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  8. Post-COVID syndrome

Post-COVID syndrome

Post-COVID syndrome is also called Long Covid, chronic Covid or post-acute Covid. Patient groups may refer to themselves as ‘long haulers’.

Post-COVID syndrome seems to be similar to Myalgic Encephalomyelitis (also called Chronic Fatigue) and resembles chronic fatigue syndrome. Chronic inflammation can exacerbate catabolism and anorexia, diabetes, heart disease and renal failure (Mechanick et al., 2021). Nutritional care is therefore crucial.

Patients have reported receiving inconsistent advice from healthcare professionals and the absence of information about fluctuating symptoms. This has resulted in patients supporting each other through media channels because this lack of recognition of symptoms and their fluctuation has isolated more people (NIHR, 2021).

Lack of diagnosis makes accessing services difficult. Primary care, community and helpline staff need better training and knowledge about ongoing effects of COVID-19 (Malnutrition Pathway, 2020) [PDF].

Epidemiology and public health specialists have reinforced the need to collect comprehensive symptom data, as neither PCR testing nor antibody tests adequately capture all disease. They have also stressed that equity is necessary to access post-COVID syndrome assessment clinics (NHS, 2020).

Symptoms

A UK review (Ansu et al., 2021) identified the 10 most common symptoms of post-COVID syndrome: 

  • fatigue
  • shortness of breath
  • muscle pain
  • cough
  • headache
  • joint pain
  • chest pain
  • altered sense of smell
  • diarrhoea
  • altered sense of taste. 

People experiencing five or more symptoms in the first stages of the disease are more prone to suffer from post-COVID syndrome (Sudre et al., 2020).

More information can be found on the University of Birmingham's therapies for post-COVID syndrome page.

Ongoing (4-12 weeks post-infection) and post-COVID syndrome symptoms appear to be common. Data reported in Italy found that almost 90% of patients reported at least one symptom 60 days after onset and half of them had three symptoms including:

  • fatigue
  • breathing difficulty
  • joint pain and chest pain
  • reduction of life quality

Another study found seven main categories of symptoms (Davis et al., 2021):

  • major fatigue, muscular or joint pains
  • neurological symptoms such as memory, mood or attention disorders
  • headaches, sensory disturbances, balance disorders, neurogenic pains
  • persistent or recurrent anosmia, hyposmia, dysgeusia, swallowing and speech disorders
  • cardiothoracic symptoms such as palpitations, chest pain
  • gastrointestinal symptoms such as diarrhoea, nausea, vomiting or abdominal pain
  • skin and vascular symptoms (related to blood and fluids in the body)

In a French cohort, scientists found that during the prolonged phase of COVID-19 more than half of patients had symptoms persisting from the onset of infection, and in 80% of the sample new symptoms arose that were not present at the start.

Dietitians have reported issues in patients with COVID-19 that required follow up after the acute care phase (Aiyegbusi et al., 2021).

Prevalence

One year after the pandemic started in the UK, it was reported that almost one million people had been admitted to hospital and it is estimated that almost half will need continued support (NIHR, 2021). In 2020, 67% of GPs reported looking after patients with Long Covid (NHS, 2020; NICE, 2020).

Data from Public Health England found that at least 10% of non-hospitalised patients have reported symptoms lasting more than four weeks (NIHR, 2021). Fluctuations in symptoms have been reported by 70% of patients and changes in the intensity of them were reported 89% of the time (NICE, 2020).

The UK COVID-19 symptom app has four million regular contributors and 10-20% report complications for longer than a month (100,000–200,000 people) (NICE, 2020; NIHR, 2021). 

Dr Sarah Berry, Reader in Nutritional Sciences, Department of Nutritional Sciences, King’s College London and Elaine Anderson, Registered Dietitian (Freelance and NHS) discuss data extracted from the COVID-19 symptom app. Watch the Diet and COVID-19 video here.

Comorbidities

Post-COVID syndrome can lead to an increase in chronic medical conditions such as:

  • depression
  • stroke
  • cardiac injury
  • chronic renal disease
  • type 2 diabetes

More information and research are being documented from a cross-disciplinary cohort of health professionals who had COVID-19 themselves. It includes a long list of symptoms and how post-COVID syndrome is affecting patients: