Long Covid – The Food Medic

This article was written by one of The Food Medic team; GP – Dr Nirja Joshi

In General Practice soon after coronavirus became more prevalent in March 2020, it became clear that some patients were having symptoms lasting longer than would be expected of an acute viral illness. We began to see patients, people who were previously fit and healthy, found to have ongoing symptoms which could be quite severe such as breathlessness, fast heart rate and crippling fatigue. After some months, it became clear that there was a consequence of having had a covid infection, which affected some individuals and led to a longer term illness. 

What is Long Covid / Post Covid?

Post Covid is a broader term for those individuals who have any symptoms after a Covid-19 infection.

Long Covid is defined as symptoms which have lasted beyond 12 weeks (1)

Generally, GPs would refer patients if their symptoms lasted over 12 weeks. The reason for this is that the number of people with symptoms after a covid infection decrease sharply after 4 weeks, and the second period where patients tend to recover is at 12 weeks without any intervention (1).

Interestingly, Long Covid symptoms are not always related to how unwell someone is with the initial infection.

What symptoms may people experience after Covid?

The symptoms which people experience can vary significantly, but some of the common symptoms include (2):

Respiratory symptoms

Cardiovascular symptoms

• Chest tightness
• Chest pain
• Palpitations

Generalised symptoms

Neurological symptoms

• Cognitive impairment (“brain fog,” loss of concentration or memory issues)
• Headache
• Sleep disturbance
• Peripheral neuropathy symptoms (pins and needles and numbness)
• Dizziness
• Delirium (in older populations)

Gastrointestinal symptoms

• Abdominal pain
• Nausea
• Diarrhoea
• Anorexia and reduced appetite (in older populations)

Musculoskeletal symptoms

Psychological/psychiatric symptoms

• Symptoms of depression
• Symptoms of anxiety

Ear, nose, and throat symptoms

• Tinnitus
• Earache
• Sore throat
• Loss of taste and/or smell

Dermatological

When to see your doctor?

If you’re worried about symptoms 4 weeks or more after having coronavirus contact your GP for an initial consultation. They can offer you the support you may need and advice on how to manage and monitor your symptoms at home. They may suggest some tests to find out more about your symptoms and rule out other things that could be causing them.

How many people are affected by Post Covid?

In April 2022 in the UK, an estimated 1.8 million individuals had been experiencing self reported symptoms more than 4 weeks after a covid infection. That is around 2% of the population (3). The difficult with post covid symptoms, is that it can have a significant impact on one’s ability to function, with 18% of sufferers citing their activity was ‘limited a lot’. 

What treatments are available for Long Covid?

There are different approaches to treating patients with Long Covid (4, 5). What we are aware of, is that patients with Long Covid do recover, however, the time in which recovery happens is variable. 

With regards to particular symptoms, patients may see a specialist or Long Covid clinic who may suggest medication such as beta blockers (to reduce heart rate), antidepressants (to help with mental health and insomnia), inhalers (for breathing) and painkillers (for body aches). 

It is important to recognise, each patient’s symptoms will be different, and the approach to treatment will vary depending on an individual’s circumstances. 

There is no ‘cure’ for Long Covid, however, we are aware that symptoms will improve over time. 

People with Long Covid can often report feeling better for a period of time, and then feeling worse again. When patients start to feel better, they can begin to engage in more activity, and then feel they are going downhill again, this is known as the ‘boom-bust’ cycle, and hence pacing activity is something discussed at Long Covid clinics to aid recovery (4).

Breathing pattern disorder is also something which has been noted with Long Covid patients. This is where your breathing method has changed and may not be as efficient for your lungs to function. Working with a respiratory physiotherapist can help with this. 

Here are some tips to help with brain fog (3):
break down complex tasks into simpler ones
allow yourself extra time to complete a task
try exercise as you are able to tolerate, gradually building this up
try to avoid alcohol
you can eat a more ‘Mediterranean diet’, which can be good for brain health
social contact can also help

Is Long Covid contagious?

Long Covid is a condition which occurs after the initial illness, and hence it is not contagious at this stage (3). However, if you redevelop symptoms such as fever, it is always important to re-test for Coronavirus, and be aware of your contact with others as this may represent another illness.

Who is most likely to get Long Covid?

Anyone can develop Long Covid, however, the highest groups reported to have symptoms were women, older adults and those with severe symptoms (more than 5) in the first week of their illness. In addition, those who are vaccinated against Covid are less likely to develop Long Covid due to reduced likelihood of catching Covid, and there is some evidence to show those who are vaccinated have a lower risk of complications (3, 5).

What to do if you have Long Covid?

Try and have as much rest as you are able to, and speak to your doctor about investigations and referral to a Long Covid clinic. In addition, the UK government has a support page for those with Long Covid as well as parents of children with Long Covid (6).

References

1. NHS. Long-term effects of coronavirus (long COVID) [Internet]. 2022 [cited 2022 Jul 10]. Available from: https://www.nhs.uk/conditions/coronavirus-covid-19/long-term-effects-of-coronavirus-long-covid/
2. Shah W. Managing the long term effects of covid-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ [Internet]. 2021 Jan 22 [cited 2022 Jul 12]; Available from: https://www.bmj.com/content/372/bmj.n136
3. ONS. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 6 May 2022 [Internet]. 2022 [cited 2022 Jul 11]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/6may2022
4. Brown K. Long COVID and self-management. The Lancet [Internet]. 2022 Jan 22 [cited 2022 Jul 10];VOLUME 399,(10322):355. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02798-7/fulltext
5. Centre for Disease Control. : National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases [Internet]. Long COVID or Post-COVID Conditions. 2022 [cited 2022 Jul 10]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
6. Gov.uk. Find help and support if you have long COVID [Internet]. 2021 [cited 2022 Jul 10]. Available from: https://www.gov.uk/guidance/find-help-and-support-if-you-have-long-covid

Long Covid was last modified: July 15th, 2022 by Nirja Joshi