LONG COVID- THE Symptoms

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Long Covid is a chronic, disabling condition that can develop after contact with the spike protein of Covid-19 and causes symptoms that can last weeks or months after the infection has long gone. This is sometimes called ‘post-COVID-19 syndrome’ or ‘long COVID’.  Many people feel better in a few days or weeks and most will make a full recovery within 12 weeks. But for some people, symptoms can last longer, and these symptoms can change over time, or new symptoms may develop.  

The chances of having long-term symptoms does not seem to be linked to the severity of illness or viral load. Anyone (more women than men) can have long-term problems. 

The official definition of Long Covid is:

• diagnosis is linked to probable COVID-19 infection;

• no test is required;

• it lasts 3 months or more;

• fluctuating symptoms;

• not explained by other conditions;

• also known as PASC (post acute sequelae of COVID).

Common Symptoms

The most common often fluctuating symptoms of Long Covid are: 

Fatigue - profound/chronic fatigue, probably unrelieved though worse at times. (Some support groups are reporting the most common symptoms are fatigue and anxiety) 

Respiratory issues from earlier variants of Covid

• shortness of breath

• chest pain or tightness

• shortness of breath

• chest pain

Cognitive Problems known as ‘brain fog’

• problems with concentration and mental stamina (‘my brain feels tired….’) 

• mental fatigue from processing complex words/concepts

• memory issues such as double checking things, many times

• difficulty grasping the meaning in rapid or complex speech

• difficulty finding familiar words

• momentary ‘memory gaps’ and ‘blanking out’

• difficulty with concentration.

Neurological/metabolic/hormonal/immunological/other

·      symptoms of depression

·      symptoms of anxiety/social anxiety

·      joint and muscle pains

·      insomnia

·      palpitations/raised heart rate which may be a symptom of Postural Orthostatic Tachycardia Syndrome (POTS)

·      dizziness, headaches

·      pins and needles/numbness

·      sudden ‘shooting’ pains in the legs

·      delirium (in older people)

·      confusion

·      tinnitus and earache

·      nausea, anorexia, diarrhoea, weight loss

·      reduced appetite (in older people)

·      high temperatures/fever, cough, headaches and sore throat

·      sore throat

·      loss of taste and/or smell

·      skin rashes

·      post traumatic stress

Associated conditions

• thromboembolic disease (blood clots);

• cardiac arrhythmias (heart);

• pulmonary fibrosis (scarring of the lungs)

• new onset allergies and anaphylaxis;

• mast cell activation (allergy);

• renal impairment;

• diabetes;

• hepatitis;

• persistent GI disturbances;

• dysphonia (voice impairments);

• myelopathy (spinal damage);

• dysautonomia (disorder of the automatic nervous system).

What is/may be going on in the body in Long Covid?

Patients will all report fatigue but apart from that, Long Covid seems to be different in each person. For example:

• asthmatics tend to become exhausted with changes in their breathing patterns contributing to a self-reinforcing cycle of anxiety and fatigue, raising their heart rate

• some find walking hard and find they need mobility aids (see the Annex for information on these)

• some have chronic joint and muscle pains

• others can do some exercise, but they tire quickly

• some have fatigue plus ongoing taste and smell (sensory) issues

• others have low mental stamina and cognitive/memory issues

• others report ongoing anxiety and depression.

Respiratory symptoms are common.  Since there is little long-term evidence about Long Covid and its development, it can be difficult to work out what symptoms are Long Covid and what may be a concurrent condition or a new condition (a GP should be consulted).  On the social and psychological side, patients have reported feelings of ‘stigma’ and anxiety as a result of lack of information available to the general public and to managers in the workplace. Patients suffering from post-Covid delirium or confusion may fear that those symptoms may attract inaccurate ‘mental health’ labels.

In Long Covid, the symptoms may be related to:

• poor oxygen transfer to periphery

• micro clots and rogue fibrin production (coagulation)

• enthesitis (inflamed blood vessels)

• poor cerebral blood flow (brain hypometabolism)

• dysfunctional metabolism (involving hormones)

• mitochondrial dysfunction in the cells

• abnormal immune and inflammation - overactive immune system

• autoimmunity - disordered immunity

• mast cell activation syndrome – releasing histamine

• antiphospholipid syndrome – increased risk of clotting

• small fibre neuropathy - skin sensation, burning, tingling

• overactive microglia, Inflamed nervous systems defence e.g. in brain