you should contact your GP for further review and support. Evidence suggests that being fully vaccinated against COVID, including getting the booster, can help prevent severe disease and make symptoms milder. You are more likely to get cold or flu-like symptoms than severe cough and breathing difficulties. Emerging data suggests it’s also protective against long COVID.
Your doctor will take a history and ask you about your initial symptoms and the symptoms that persist. They will ask you about your medical history, any regular medication you take, and they may decide to perform some basic investigations on you, such as an taking your vital measurements (blood pressure, pulse, oxygen saturations), request blood tests, ECG of your heart and maybe a chest X-ray. If your doctor thinks you are suffering from long COVID, they may consider referring you to a local specialised clinic. Each region in the UK has its own referral criteria, but this is usually a lengthy series of questions about symptoms and some tests specific to each symptom, to better inform the clinician when you are seen. For example, if you have breathing difficulty, they may ask you to sit and stand as often as possible in a minute, taking count and noting your oxygen saturations. Your doctor can also discuss with you any amendments that may help symptoms at work, or consider supporting more sick leave if you feel unable to work or study.
We, as doctors, have come to expect the unexpected from COVID, and persistent symptoms can be wide-ranging, so everyone’s experience is different. As such, all symptoms should be managed according to their effect on you. If you are suffering immense fatigue, it won’t help to push through to return to work or meet a deadline or have lots of things on the go at once. You need to listen to your body and rest to allow it to recuperate. You may need more time off work, or to reduce the number of activities to the minimum. As always, you can nurture yourself with regular, healthy balanced meals and keep well-hydrated, and introduce light exercise such as a walk outdoors and some relaxation time – just what you can manage, but push yourself to increase this as your health improves. It’s not had lots of media attention, but specialists tell us that COVID infection has caused lots of mental health problems, from difficulty concentrating or remembering, to anxiety and depression. If this applies to you, make sure you book with your doctor to discuss how you’re feeling and how they can help. If you and your GP think that your symptoms are negatively impacting your life, your GP can decide to refer you to a long covid clinic for further assessment and management.
Long COVID clinics are hospital-based services that cater to those who have been suffering from prolonged symptoms since their initial infection – the criteria is more than 3 months. It is managed by a team of healthcare professionals, including respiratory or allergy doctors and nurses, physiotherapists, occupational therapists and mental health support workers. They are still learning about long-term effects of COVID, but are best placed to assess you and advise on strategies or medication that may help your recovery.