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illness & disability

Long COVID: Symptoms and Help for COVID Long Haulers

Have the aftereffects of COVID-19 left you with fatigue, depression, anxiety, or sleep and concentration problems? Here’s how to recognize post-COVID symptoms and get the help you need.

Young woman sitting on floor, weary, uncomfortable

What is long COVID?

Long COVID is a condition where the effects of COVID-19 linger for weeks or months after the initial illness, even when the virus is no longer detected in the body. While most people who contract coronavirus recover within a few weeks, others experience long-term symptoms that include fatigue, respiratory problems such as shortness of breath, and psychological issues like depression, anxiety, sleep difficulties, and “brain fog”.

Otherwise known as post-COVID-19 syndrome, long-tail COVID, or long-haul COVID, the effects can impact your ability to work, study, manage your finances, take part in social activities, or make decisions. Even light physical activities, such as housework, driving, or making a phone call can leave you feeling exhausted and aching. You may be unusually forgetful, find it difficult to concentrate on simple tasks, or feel like you’re unable to think straight. Some people with long COVID feel like their head is clouded or in a fog, making it difficult to do math calculations, for example, or find the right word to say. As a “long hauler”, you may also suffer changes in your mood, most commonly exhibiting symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD).

Of course, because it’s such a new virus, much remains unclear about the lasting effects of COVID-19, including why some people are affected by long COVID, what exactly causes the symptoms, or how long they’re likely to last.

How common is long COVID?

Different studies have varied wildly in their results, estimating that anywhere from 10% to 60% or more of COVID-19 patients may be affected by lingering symptoms such as fatigue, sleep problems, and mood changes. Even those who weren’t hospitalized and only experienced mild coronavirus symptoms may still experience long COVID. Perhaps the most startling research has suggested that up to one third of COVID-19 survivors are likely to suffer neurological or mental health problems within six months, ranging from mood disorders to dementia or stroke.

If you’ve had and recovered from COVID-19, though, try not to let the numbers alarm you. Many long COVID symptoms are hard to quantify and some may be due to the trauma of the pandemic with all its stress, grief, isolation, and upheaval, rather than the virus itself. After all, how many of us haven’t experienced anxiety, a depressed mood, or had trouble sleeping or concentrating at some point during this difficult time?

The length of the pandemic, its escalating death toll, and all the associated lockdowns, quarantines, and financial hardships have taken a huge toll on our collective mental health, with skyrocketing rates of anxiety, depression, and other emotional problems—all of which can trigger physical symptoms as well.

Similarly, it’s common for long-term health effects such as fatigue, anxiety, and PTSD to follow treatment for any life-threatening illness, especially if it involves hospitalization (in the case of COVID-19, hospitalization coupled with isolation from family and loved ones).

[Read: Coping with a Life-Threatening Illness or Serious Health Event]

Whether your symptoms are directly linked to the virus, a post-viral syndrome, or the effects of the pandemic, it doesn’t mean that your suffering is any less real or that you’re powerless to improve how you feel. While there’s still much we don’t know about long COVID, there are steps you can take to ease your symptoms, regain your health, and support your mood.

Symptoms of long-haul COVID

There’s no formal definition of long COVID yet. Some medical authorities and researchers define it as extending a few weeks after recovery, others several months. And while there are also no established diagnostic criteria, the most common symptoms reported include:

Physical symptoms

  • Fatigue, muscle aches, and weakness
  • Chest pain and heart palpitations
  • Headache
  • Shortness of breath
  • Joint pain
  • Rash or hair loss
  • Intermittent fever
  • Cough

Mental or neurological symptoms

  • Memory and concentration problems
  • Difficulty thinking straight (brain or COVID “fog”)
  • Sleep disruption—ranging from sleeping too much to insomnia
  • Depression
  • Anxiety
  • PTSD
  • Changes in mood, extreme emotions
  • Altered smell and taste

The nature and extent of symptoms can vary greatly from one person to another. Symptoms can also often fluctuate, so you may feel more fatigued one day than the next, for example, find that difficult emotions ebb and flow, or feel less mentally sharp on certain days. You may also face a lack of understanding from others at home or work who feel that you should have recovered by now or even accuse you of malingering. If you’re unable to work, the added stress and worry of losing your income can make your symptoms even worse.

[Read: Coping with Financial Stress]

Less commonly, some people recovering from COVID-19 have serious long-term complications affecting the function of their lungs, kidneys, heart, or brain. Others report a sensitivity to light and sounds, excessive bruising, or numbed limbs. Experiencing such disturbing symptoms can take a further toll on your mental health and well-being.

Causes of long COVID

Post-viral conditions are not unusual; other viral infections can also have long-lasting effects. Meningitis and glandular fever, for example, can trigger chronic fatigue syndrome. The 1918 flu pandemic was linked to cases of encephalitis (inflammation of the brain), while the 2003 outbreak of severe acute respiratory syndrome (SARS) left some patients suffering flu-like symptoms similar to those of long-haul COVID.

While we don’t know why some people suffer from long COVID and others don’t, contributing factors could include:

  • Inflammation of the brain or immune system caused by the virus.
  • A reduced or absent response from your immune system’s antibodies.
  • Experiencing a relapse or a reinfection of the coronavirus.
  • Trauma following the stress of hospitalization or intensive care.
  • Deconditioning or a decline in your physical health following the period of bedrest and inactivity while infected with COVID-19.
  • Damage to the immune system, lungs, or other organs caused by the virus or low oxygen levels.

What to do if you have long COVID

Since the symptoms and impact of long COVID can vary so much from patient to patient, it’s important to tailor your coping strategies to your specific symptoms. Physical problems such as shortness of breath, fever, and pain may leave you feeling drained of energy, mentally exhausted, and lead to a depressed mood, all of which require different coping skills.

While it can feel overwhelming, there are steps you can take to care for your overall health and ease your distress at this difficult time.

Seek medical help immediately if you experience chest pain, trouble breathing, a profound change in weight, or are unable to stay awake, eat, or drink. Your doctor may also be able to help relieve physical symptoms and rule out any serious complications or underlying causes.

Get vaccinated. While research is ongoing, some long-haulers have reported that having a COVID-19 vaccine has helped relieve their symptoms.

Continue to practice caution to avoid reinfection. Wear a mask if you’re out in public, avoid non-essential travel, wash your hands frequently with soap and water or use a hand sanitizer that contains at least 60% alcohol.

Eat a healthy diet. The food you eat can impact both your mood and your energy levels. Aim to eat a balanced, nutritious diet rich in fruit and vegetables. If your physical symptoms leave you feeling nauseous, try eating little and often and focusing on starchy foods. If you’re too fatigued to shop and prepare your own meals, ask a loved one to help, order groceries online, or subscribe to a meal kit delivery service.

Limit your alcohol and caffeine intake. Both can disrupt your sleep and adversely affect your immune system. Caffeine may give you a short-term boost but it can lead to a painful crash in energy later.

Quit smoking. Nicotine in tobacco increases your heart rate and blood pressure, irritates your respiratory system, and reduces lung function, all of which will exacerbate symptoms of long COVID. While quitting can be tough, your circulation and breathing will improve very quickly.

Find support. This is a time when you need the help and support of others the most. But feeling persistently fatigued and in pain can make it difficult to reach out and even cause you to withdraw. Some people may find it hard to understand why your symptoms are persisting, making you feel even more isolated and alone. Try contacting an understanding loved one or connecting to an online support group (see the “Get more help” section below).

In addition to taking care of your overall health and wellness, you can use the following tips to cope with some of the most common symptoms of long COVID.

Managing fatigue

Persistent fatigue is one of the most frequently reported symptoms and it may be tempting to rest completely when you feel so exhausted. However, with chronic fatigue syndrome (myalgic encephalomyelitis), for example, there’s little evidence that complete rest offers any benefits. In fact, over time a lack of activity can reduce your muscle mass, diminish your immune system, and leave you feeling even weaker and more fatigued.

For most people, it’s better to maintain a balance between effort and rest, aiming for a very gradual resumption of exercise and activity levels. Since long COVID can cause you to experience peaks and troughs of energy, it’s important not to overdo things on the days where you feel more energetic. This will only make the trough the next day feel deeper and could even set your recovery back.

Instead, establish regular patterns for activity and rest. Consistency can help you avoid getting too tired or resting too much. It can also provide a baseline from which to gradually increase what you’re able to do.

Rest and relaxation. True relaxation doesn’t mean sitting on the couch watching TV. Rather, it means activating your body’s natural relaxation response, a state of deep rest that lowers your heart rate, reduces your blood pressure, and relieves stress and anxiety. You can achieve the relaxation response by regularly practicing a relaxation technique such as meditation, deep breathing, or progressive muscle relaxation. Schedule regular breaks between activities and practice a different technique until you find the ones that work best for you.

[Listen: Progressive Muscle Relaxation]

Exercise. It may sound counterintuitive, but being active can boost rather than drain your energy—if your physical symptoms allow. However, it’s important not to try to do too much or push yourself to the limit of your energy. Instead, take a step-by-step approach and set modest, realistic goals for yourself. Start very slowly with a short walk or gentle stretches, for example, and try to gradually increase how much you do over time. But always stop if you develop a fever, breathlessness, or any kind of muscle pain.

Avoid too much sensory stimulation. Crowded, noisy places, brightly-lit stores, and playing video games, for example, can quickly drain your energy and exacerbate symptoms such as headache, anxiety, and brain fog. Spend time doing more soothing activities instead, such as chatting with a friend or listening to an audiobook.

Fatigue as a symptom of depression

Fatigue is also a common symptom of depression. When you’re depressed, you may feel slow, sluggish, and physically spent after even the smallest tasks. And the things that can best help to relieve your depression—like getting moving and connecting to others—are often the hardest to do when you feel drained of energy and hope.

However, if you think your fatigue may be a symptom of depression, there are small but positive steps you can take each day to escape the cloud of depression and improve how you feel.

[Read: Coping with Depression]

Use the “3 Ps” approach to daily tasks

When you’re suffering from long COVID, even the gentlest activity can seem exhausting. By making small changes to how you pace, plan, and prioritize your daily tasks, though, you can conserve energy and get more done during the day.

Pace, Plan, and Prioritize
Pace yourself by breaking large tasks into smaller, more manageable ones and building in rests during and between activities. For example, spread household chores throughout the day, taking a break between each one. Sit down while you’re in the shower, brushing your teeth, or doing the dishes. Read or work at the computer for short bursts, taking plenty of rest in between.
Plan ways to space out tasks or schedule them for the times of day when you feel more energetic. Go to the grocery store when it’s less crowded, for example. Cook enough food to freeze leftovers to eat when you don’t feel up to cooking, or plan on wearing only clothes that don’t need to be ironed.
Prioritize the tasks and activities that are really necessary and look for energy saving alternatives. Online shop to save you going to the store, for example, arrange for a friend to help you pay bills or do any heavy lifting, or put off yardwork until you’re feeling stronger.

Addressing sleep problems

Sleep helps support your immune system, energy levels, and mood, but the quality of your sleep is just as important as the quantity. While sleep problems can be triggered by long COVID, they can also exacerbate other symptoms. Poor quality sleep at night impacts how well you feel during the day, which in turn impacts how well you’re able to sleep at night. Before you know it, you’re trapped in a vicious downward cycle of poor sleep and increasing daytime fatigue.

Some people with long COVID struggle to get to sleep at night or wake up feeling unrefreshed. Others tend to oversleep, sleeping for more than nine or ten hours at a time. This can lead to daytime tiredness, a lack of energy, and problems concentrating. In many cases, you can get on a better sleep schedule by adopting healthier sleep habits.

Improve your quality of sleep at night

Clean up your bedtime habits and sleep environment. Go to bed and wake up at the same times every day, avoid alcohol in the evening, and turn off screens at least one hour before bedtime. Try to make your room as comfortable, dark, and quiet as possible.

Adopt a relaxing bedtime ritual. To help you unwind before bed, take a warm bath, play soothing music, or practice a relaxation technique such as meditation, deep breathing, or some yoga stretches.

[Listen: Bedtime Meditation for Sleep]

Use sleep medications with caution. Long COVID symptoms such as pain can interfere with your sleep at night, but many sleep aids or sleeping pills have side effects. Some may aggravate other symptoms, such as daytime fatigue or trouble focusing.

Do a quiet, non-stimulating activity if you wake up during the night and can’t get back to sleep. Try reading a book or listening to music, for example. Just remember to keep the lights dim and avoid using screens.

Dealing with anxious thoughts at night

If worries about your health or welfare are preventing you from sleeping at night, try making a brief note of your specific fears on paper. Then postpone worrying about them until the morning when you’ll be more rested and better able to work towards a solution.

There are also strategies you can use to deal with uncertainty and learn to face the future with more confidence.

Reduce oversleeping

In chronic fatigue syndrome, a condition that shares some similarities with long COVID, oversleeping rarely improves symptoms. Rather, sleeping late or napping during the day may interfere with the quality of your sleep at night and preserve the cycle of poor sleep and increasing daytime fatigue.

To help correct oversleeping:

  • Gradually reduce then eliminate sleeping during the day. Start by scheduling more rest breaks between tasks and activities so you avoid becoming so tired that you feel the need to sleep.
  • When your energy flags, instead of taking a daytime nap, try to be physically active or practice a relaxation technique such as meditation. Both will help you feel more energized without the grogginess that can often follow waking up from a nap.
  • When you’ve eliminated daytime sleeping, start to cut down on the amount you’re sleeping at night. You can do this gradually by going to bed slightly later each night and waking up a little earlier every morning. You can also replace the lost sleep with additional relaxation.

Coping with changes in mood

The most common changes in mood and mental health that accompany long COVID are anxiety, depression, and trauma. While the issues seem to be most severe in those who experienced acute COVID-19 symptoms and were hospitalized, they are still common among those who were only treated as outpatients.

What we know for certain is that physical and mental health are closely linked. By taking care of your mental health, you may be able to reduce the debilitating effects of your physical symptoms as well.

Anxiety. When you’re struggling with long-haul COVID, it’s understandable to feel anxious or uncertain about how soon you’ll recover, whether you’ll suffer any long-term complications, or when you’ll be able to fully resume your old life. While constant tension, unease, and worry can wear you down, there are steps you can take to ease your anxiety. Creating a worry period, challenging anxious thoughts, and learning to accept uncertainty can significantly reduce worry and calm your anxious mind.

Depression. Feelings of hopelessness and despair can seem overwhelming when you’re struggling with a serious health issue. Depression can feel like you’re living your life under a dark cloud and change how you think and function in your daily activities. It can also manifest itself in physical symptoms such as fatigue, weight gain or loss, concentration problems, and unexplained aches and pains. But there are ways to cope with depression, improve your mood and physical well-being, and regain your sense of hope.

Trauma. It’s not unusual to experience traumatic stress following a life-threatening illness such as COVID-19, especially if you were hospitalized and received intensive care. Traumatic stress can shatter your sense of security, leaving you feeling physically and mentally drained, overwhelmed by grief, and unable to properly sleep or focus. Often, these symptoms will gradually start to fade as life returns to normal. But if you’re unable to move on, you may need help for post-traumatic stress disorder (PTSD) to regain your emotional balance.

Stress. While high stress levels can contribute to anxiety, depression, and other mental health issues, there are plenty of things you can do to lower your stress. While you’re coping with long COVID symptoms, try to cut down on your responsibilities and learn simple but effective stress management techniques to help you feel more calm and focused.

Last updated: April 2021.

Get more help

References

Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 – Symptoms and duration of prolonged illness in adults hospitalized with COVID-19. (CDC)  

Persistent Symptoms in Patients After Acute COVID-19 – Study estimating that the incidence of a neurological or psychiatric diagnosis in COVID-19 patients was 33·62%. (The Lancet)  

6-month neurological and psychiatric outcomes in survivors of COVID-19 – Research that shows effect of different psychological coping styles. (NCBI)

Mysterious Ailment, Mysterious Relief: Vaccines Help Some COVID Long-Haulers – Anecdotal evidence indicating vaccines may help with long COVID. (NPR)

Support groups

Long Covid Support Group – International Facebook support group. (Long Covid Support)  

Patient Resources – Support groups and resources for managing symptoms. (Long Covid Support)