- “Long COVID” refers to prolonged symptoms following infection with SARS-CoV that are not explained by an alternative diagnosis. The term embraces the NICE terms “ongoing symptomatic COVID” (Symptoms that last 4-12 weeks) and “post COVID-19 syndrome” (symptoms beyond 12 weeks); the US CDC definition of “post COVID conditions; and the WHO “post COVID-19 conditions”.
- The symptoms can be wide ranging, occur across multiple systems, though one system may dominate, and can start up to 1 year following initial infection. Clusters of symptoms are recognised, though not fully explained.
- The evidence that has been collected so far suggests that the majority of patients with Long COVID see an improvement in symptoms over time (sometimes years), though it is recognised that some patients will have a fairly constant course, and others have a relapsing and remitting course with or without identifiable triggers.
- There is currently no specific treatment for Long COVID, though there are some recognised complications that have clear management plans once a formal diagnosis has been made.
Respiratory Complications
- It is very well recognised that there is a significantly higher risk of developing PE following COVID infection. Though this peaks within 4 weeks of infection, there is still increased risk at 12 months. Any assessment of respiratory symptoms following COVID infection must include the consideration of acute, sub-acute, and chronic PE.
- Pulmonary fibrosis following COVID infection is a rare, but recognised complication. It is more likely following more severe infection, and very unlikely in any patient who was not admitted to a critical care setting due to their COVID infection. HRCT chest is the diagnostic test that could be considered if relevant abnormalities are present on either a chest radiograph (CXR) or pulmonary function tests.
- It is very common for any viral infection to worsen airways disease, particularly asthma. A deterioration in asthma control following COVID infection should be managed in the usual way: optimisation of asthma therapies, escalation of therapy according to local protocols, and referral to secondary care as appropriate.
- Chronic fatigue with Long COVID is common and can present in association with breathlessness on exertion. This is not associated with hypoxaemia. A normal clinical examination, CXR, ECG, FBC and exercise oxygen saturation (e.g. sit-to-stand test) is very reassuring: it is very unlikely there is an underling respiratory cause to the breathlessness in this situation. A structured exercise and daily activity management programme is important here, as the chronic fatigue associated with Long Covid is not the same as simply being unfit.
- Some individuals with Long Covid presenting with breathlessness have developed a syndrome of dysfunctional breathing following the insult of their initial Covid infection. There is no explanation as to why this occurs, but is a recognisable syndrome that can be managed through breathing retraining exercises.