Do I have Long COVID?
Post COVID-19 condition, also known as long COVID, occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19. Symptoms last for at least 2 months and cannot be explained by an alternative diagnosis (World Health Organisation, 2022)
Who can have Long COVID?
Long COVID can affect people who were hospitalised with acute COVID-19 and those who recovered at home. Individuals who have experienced either mild or severe COVID-19 can go on to have prolonged symptoms or develop Long COVID.
Do I have mild or severe COVID?
Clinical spectrum of COVID-19
| Asymptomatic | Individuals who test positive for SARS-CoV-2 using a virologic test (i.e., a nucleic acid amplification test [NAAT] or an antigen test) but who have no symptoms that are consistent with COVID-19. |
| Mild | Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell) but who do not have shortness of breath, dyspnea, or abnormal chest imaging. |
| Moderate | Individuals who show evidence of lower respiratory disease during clinical assessment or imaging and who have an oxygen saturation measured by pulse oximetry (SpO2) ≥94% on room air at sea level. |
| Severe | Individuals who have SpO2 <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mm Hg, a respiratory rate >30 breaths/min, or lung infiltrates >50%. |
| Critical | Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction. |
(U.S. Department of Health and Human Services, 2022)
Why do I have Long COVID?
According to evidence, the driver of persistent inflammation after a COVID-19 infection still remains unclear, with different explanations behind the cause of the disease for different people. On one hand, there may be an autoimmune component, where one may have an overactive immune response, which causes persistent side effects due to the body attacking itself. On the other hand, the persistent inflammation may be due to fragments of the virus still remaining in the body, or echoes of the initial inflammatory response to infection. (National Centre for Infectious Diseases Singapore, 2021). Research has also found four key factors that increase the risk of long COVID: the viral load during infection, the presence of diabetes, the presence of auto-antibodies, and the reactivation of the Epstein-Barr virus in some patients (Su et al, 2022).
What are the Long COVID symptoms?
Long COVID is a multi-system disease with over 200 listed symptoms occurring in variable combinations and can fluctuate in patterns of flare-ups and remissions. Symptoms of long COVID come and go.
Most common symptoms experienced after 6 months are:
- Shortness of breath
- Fatigue
- Post exertion worsening of symptoms
- Problems with memory and concentration (brain fog)
Other symptoms include:
- Chest pains or tightness
- Palpitations
- Dizziness
- Muscle and joint pain
- Diarrhoea, stomach aches, loss of appetite
- Tinnitus, ear aches
- Rashes
- Depression and anxiety
How can Physiotherapy help with Long COVID?
We will assess and screen individuals appropriately and work with individuals to create an individualised treatment plan to assist in the management of the following areas:
- Reducing fatigue
- Breathing pattern disorders
- Breathlessness and airway clearance
- Reduced stamina
- Joint and muscle pain or discomfort
- Muscle weakness
- Post Exertional Symptom worsening
What can I expect from the physiotherapy session?
The session will consist of assessing breathing, current symptoms faced, challenges faced during usual activities as well as assessing your current fitness level. For individuals who face high levels of fatigue, sessions will be paced and kept short to avoid over-exertion and post exertion symptom worsening. Should there be changes in breathing patterns such as hypertension, appropriate breathing training will be conducted during the first few physiotherapy sessions.
We are cautious about progressing back to activities and exercise as we understand that it can be exhausting for patients with Long COVID fatigue symptoms. Our sessions will be carefully planned and paced to the needs of each individual.
Advice will be given on resuming everyday activities gradually, at an appropriate pace that is safe and manageable for energy levels within the limits of your current symptoms, and exertion should not be pushed to the point of fatigue or worsening of your symptoms.
Breathlessness, chest discomfort and heart rate will also be monitored when exercising to avoid over-exertion, minimise risk of injury and to ensure exercise programmes are restorative and do not make the individual’s symptoms worse. Rehabilitation should aim to prevent oxygen desaturation on exertion.
What if my long COVID symptoms are not improving?
Moving forward, you may start feeling better gradually. Your recovery from post-viral fatigue could be slow and take several months to a year or more. As you start to gradually improve, remember to keep a balance of quality rest, routine and fun activities. Stress and worry depletes your energy reserves, so give yourself time to heal and be kind to yourself.
Whenever indicated, we would also provide an onward referral to the appropriate medical healthcare professional to facilitate your recovery.
Get Started Now!
Speak to us to find out more about how we can start on a recovery programme with you today!
References
- World Health Organization. (2022) Post covid-19 condition (long covid). World Health Organization. Retrieved November 30, 2022, from https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition#:~:text=Definition,explained%20by%20an%20alternative%20diagnosis.
- U.S. Department of Health and Human Services. (2022, September 26). Clinical spectrum. National Institutes of Health. Retrieved November 30, 2022, from https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/
- Long COVID not common here among vaccinated patients – National Centre for Infectious Diseases Singapore. (2021, October 4). National Centre for Infectious Diseases. https://www.ncid.sg/News-Events/News/Pages/Long-COVID-not-common-here-among-vaccinated-patients.aspx
- Su, Y., Yuan, D., Chen, D. G., Ng, R. H., Wang, K., Choi, J., Li, S., Hong, S., Zhang, R., Xie, J., Kornilov, S. A., Scherler, K., Pavlovitch-Bedzyk, A. J., Dong, S., Lausted, C., Lee, I., Fallen, S., Dai, C. L., Baloni, P., Smith, B., … Heath, J. R. (2022). Multiple early factors anticipate post-acute COVID-19 sequelae. Cell, 185(5), 881–895.e20. https://doi.org/10.1016/j.cell.2022.01.014