Long COVID:  Symptoms, risk factors, and treatment options explained

What is Long COVID?

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is a chronic condition that affects people of all ages. It refers to the series of symptoms that last for weeks or months after the initial phase of COVID-19 has subsided. While most people recover from COVID-19 in a few weeks, according to a study by the Australian National University (ANU), of more than 11000 Australians who tested positive for COVID-19 in 2022, one in five were still experiencing symptoms three months after their initial diagnosis. These symptoms may impact multiple body systems, including the respiratory, cardiovascular, neurological, and mental health systems. The risk of long COVID is greater for women and people aged 50 to 69, as well as those with existing health issues and individuals with fewer vaccine doses. Note: This content is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Long COVID is a complex condition. While telehealth GPs can coordinate care and provide referrals, physical examination is often required to rule out other heart or lung conditions. We recommend sharing your consult summaries with your regular GP and bulk billing is available for eligible patients during Medicare-defined periods; otherwise, private fees apply.

Common symptoms of long COVID

Long COVID symptoms can be mild or severe and may vary significantly from person to person. Common symptoms include:

Respiratory:

• Shortness of breath
•  Persistent cough
•  Chest pain

Neurological:

• Brain fog
•  Difficulty speaking
•  Memory loss
•  Headache

Musculoskeletal:

• Joint and muscle pain

Gastrointestinal:

• Diarrhoea
•  Constipation

Psychological:

• Anxiety and depression

Other:

• Fatigue
•  Sleep disturbances
•  Loss of taste and smell
•  Fever
•  Rash

While chest pain and breathlessness can be Long COVID symptoms, new or worsening pain can indicate dangerous complications (like blood clots or heart inflammation). Call 000 immediately if you experience: • Sudden, severe chest pain. • Severe difficulty breathing. • Fainting or loss of consciousness. • Coughing up blood.

Why does COVID-19 cause ongoing health problems?

Scientists are still discovering what Long COVID is, but several theories for what happens after infection have emerged:

1. Immune system dysregulation: COVID-19 may hyperdrive the immune system, rendering inflammation unrelenting. This inflammation persists even after the virus itself has left the body, possibly harming tissues and organs.
2. Viral persistence: The virus may leave traces of itself in the body, which can trigger ongoing symptoms.
3. Tissue damage: Severe COVID-19 can harm the lungs, heart, or brain in ways that leave these organs working poorly for extended periods.
4. Dysautonomia: For some individuals, COVID-19 appears to have a devastating impact on the autonomic nervous system, resulting in disorders such as postural orthostatic tachycardia syndrome (POTS).

How is long COVID diagnosed?

Long COVID is diagnosed through an examination of the patient's medical history, the persistence of symptoms lasting four weeks or more after recovering from COVID-19, and the exclusion of alternative medical conditions, given that no specific diagnostic test exists for this condition. The diagnostic process encompasses several essential steps:

1. Medical history evaluation: The medical practitioner will conduct a thorough review of the patient's COVID-19 history, which includes assessing the severity of the infection, the symptoms experienced, and the treatments administered. It is important to note that long COVID may occur even following mild or asymptomatic infections.
2. Assessment of symptoms: The presence of symptoms such as fatigue, cognitive impairment, shortness of breath, joint pain, or palpitations, will be carefully evaluated.
3. Physical examination and diagnostic testing: Based on the reported symptoms, the doctor may recommend various tests, including blood analyses, imaging studies (such as X-rays or advanced imaging), or evaluations of lung function, to identify any underlying complications.
4. Exclusion of alternative conditions: Since many symptoms associated with long-term COVID can overlap with those of other medical conditions, including thyroid disorders, chronic fatigue syndrome, or anxiety disorders, a significant part of the diagnostic process involves ruling out these possibilities.

Risk factors for long COVID

Several factors contribute to an increased likelihood of developing long COVID following a SARS-CoV-2 infection. The following elements are significant:

1. Severity of initial infection: Individuals who experience hospitalisation or severe manifestations of COVID-19 are at a heightened risk for long-term COVID.
2. Underlying health conditions: The presence of health issues such as diabetes, obesity, and cardiovascular diseases elevates the risk of long COVID.
3. Gender: Research indicates that women are more susceptible to long COVID symptoms compared to men.
4. Age: Long COVID is observed more frequently in middle-aged and older adults, although it may also affect younger individuals.
5. Multiple symptoms during acute infection: The occurrence of a diverse array of symptoms, encompassing respiratory and systemic manifestations during the initial infection, is associated with an increased risk.
6. Pre-existing mental health conditions: Individuals with anxiety or depression before contracting COVID-19 may experience a greater vulnerability to long-term COVID.
7. Delayed vaccination: Individuals who remain unvaccinated or receive vaccination post-infection may face elevated risks compared to those vaccinated before infection.

What management is available for long COVID?

At present, a universal treatment for long COVID remains unavailable; however, various therapies and management approaches exist to mitigate symptoms and enhance overall quality of life.

Primary care management:

Patients are encouraged to engage in regular consultations with healthcare providers to monitor and address their symptoms. In cases of ongoing concerns, referrals to specialists may be necessary, such as consulting a pulmonologist for respiratory difficulties or a neurologist for cognitive impairments. Note: Specialist services such as neurology or pulmonary rehabilitation are not provided directly by Hola Health and are mentioned for informational purposes only.

Acute Infection Management:

While antivirals are used to treat acute COVID-19 infection in the first 5 days, they are not currently a standard treatment for established Long COVID. However, your doctor can review your current medications to ensure they aren't contributing to your symptoms.

Symptom-specific treatments:

• Fatigue: Strategies such as energy-conservation methods, progressive exercise regimens, and physical therapy are recommended.
•  Breathing problems: Options include pulmonary rehabilitation and specific breathing exercises.
•  Cognitive issues: Interventions consist of cognitive rehabilitation and memory enhancement exercises.
•  Pain or muscle weakness: Treatments may involve physiotherapy and pain management techniques.

Mental health support:

Access to counselling or therapeutic services is essential for addressing anxiety, depression, or post-traumatic stress disorder linked to long COVID. Additionally, practices focusing on mindfulness and stress management are advised. Speak to a doctor or medical practitioner about a Mental Health Treatment Plan to access subsidised psychological support. Note: Telehealth Mental Health Plans require a longer consultation and private fees may apply.

Medications:

Pharmaceutical interventions may be prescribed to manage chronic symptoms, including pain, inflammation, and irregularities in heart rate.

Lifestyle adjustments:

Adopting a balanced diet, ensuring adequate hydration, and prioritising quality sleep are vital components of a holistic approach to care.

What should someone who's experiencing post-COVID syndrome do?

1. Keep track of your symptoms: Record in a journal or health app how often symptoms occur and how severe they are. This information can be helpful when reporting to a provider.
2. Develop a healthy lifestyle: Eat well, stay hydrated, and engage in light physical activity. Gradually increase your activity level—overexertion may exacerbate symptoms.
3. Incorporate mindfulness and stress reduction: Activities such as yoga, meditation, or deep breathing can help with the psychological effects of Long COVID.

• Hydration and electrolytes: Proper hydration may alleviate fatigue and brain fog. Coconut water and other electrolyte beverages are good alternatives. • Anti-inflammatory foods: Foods high in antioxidants, such as berries, nuts, fish, and leafy green vegetables, should be included in your diet. • Sleep hygiene: Avoid screens before bedtime and maintain a regular sleep schedule to improve sleep quality. • Pace yourself: Plan your day to include energy conservation.

Self-care at home

The management of long COVID symptoms frequently necessitates the establishment of a supportive environment at home. The following self-care strategies may prove beneficial:

1. Prioritisation of rest and activity management Fatigue represents a prevalent symptom associated with Long COVID. It is essential to prioritise rest and remain attuned to the body's signals. Individuals should engage in activity management by balancing their tasks with sufficient rest intervals to prevent overexertion.
2. Adherence to a nutritious diet: Emphasis should be placed on the consumption of nutrient-dense foods, including but not limited to fruits, vegetables, whole grains, lean proteins, and healthy fats. It is imperative to maintain hydration throughout the day to promote overall health.
3. Incorporation of gentle physical activity: Participation in light physical activities, such as walking or stretching, can aid in maintaining mobility and enhancing circulation. Individuals are advised to refrain from engaging in strenuous workouts that may exacerbate fatigue.
4. Support for mental health: The practice of relaxation techniques, including meditation, deep breathing exercises, or yoga, is recommended. Maintaining connections with friends and family is important, and individuals should consider speaking to a GP about a mental health treatment plan if they experience anxiety, depression, or stress.
5. Documentation of symptoms: The maintenance of a journal for recording symptoms, potential triggers, and improvements is advisable. Such documentation can assist healthcare providers in customising treatment plans based on the individual's experiences.
6. Management of specific symptoms: For breathing difficulties, it is recommended to engage in breathing exercises or consult a respiratory therapist. To address cognitive challenges associated with brain fog, individuals should utilise organisational tools such as lists and reminders. To mitigate sleep disturbances, the establishment of a consistent bedtime routine and the creation of a conducive sleep environment are necessary.

Note: This information is for educational purposes only. You should consult a medical practitioner before attempting home remedies to ensure they are safe for your specific condition.

 When to seek doctor’s appointment?

Seek medical care if your post-COVID symptoms are causing significant disruptions in your life or worsening over time. Key symptoms that require professional attention include:

• Chest pain, shortness of breath, and heart palpitations (potential heart or lung problems).
•  Neurological symptoms such as confusion or severe headaches.
•  Persistent fatigue despite getting enough rest.
•  Need medical documentation such as medical certificates, online prescriptions and online referrals

Specialised Long COVID clinics are available in various locations, offering comprehensive care from a panel of specialists.

Can an online doctor help?

An online doctor or medical practitioner is equipped to assist with a range of health issues, including sneezing, a runny nose, or other related symptoms that an individual may be experiencing. The doctor is capable of evaluating these symptoms and providing recommendations regarding their potential association with allergies, colds, influenza, or other medical conditions. Furthermore, the online doctor can suggest appropriate treatment alternatives, including over-the-counter medications, or may prescribe pharmaceutical options if necessary. Hola Health offers a comprehensive range of telehealth services designed to enhance healthcare accessibility in Australia. Their services include:

• Telehealth consultations: Patients can consult with Australian registered medical practitioners 24/7 via video calls
•  Medical Certificate online Australia: Users can obtain valid medical certificates for work, school, or carer responsibilities online, with approval from accredited practitioners.
• Online Prescriptions: Patients can receive online prescriptions and have medications delivered directly to their homes, often within two hours.
•  Referrals: Hola Health facilitates referrals to specialists as needed during consultations.
•  COVID 19 Care: The service provides medical assessments for COVID-19 to determine clinically appropriate treatment plans.
•  Mental Health Care Plans: Patients can receive tailored mental health care plans from qualified GPs as part of their telehealth services.

While telehealth provides accessible care, it is a complementary service and not a replacement for a physical examination. If a physical assessment is required, our medical practitioners will recommend an in-person visit. To maintain clinical integrity, we encourage sharing your consultation summary with your regular GP.

Preparing for a telehealth appointment

Thorough preparation is essential for maximising the benefits of a telehealth consultation.

• It is advisable to document symptoms comprehensively. This includes maintaining a detailed log of the symptoms experienced, their duration, and any identifiable triggers. It is important to compile a list of one's medical history. This list should encompass any pre-existing conditions, previous COVID-19 diagnoses, and treatments that have been administered.
• Individuals should provide information regarding medications. This involves sharing details about any medications or supplements currently being taken.
• Prepare a set of questions in advance. These may pertain to symptom management, potential referrals, or necessary diagnostic tests. One should ensure a stable setup for the appointment. This entails creating a quiet environment equipped with a reliable internet connection.
• Have all relevant records readily accessible. This includes medical reports, test results, and vaccination records. Organising these aspects facilitates the healthcare provider in delivering customised advice and formulating an appropriate care plan.

Recovery is a process

Long COVID can be frustrating and unpredictable, but recovery is possible. Coping with symptoms, knowing when to reach out for help, and being kind to yourself are crucial. If you’re feeling overwhelmed, contact a health care provider—your health is worth the investment. Long COVID is a multifaceted and challenging condition that affects a significant number of individuals who have recovered from the acute phase of COVID-19. While there is no definitive cure, treatments focusing on symptom management, lifestyle adjustments, and multidisciplinary care can help improve the quality of life.