Millions of people are still feeling the impact of Covid long after their infection has gone – and it’s making everyday tasks a struggle. According to one of the largest Government studies into the virus, around two million people in England alone have had long Covid, where one or more Covid-19 symptoms last for at least 12 weeks.
With further studies suggesting one in three people who catch the virus will experience ongoing health issues, that number is likely to rise.
Long Covid is a complex condition associated with a range of symptoms including joint pain, heart palpitations, brain fog, nausea, fever and rashes.
But the most common problems – extreme tiredness and breathlessness – are also hallmarks of post-viral fatigue, which often follows glandular fever, pneumonia and other infections.
Dr Charles Shepherd, an adviser to the ME Association, believes there is an overlap with myalgic encephalomyelitis, the chronic fatigue syndrome (CFS) once dismissed as “yuppie flu” because, like long Covid, it often affected young, previously healthy people.
Extreme fatigue is common after a prolonged spell in hospital, too.
Could more be done to help long Covid sufferers? Have your say in the comment section
Professor Manoj Sivan, an expert in rehabilitation medicine at Leeds University, and consultant at Salford Royal Hospital, explains: “Anyone who has been admitted for three or four weeks will take at least three or four months to recover.
“People become deconditioned, and there is a degree of muscle wastage.”
In the past, taking time out after illness was expected, and positively encouraged. One of the greatest advocates for convalescence was Florence Nightingale.
Now, long Covid is highlighting the importance of recovery after illness, and this could also benefit the one in
17 people with conditions such as fibromyalgia, characterised by widespread pain and tiredness, and CFS.
What is long Covid?
Patients first used the “long Covid” hashtag to share their experiences of prolonged problems and the term is now used by the NHS, the World Health Organisation and other organisations.
Many sufferers are frontline medics who were active and healthy. Around 10per cent had such mild symptoms they were not admitted to hospital.
It is more common in working-age adults and also affects children.
Professor Sivan says three out of four people seeking help for long Covid are women and he believes this is because the underlying problem is an immune-system fault. Auto-immune conditions are far more common in women, and notoriously unpredictable, as is often the case with long Covid.
Immunity impacts every aspect of health, which would also explain why long Covid can trigger more than 200 symptoms, involving 10 organ systems.
Professor Sivan says: “I don’t think anyone has a clear answer, but the virus seems to cause a derangement of the immune system. After the initial infection, there’s a delay in resetting the immune system and in some people it doesn’t reset at all.”
When to seek help
Professor Sivan says it’s common to feel below par for at least four weeks after Covid-19 and if you are still struggling, he suggests self-help strategies and the NHS Your Covid Recovery website.
“After 12 weeks, if symptoms are still interfering with daily activities, seek help: GPs are getting quite upskilled in managing long Covid and there are 83 specialist NHS centres.”
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It is also important to rule out any underlying problems such as heart or kidney disease, and some red-flag symptoms should be checked immediately.
These include: chest pain during exercise; sudden chest pain that lasts more than 15 minutes; becoming breathless when you have not been active, and heart palpitations with dizziness, chest pain or fainting.
Don't fight fatigue
The key to beating fatigue is accepting you can’t and acknowledging there will be days when even basic tasks are exhausting.
Professor Sivan says: “Return to activity in a very gradual fashion.
“If you try to do too much too quickly you won’t give your system a chance to reset and fatigue could become a chronic problem.”
Dr Shepherd adds: “When you have a good day it is easy to overexert yourself and crash the following day.”
With long Covid this can reactivate viral symptoms such as fever, breathlessness and muscle pain.
Plan each day and save your strength for things that matter.
Dr Shepherd suggests: “Work out a baseline of physical and mental activities that is achievable, and comfortable, and break big tasks into bite-size amounts with periods of rest in between. If you’ve a busy day ahead, keep the next day clear to recover.”
Gradually increase activity, but stop and rest whenever you hit your limit.
Breathe easier
Professor Sivan warns that pulmonary rehabilitation, which can help COPD, asthma and after pneumonia, is counter-productive for people with long Covid.
This form of rehab focuses on learning breathing techniques and exercises that push you to the point of breathlessness. Online courses are available in some areas, but may require a GP referral. The British Lung Foundation also provides resources.
However, people with long Covid should aim to calm and slow their breathing, to make it as effortless as possible. One simple technique is a breathing rectangle, where you make out-breaths twice as long as in-breaths.
When you feel breathless, try not to panic, drop your shoulders and focus on calming your breathing.
Cooling your face and nose with a wet flannel can help.
Pain barriers
People with chronic fatigue and long Covid could benefit from recent research that shows fibromyalgia is an autoimmune problem, not a psychological one, as was once thought.
Scientists at King’s College London have identified antibodies that increase activity in pain-sensing nerves. They believe this could lead to better diagnosis and repurposing existing autoimmune therapies to treat fibromyalgia, CFS and long Covid.
Until then, gentle stretching and strength exercises will help relieve symptoms and maintain mobility.
Dr Deepak Ravindran, a consultant in pain and musculoskeletal medicine, and member of the British Society of Lifestyle Medicine, says a plant-based diet, or a low-histamine regime that eliminates alcohol and fermented foods, can reduce inflammation.
Being mindful
While the experts emphasise that chronic fatigue is not all in the mind, it can be associated with memory and cognition problems and depression.
The best way to manage symptoms is the 3 Ps – pacing, planning and prioritising.
If concentration is a problem, reduce distractions and search music streaming apps for ‘focus’ playlists.
If memory is an issue, use your phone’s calendar app to set reminders and notes, or use the voice recorder to help remember what you have done.
Routines, sleep and avoiding alcohol will all help.
Dr Ravindran adds: “Stress management is so important. Cognitive behavioural therapy, gentle swimming, yoga and a massage can be beneficial.”
'We must take this seriously'
Dr Stephanie de Giorgio caught Covid-19 in March 2020, in the first wave of the pandemic. As the clinical lead of an urgent treatment centre at an NHS hospital it was always a risk. Although she was not hospitalised, she was “quite ill for 14 days” and took four weeks off work.
Stephanie, 45, from Dover in Kent, is still struggling.
“It’s rubbish,” she says simply. “I have never felt normal since. You will have times when you can do a lot more, and then two, three, four weeks on, you are just wiped out again.”
Sometimes there is an obvious trigger, sometimes it just happens.
“It’s just the weirdest disease,” Stephanie adds. “I have asthma and struggle really badly with colds and exacerbation, but when I got Covid I sailed through. I didn’t have any breathing problems.
“If you take the misery of living with it out of the way, on the academic side, it’s fascinating.”
Stephanie’s most troubling symptoms have been heart palpitations, dizziness and extreme fatigue. Tests confirmed an abnormal heart rhythm and she now takes the heart-failure drug Ivabradine, which has eased the palpitations and dizziness. Fatigue is an ongoing issue and she relapses into a high fever when she overexerts herself.
Like many others with long Covid, Stephanie also experiences numbness and tingling, headaches and cognitive problems.
“I could not think straight. When I was baking, I put the eggshells in the bowl and threw the egg away.”
She is still learning to live with the condition — as is her nine-year-old daughter Alice, who caught it at the same time. Alice suffers extreme fatigue and crippling migraines, and has managed just four complete weeks at school in 16 months.
Stephanie admits: “I never really understood chronic fatigue, I knew it was awful, but you are not taught about it at medical school. One of the things I hope that comes out of this is that the medical profession takes chronic fatigue far more seriously.”
