In the last one-year experience in COVID-19, we have learned that the disease may present itself in different clinical pictures. In rough speaking, acute illness lasts about 3 weeks. Chronic type lasts for up to 12 weeks.

Lately, the National Institute for Health and Care Excellence (NICE) defines long COVID as disease effects lasting for more than 12 weeks. Nearly 10% of patients with positive PCR for COVID do not recover after 3 weeks, and a smaller proportion for months.

Why do some people develop long COVID?

It is not known why some people recover late from COVID.

Scientists believe that;

• Persistent viremia due to weak or absent antibody response,
• Relapse or reinfection,
• Inflammatory and other immune reactions,
• Diminished physical strength and function,
• Mental factors such as post-traumatic stress, may all contribute.

Moreover, long term respiratory, musculoskeletal, and neuropsychiatric sequelae may be observed in long COVID.

Are symptoms different in long COVID?

Symptoms of long COVID vary widely. Researchers divide the symptoms into two main groups as ones related to respiratory system (including headache and fatigue), and symptoms related to different parts of the body (i.e. heart, brain).

The most commonly reported symptoms are:

• Fatigue
• Shortness of breath (dyspnea),
• Cough,
• Joint pains,
• Chest pain,
• Depression,
• Muscle pain,
• Low-grade fever,
• Digestive system (gastrointestinal) problems,
• Headache,
• Metabolic disruptions (i.e. poor control of diabetes),
• Thromboembolic conditions,
• Brain fog (it presents with confusion, difficulty in concentration and inability to express thoughts),
• Skin rashes in various forms (i.e. vesicular, maculopapular),
• Loss of smell is a very well-known, and long lasting symptom.

Another feature of long COVID is that some patients report that their symptoms have come back after recovery. When compared with short COVID, the recurrence rate is twice.

Are there any risk factors for long COVID?

Recently, a research group from the United Kingdom, the United States of America, and Sweden have conducted a self-reported study to define risk factors for developing long COVID by using a mobile application. It is shown that there is a clear link between having asthma and long COVID development.

Other predictive characteristics of patients for developing long COVID are:

• Old age (>70 years),
• Female gender,
• Presence of five or more symptoms at the onset of the disease,
• High body mass index (obesity),
• Having diabetes or hypertension,
• Having depression,
• Severe acute COVID infection,

These characteristics are drawn as predictors from studies with limited sample size, and may be considered as preliminary findings. For more concrete definitions, further clinical studies with larger sample sizes should be performed.

How long does it take to recover from long COVID?

There is no definite time frame for recovery from long COVID; it may vary from person to person. Leicester researchers have reported that seven out of ten hospitalized patients with COVID-19 not fully recovered 5 months after the discharge.

The findings have once again supported that long COVID is a multisystem disease, because some signs related to autoimmunity, systemic inflammation, mental and neurological health problems are determined in post-hospitalization survivors.

Can children develop long COVID?

The Office for National Statistics (ONS) has published data of 9063 respondents of all ages from the UK Coronavirus Infection Survey. The survey is conducted to investigate ratio of COVID patients with elongated symptoms more than five weeks. The “estimates” have suggested that 13% of children between 2 and 11 years, 14.5% of children between 12 and 16 years have complaints including fatigue, cough, headache, muscle pains, loss of taste or smell still after 5 weeks of the diagnosis. Despite the limited data, it is clear that some children may also have long COVID.

Some recommendations for managing your symptoms at home

For fatigue and breathlessness

• Do not over exert yourself: Carefully plan what you will do during the day
• Break tasks into small pieces, so that when you sum up, the task will be completed.
• Do some easy and some harder activities alternatively. Have some rest between them.
• Plan your day according to your energy level.
• Frequent resting is better than a few longer ones. Do not let yourself become exhausted.
• If you feel breathless while doing something, rest for a while. Then go on the activity again. If you stop using your muscles, they will get weaker, and this will cause more problem in breathing. You must use your muscles.
• Level of daily activity/exercise should be increased slowly and gradually i.e. short walks, simple strength exercises.

For mood and mental health

• Be aware that some days may be worse during healing. Be prepared mentally and try to be kind to yourself.
• Even you are isolated you can get in touch with family and close friends by phone. This will boost your mood.
• Have a daily plan. This will help you develop the sense of stability.
• Stay active (as far as possible of course) at home. When your body moves, then endorphins will be released more. Endorphines are known as “hormones of happiness).”

For memory and effective thinking

• Make notes to remember i.e. your daily plan, medical appointments
• Try to reduce distractions. A quiet environment may help you to be more concentrated.
• A clear plan divided into steps will always be easier for you to apply and follow.

For joint or muscle pains

• Flexibility exercises i.e. stretches, yoga, tai chi,
• Strength exercises i.e. climbing stairs, lifting weights, working with resistance bands, may help for joint and muscle pains.
• If you plan to have an exercise program, you should consult it with your doctor in the first place.

References:

1. BMJ 2020;370:m3026 | doi: 10.1136/bmj.m3026. Last access 8.4.
2. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/long-covid. Last access 8.4.2021.
3. https://www.aid.org.tr/long-covid-ya-da-uzamis-covid/. Last access 8.4.2021.
4. https://covid.joinzoe.com/post/long-covid. Last access date4.2021.
5. https://le.ac.uk/news/2021/march/covid-19-patients-not-fully-recovered. Last access date 12.4.2021.