Long COVID: What We Know and How We Can Help | Rodolico Health

Understanding Long COVID

For most people, COVID-19 is an acute illness from which they recover within days or weeks. However, for some, symptoms persist long after the initial infection has resolved, affecting their ability to work, exercise and enjoy everyday life.

The World Health Organization (WHO) uses the term Post COVID-19 condition (PCC) because it describes symptoms that persist after the infection has resolved, although Long COVID remains the term most people recognise so we have chosen to use it throughout this article.

Long COVID has become one of the most widely discussed post-infectious syndromes in modern medicine. Unfortunately, it has also become one of the most polarising. Some sources dismiss it entirely, while others promote investigations and treatments that are not supported by robust scientific evidence.

At Rodolico Health, we take a different approach. We recognise that persistent symptoms following COVID-19 can be profoundly disabling. At the same time, we believe patients deserve clear, evidence-based information about what is currently known—and where important uncertainties remain.

Although Long COVID has brought unprecedented attention to persistent symptoms following infection, clinicians have recognised similar post-infectious syndromes following a range of viral and bacterial illnesses for many years. Research into Long COVID is therefore not only helping people affected by COVID-19, but also improving our understanding of post-infectious illness more broadly.

What is Long COVID?

The World Health Organization defines Post COVID-19 condition as symptoms that:

• develop following confirmed or probable SARS-CoV-2 infection;
• usually begin within three months of the initial illness;
• persist for at least two months; and
• cannot be explained by another medical diagnosis.

Symptoms may fluctuate over time, improve and relapse, and often involve several different body systems.

Importantly, this is a clinical definition designed to guide diagnosis and research. It does not mean that Long COVID is one single disease with one underlying biological cause.

How common is Long COVID?

Estimating how common Long COVID is remains challenging because studies use different definitions, populations and follow-up periods.

The World Health Organization estimates that around 6% of people who develop COVID-19 go on to develop Post COVID-19 condition, although reported figures vary between studies. The risk appears to have fallen since the early years of the pandemic, likely reflecting widespread vaccination, changes in circulating variants and increasing population immunity.

Certain groups appear to be at higher risk, including:

• women;
• older adults;
• people with obesity or underlying chronic medical conditions;
• those who experienced more severe acute COVID-19; and
• people who have had repeated SARS-CoV-2 infections.

Fortunately, most people improve over time, although recovery may take many months and a minority continue to experience symptoms for considerably longer.

What causes Long COVID?

This remains one of the biggest unanswered questions.

Rather than representing a single disease, Long COVID is best thought of as a clinical syndrome, with several different biological mechanisms likely contributing in different individuals.

Current research is exploring a number of possible explanations, including:

• persistent activation of the immune system following infection;
• small amounts of remaining viral material and potentially continuing to stimulate the immune system;
• inflammation affecting the brain and nervous system;
• disruption of the autonomic nervous system, including conditions such as Postural Orthostatic Tachycardia Syndrome (POTS);
• dysfunction of the small blood vessels, sometimes described as microvascular dysfunction; and
• changes in the way cells produce and use energy.

These mechanisms are not mutually exclusive, and different processes may predominate in different patients. Although considerable progress has been made, no single mechanism has yet been shown to explain every case.

One important concept is that an infection can act as a trigger rather than an ongoing cause. Even after the virus has been cleared, changes in the immune system, nervous system or other physiological processes may take much longer to settle. This is not unique to COVID-19 and has been recognised following several other infections.

What symptoms can Long COVID cause?

Long COVID has been associated with more than 200 reported symptoms, although most people experience a much smaller number of persistent problems.

Common symptoms include:

• fatigue;
• worsening of symptoms after physical or mental exertion, often called post-exertional malaise or post-exertional symptom exacerbation;
• breathlessness;
• reduced exercise tolerance;
• chest pain or palpitations;
• dizziness, particularly when standing;
• headaches;
• muscle and joint pain;
• poor concentration or “brain fog”;
• disturbed sleep;
• altered taste or smell; and
• anxiety or low mood.

Symptoms frequently fluctuate, with periods of improvement followed by relapse.

How is Long COVID diagnosed?

There is currently no single blood test, scan or biomarker that confirms Long COVID.

Diagnosis relies on three key principles:

• a history compatible with previous COVID-19 infection;
• persistent symptoms fitting recognised clinical patterns; and
• careful assessment to exclude other conditions that may better explain those symptoms.

The purpose of investigations is usually to exclude alternative diagnoses or identify complications rather than to confirm Long COVID itself.

This is particularly important because symptoms such as fatigue, breathlessness and cognitive difficulties can also be caused by many other medical conditions, including:

• anaemia;
• thyroid disease;
• diabetes;
• vitamin deficiencies;
• inflammatory disorders;
• heart or lung disease;
• sleep disorders; and
• medication side effects.

Good medical care means considering these possibilities rather than assuming that every persistent symptom following COVID-19 is necessarily caused by Long COVID.

Management and recovery

At present, there is no single treatment that cures Long COVID. Management is therefore tailored to the individual’s symptoms, functional limitations and pattern of recovery.

Management may include:

• education about pacing and energy management, particularly for people experiencing post-exertional symptom exacerbation;
• rehabilitation tailored to the individual’s symptoms and tolerance;
• management of headaches, pain and sleep disturbance;
• assessment and treatment of autonomic dysfunction, such as POTS, where appropriate;
• treatment of co-existing medical conditions; and
• psychological support where anxiety, depression or adjustment difficulties are contributing to the overall impact of the illness.

Pacing aims to reduce symptom flare-ups by balancing activity with adequate rest and recovery. It does not necessarily mean avoiding all activity. The appropriate level and type of activity will vary between individuals and may need to change as symptoms improve or fluctuate.

Rehabilitation should therefore be individualised. A programme that is helpful for someone with reduced fitness but no post-exertional symptom exacerbation may not be appropriate for someone whose symptoms deteriorate significantly after exertion.

Research into antiviral medication, immune therapies and other targeted treatments is progressing rapidly. Although several approaches are being investigated, none has yet become an established standard treatment for the majority of patients.

Our understanding of Long COVID continues to evolve, and recommendations may change as higher-quality evidence becomes available.

Can people recover from Long COVID?

Many people with Long COVID improve gradually over time, although the speed and pattern of recovery vary considerably.

Some experience steady progress, while others have a fluctuating course with periods of improvement followed by temporary relapses. Recovery may be influenced by the nature and severity of symptoms, other medical conditions and the presence of post-exertional symptom exacerbation.

It is important to remain realistic without losing hope. A slow recovery does not necessarily mean that symptoms will be permanent, but improvement may need to be measured over months rather than days or weeks.

When should you seek medical assessment?

You should consider seeking medical advice if symptoms:

• persist beyond several weeks after COVID-19 infection;
• are worsening rather than gradually improving;
• interfere with work, education, exercise or everyday life; or
• include concerning features such as chest pain, significant breathlessness, fainting or new neurological symptoms.

New or severe chest pain, severe difficulty breathing, collapse, sudden weakness, confusion or other acute neurological symptoms require urgent medical assessment.

A thorough assessment helps identify patients with Long COVID while ensuring that other potentially treatable illnesses or complications are not overlooked.

How Rodolico Health can help

Persistent symptoms following infection deserve careful, thoughtful and compassionate medical assessment.

Our approach begins by listening carefully to your experience, understanding the pattern of your symptoms and identifying whether further investigation is needed. Where tests are appropriate, we will explain why they are being performed. Equally, we are honest when the evidence does not support unnecessary investigations or unproven treatments.

Medicine is continually evolving. Although our understanding of Long COVID has advanced enormously since 2020, many important questions remain unanswered. We believe patients deserve transparent, evidence-based care that acknowledges both what modern medicine knows and where uncertainty still exists.

Our aim is not simply to attach a diagnosis, but to help you understand your symptoms, exclude other treatable conditions and develop a realistic, individualised management plan that supports recovery.

Our role is neither to dismiss persistent symptoms nor to promise miracle cures. Instead, we provide careful assessment, evidence-based medicine and honest guidance through what can often be a complex and uncertain recovery.

If you would like to discuss any of the issues raised in this article, you are very welcome to get in touch or book an appointment.

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