Patient information · General health
Long COVID
pacing, not pushing
Long COVID describes symptoms continuing for more than twelve weeks after COVID-19 that are not explained by anything else. It is real, it is common, and the single most useful thing to understand early is that pushing through worsens it in a substantial proportion of people.
Seek urgent assessment if you have
- chest pain, severe breathlessness or fainting
- calf swelling and pain, or breathlessness with coughing blood
- new confusion, weakness or speech difficulty
- oxygen levels below 92% if you are monitoring at home
- severe worsening after a period of stability
- thoughts of harming yourself
Blood clots, heart inflammation and lung damage all occur after COVID and need excluding rather than assuming symptoms are 'just long COVID'. If you are struggling with your mood, Samaritans are free on 116 123 at any hour.
The common symptom clusters
- Fatigue — the most common, and unlike ordinary tiredness in that rest does not restore it
- Breathlessness and reduced exercise tolerance
- Cognitive difficulty — brain fog, word-finding problems, poor memory and concentration
- Palpitations and dizziness on standing, sometimes from a condition called PoTS
- Pain — muscle, joint, chest, headache
- Sleep disturbance, altered taste or smell, gut symptoms, rashes
- Anxiety and low mood — consequences as much as contributors
Post-exertional malaise changes the advice
Many people with long COVID experience a delayed crash — a marked worsening of all symptoms 12 to 72 hours after physical, cognitive or emotional exertion, lasting days or longer. Where this is present, graded exercise programmes that push through symptoms are harmful and can cause lasting deterioration. This is a significant change from older rehabilitation advice. The approach is pacing: working within your energy limit rather than trying to expand it by force.
Pacing
- Find your baseline — the level of activity you can do on a bad day without triggering a crash. Start below it.
- Break activities into short blocks with planned rest between, and rest before you feel you need to.
- Count cognitive and emotional effort as activity, not just physical. Screens, conversation and stress all consume the same budget.
- Increase only when you have been stable for a fortnight, and only by a small amount.
- Plan for events — bank rest before, and after.
- Keep a simple diary of activity and symptoms to find your patterns.
What should be excluded
Long COVID is a diagnosis made after other explanations have been considered. Reasonable baseline investigation includes a full blood count, ferritin, B12, folate, thyroid function, kidney and liver function, glucose or HbA1c, calcium, CRP, coeliac screening and vitamin D. Heart, lung or clotting investigation is added where symptoms point that way. Finding treatable anaemia, thyroid disease or diabetes is common and worth doing.
What helps
Helps
- Pacing, consistently, before you feel you need to
- Treating orthostatic symptoms — fluids, salt, compression, slow position changes
- Sleep routine, even when sleep is poor
- Breathing retraining for dysfunctional breathing patterns
- Occupational health input and phased return to work
Unhelpful
- Pushing through, and 'boom and bust' cycles
- Graded exercise where post-exertional malaise is present
- Expensive unproven treatments and supplements
- Comparing yourself to your pre-COVID capacity daily
- Returning to full-time work before you are ready
Work and benefits
Long COVID may meet the definition of a disability under the Equality Act 2010, which means reasonable adjustments can be requested — reduced or flexible hours, working from home, rest breaks, changed duties. A phased return is usually more successful than a full one. We can provide fit notes with specific recommendations rather than simply signing you off.
Why come to us. Long COVID is a condition where ten-minute appointments fail people. We offer unhurried consultations, the full baseline blood panel in-house with results explained face to face, ECG and echocardiography on site where palpitations or breathlessness need assessing, and imaging through our CQC-registered partners. We provide detailed fit notes and workplace recommendation letters, and can refer for physiotherapy, psychology and specialist opinion. Seven days a week, on one clinical record.
Unhurried assessment, and the causes excluded
Full bloods, ECG and echo in-house. Fit notes with recommendations.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.