While coronavirus symptoms may pass quickly, some people are suffering long-term effects. We outline the symptoms of long Covid, and some tips to help manage them.
What is long Covid?
Long Covid is a term to describe the effects of Covid-19 that continue for weeks or months beyond the initial illness. The health watchdog the National Institute for Health and Care Excellence (NICE) defines long Covid as lasting for more than 12 weeks, although some people consider symptoms that last more than eight weeks to be long Covid.
Research published in June 2021 by Imperial College London, based on half a million people in England, found two main categories of ongoing symptoms: a smaller group of people with respiratory symptoms, such as a cough or breathlessness, who were more likely to have had severe Covid-19 illness initially, and a larger group with a cluster of more general symptoms, particularly tiredness and fatigue.
Research based on people who reported their symptoms of long Covid on the COVID Symptom Study app also identified two main groups of symptoms, one mainly respiratory, but including fatigue and headaches, and a second group of symptoms affecting many parts of the body, including the heart, brain and the gut. In the study of 4,182 people, heart symptoms were commonly reported, such as palpitations or increased heartbeat, as well as pins and needles, numbness and ‘brain fog’.
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How many people get long Covid?
Details of how many people are affected by long Covid are still emerging.
According to an estimate from the Office for National Statistics in May, 1.1 million people in the UK were reporting long Covid symptoms in the four weeks to 6 March 2021. These were defined as symptoms that had lasted more than four weeks from initial infection, though for more than two thirds of these people the symptoms had lasted more than 12 weeks. A fifth said their symptoms limited their daily activities a lot.
Other studies suggest the numbers could be considerably higher. A study published in June by Imperial College, London, of half a million adults in England who reported having Covid illness found that over a third still had at least one symptom 12 weeks later. When these findings are applied to all the people in England who have been ill with Covid, this could mean more than two million people may have experienced long Covid.
The Imperial College study in June produced estimates of numbers people with long Covid which were nearly double those from the ONS in May. One difference is that the Imperial study asked people if they had persistent symptoms, rather than asking if people had long Covid. Another difference is that the Imperial study asked people if they had experienced these symptoms between September 2020 and February 2021, whereas the ONS study covered people who were still experiencing them in April and early May 2021.
A study led by the University of Leicester of just over 1,000 people who had needed treatment in hospital for Covid found that the majority (seven in 10) had not fully recovered five months after they were discharged. The report authors said that one in five of those in the study could be considered to have a new disability.
Of those who were working before they had Covid-19, 17.8 per cent were no longer working and a further 19.3 per cent had experienced a health-related change to their work.
What are the symptoms of long Covid?
Although most people who get Covid-19 recover quickly, for some the effects of the virus can last for weeks or months. This is known as “long Covid”.
For some, it can seem like a cycle of improving for a time and then getting worse again. These long-term effects aren’t only among those who needed to go to hospital, or even who felt seriously unwell when they first caught the virus.
Lasting symptoms of coronavirus can include:
- fatigue
- breathlessness or shortness of breath
- difficulty sleeping
- anxiety and depression
- heart palpitations
- chest tightness or pain
- joint or muscle pain
- not being able to think straight or focus (‘brain fog’)
- change to your sense of smell or taste
- persistent cough
Is it normal to get chest pain after Covid?
Chest pain is a common symptom of Covid-19. Some people are experiencing chest pain that lasts beyond their initial Covid-19 infection, or that starts in the weeks after they’ve had the virus.
It’s important to remember that even if you have had Covid-19 and are now are experiencing chest pain, it may not be related to the virus.
If you experience any new type of chest pain, it’s important to get medical advice, as chest pain can be a sign of something more serious, like a heart or lung problem.
When should I seek urgent medical help?
- Chest pain that is sudden or severe and doesn’t go away
- Sudden chest pain that is accompanied by vomiting, nausea, sweating, or shortness of breath
- Sudden chest pain that is accompanied by a loss of consciousness
If you have chest pain that comes and goes, you should still speak to your GP about it or call 111 – as chest pain should never be ignored.
Some people with severe Covid-19 also experience heart and circulatory problems during their illness.
What type of chest pain do people get after Covid-19?
We are still learning more about chest pain following Covid-19, but it seems likely that it can be caused by a variety of things.
Muscle pain or soreness (myalgia)
Severe viral infections, including Covid-19, can cause muscle pain or soreness, which can be in a specific area or spread more widely. The affected area feels sore to the touch and is made worse by specific movements such as turning the chest or stretching.
Non-specific chest pain
Non-specific chest pain, which is also called non-cardiac chest pain, can be sharp or dull, and can happen in short bursts or be ongoing. It often doesn’t have a cause that can be found.
How long does it take to recover from long Covid?
We are still learning how long the illness lasts and it can vary in different individuals. It’s important to note that this isn’t unique to Covid-19 – other viral illnesses can also have lasting effects. The study led by Leicester researchers described above suggests that among those who needed hospital treatment for the initial illness, it is common for it to last five months or more, and there are separate reports of it lasting 12 months or more (this includes both people who didn’t need hospital treatment initially and those who did.)
Who is most at risk of developing long Covid?
Researchers have analysed data from the COVID Symptom Study app to discover who is most at risk of developing long Covid. They found that older people, women, and those who had five or more symptoms in the first week of becoming ill with Covid-19 were more likely to develop long Covid.
They found that long Covid affects around ten per cent of 18-49 year olds who get Covid-19, increasing to 22 per cent of people over 70. The researchers also found people with asthma were also more likely to develop long Covid. This was the only clear link they found to existing health conditions in people who developed long Covid.
A study by Imperial College London also found that long Covid tended to increase with age (it found a 3.5% increase in persistent symptoms with every decade of life) and was more likely to affect women. It found that long Covid was higher among people who are overweight or obese, who smoke, live in deprived areas or had severe Covid illness and needed to be admitted to hospital. The study was carried out by analysing data from half a million adults in England who reported having Covid illness between September 2020 and February 2021.
Can children get long Covid?
The Office for National Statistics (ONS) has published data from the UK Coronavirus Infection Survey which looked at how many people showed symptoms five weeks after infection. The ONS described these as ‘experimental estimates’. The estimates suggested that almost 13 per cent of children in the survey aged between two and 11 and 14.5 per cent of children aged 12 to 16 reported certain symptoms including fatigue, cough, headache, muscle aches or loss of taste or smell five weeks after falling ill with Covid-19. It is important to bear in mind that ‘experimental estimates’ means the data are still being tested. The data was based on 9,063 respondents of all ages but it is unclear what proportion of these were children. However, it is clear that some children are affected by lingering symptoms following initial infection.
Why do some people get palpitations, feel lightheaded or faint after Covid?
There is emerging evidence that some people who develop long Covid have similar symptoms to people with a condition known as postural tachycardia syndrome, or postural orthostatic tachycardia syndrome (PoTS). This condition can cause dizziness when moving to an upright position and can be triggered by infections. The most common symptoms are feeling lightheaded, palpitations (being aware of your heartbeat) and fatigue.
There have been several case reports in medical journals of people who had continuing symptoms following Covid-19 infection, and some were found to have PoTS. PoTs happens because your body’s ways of avoiding a drop in blood pressure when you stand up aren’t working properly. Normally when you sit up or stand up, gravity makes some of your blood flow downwards, which can cause a fall in blood pressure. Your body responds to prevent a fall in blood pressure by narrowing your blood vessels and slightly increasing your heart rate. But if you have PoTS these automatic changes don’t happen. When you move to an upright position the supply of blood to your heart and brain drops and your heart starts beating faster to compensate.
While there is no cure for PoTS, it can be managed by diet, exercise and medication, and the researchers say it is important to get an accurate diagnosis so patients can be treated and advised on how to manage their symptoms.
If this sounds like your symptoms after having Covid-19, you should let your doctor know to ensure you are correctly diagnosed and can receive effective treatment.
The Royal College of Physicians (RCP) have published guidance for doctors that recognises orthostatic problems (including PoTS) as symptoms of long Covid. Orthostatic means relating to, or caused by, being upright.
The RCP recommend to doctors that patients experiencing breathlessness, palpitations, fatigue, chest pain and fainting should be checked carefully for orthostatic problems. This includes having an active stand test, which measures a patient’s changes in heart rate and blood pressure after moving from a lying to a standing position.
Is long Covid contagious?
Long Covid is not contagious. Long Covid symptoms are caused by your body’s response to the virus continuing beyond the initial illness.
To avoid passing coronavirus on to others, you should self-isolate for 10 days from your original symptoms or positive test, or if after 10 days you still have a temperature, or runny nose or sneezing, or sickness or diarrhoea, until these symptoms have gone.
If I have long Covid will I test positive?
Long Covid symptoms are caused by your body’s response to the virus continuing beyond the initial illness. So having long Covid symptoms won’t cause you to test positive.
If you get a positive Covid test result it’s most likely to be a new infection from the one that caused your long Covid symptoms. If you have a positive test, as always, you need to self-isolate for 10 full days to avoid passing it on. If after 10 days you still have a fever, or are feeling hot or shivery, or have a runny nose or sneezing, or are feeling or being sick, or have diarrhoea, you should self-isolate until those symptoms have gone. If any of these symptoms are lasting a long time and you think they may be symptoms of long Covid, you can get another PCR test to see if you still have an active infection.
Some tips for managing your symptoms:
Manage fatigue and breathlessness
- Pace yourself – plan what you’re going to do and don’t over-exert yourself.
- Try to break tasks which feel difficult down into smaller chunks, and alternate easier and harder activities.
- Consider the best time of the day to do certain activities based on your energy levels.
- Frequent short rests are better than a few longer ones, so rest before you become exhausted.
- Don’t stop doing things that make you feel breathless. If you stop using your muscles, they’ll get weaker, which can make you more breathless when you try to use them.
- Try to gradually increase the amount of exercise you do. Try going for short walks or doing simple strength exercises and build up from there.
- If you use a walking stick or a frame, lean forward on it when you feel breathless.
- The ME Association has published a leaflet about post-Covid fatigue. You can also call them on 0344 576 5326 for further support.
Boost your mood and stay on top of your mental health
- Be kind to yourself during your recovery – be prepared that some days will be worse than others
- Connecting with other people can help you feel happier – make sure to keep in touch with family and friends.
- Having a daily routine can be good for your mood and sense of stability.
- Stay active – continuing to move will help release endorphins and improve your mood.
Tips for thinking or memory problems
- Make notes to help you remember things – whether it’s in work meetings or medical appointments.
- Try to reduce distractions.
- It can help to make a clear plan before approaching any new or complicated problem or situation. Break it down into steps, and keep checking your plan as you follow it.
Relieving joint or muscle pain
- Flexibility exercises (like stretches, yoga and tai chi) and strength exercises (like climbing stairs, lifting weights and working with resistance bands) can be useful. Check with your doctor before starting a new exercise regime.
What support can I get for long Covid?
- Long Covid clinics are being rolled out across England and have started in Wales to help those struggling with ongoing symptoms. Speak to your GP or healthcare professional to find out if you are being referred. No similar services have yet been announced in Scotland or Northern Ireland.
- Your Covid Recovery has been set up by the NHS to provide information and support to those who’ve had Covid and are still suffering with symptoms. A bilingual version of the app has been developed by NHS Wales.
- If you’re worried about your symptoms, or if they are getting worse, contact your GP. You may be able to be referred for physiotherapy, or for psychological support such as cognitive behavioural therapy (CBT).
- Always call 999 if you have any emergency symptoms, such as sudden chest pain, shortness of breath or if you think you may be having a heart attack or stroke. Find out more information on when to get medical help.