Long Covid Q&A with Dr Zoe Williams: what we know so far

It’s been more than two years since Covid-19 brought the world to a halt and while it seems like lockdowns are finally a thing of the past, Covid infections are still rampant in the UK and across the world.

A recent ONS survey estimates that 2.5% of adults aged 35-49 are living with long Covid, yet still we know so little about the disease. We asked Dr Zoe Williams to answer some of your most pressing questions about long Covid and for her tips on how to aid recovery for you and your loved ones.

What is long Covid and who can it affect?

1. How long do you have to be suffering from Covid for it to be classed as long Covid?

Long Covid, or post Covid-19 syndrome could be considered if there are “Signs and symptoms that develop during or after an infection consistent with Covid-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.”

2. What are the most common symptoms of long Covid?

The three symptoms which are most common include fatigue, trouble breathing and cognitive dysfunction, which is sometimes called brain fog. However, there have been over 200 different symptoms described by people who have been affected, and just about any organ or system could be involved in this, from the lungs to the nervous system to the skin and even mental health.

3. Is someone at higher risk of long Covid if they are immunosuppressed?

Evidence has shown overall that immunocompromised people are more likely to have severe infection with increased morbidity and mortality, even following two doses of Covid-19 vaccine, and therefore may remain unprotected from Covid-19. As a result, this group of patients has been advised to receive a third primary dose of vaccine, and then a fourth dose as a booster, three months later.

It is not known with certainty if people who are immunocompromised are at lesser, greater, or the same risk of developing long Covid. There are many studies ongoing and one thing many of us can do to support this is to sign up to studies which we are eligible for.

Researchers at Imperial College London are currently recruiting some immunocompromised people to a study, called the MELODY study, to try to find out more, in order to guide better treatments and care in the future. Follow this link to find out more, and apply to participate.

4. Is there an age group that are more prone to respiratory problems post-Covid or is it more down to any existing respiratory condition that a person may have e.g. asthma?

Research by the UK’s Office for National Statistics (ONS) has suggested that Long Covid is more likely to strike people in mid-life. In this study the diagnosis of Long Covid was based on individuals self-reporting that they had it. It found that 1.3 million people in the UK (2% of the population) were experiencing Long Covid in December 2021, with the highest prevalence among those aged 35 to 69.

In a separate study, researchers at King’s College London examined data from studies involving 45,096 participants. This suggested that pre-existing poor mental health was associated with a 50% increase in the likelihood of reporting Long Covid, while asthma was associated with a 32% increase. Many researchers believe that long Covid may not be a single syndrome however, so it is possible that different groups are at higher or lower risk of different types of persistent symptoms.

5. What is the likelihood of a child having long Covid or serious Covid symptoms? For healthy children who are not clinically extremely vulnerable, should they be vaccinated? 

Children are much less likely than adults to become seriously unwell with Covid-19 infection, and it seems that the younger the child, the lesser the risk. When it comes to long-Covid though, the few studies done so far also suggest that children’s long-Covid symptoms could be similar to those seen in adults. The recent CLoCk study suggests that, in the United Kingdom alone, tens of thousands of children and young people might have long Covid. These findings need to be confirmed by more detailed surveys.

The ONS estimate that the percentage of people suffering Long Covid in the overall population (i.e., not only those infected) by age group are:

• 0.29% of children aged 2 to 11

• 1.39% of people aged 12 to 16

• 2.28% of people aged 17 to 24

• 1.79% of people aged 25 to 34

• 2.55% of people aged 35 to 49

• 2.49% of people aged 50 to 69

• 1.21% of people aged 70+

The best way to prevent long Covid is to prevent Covid-19 in the first place, and vaccination is an effective method of achieving this.

6. Are children with asthma more likely to suffer complications?

It may be more closely linked to the severity of a child’s asthma and how well controlled their asthma is, rather than whether they have asthma or not.

A recent study, published in the Lancet, states that the rate of Covid-19 hospital admission was higher in children with poorly controlled asthma than in those with well controlled asthma or without asthma.

7. Why do some people develop long Covid while others do not?

As this is still a new and relatively poorly understood condition, the answer is unfortunately still unknown. We don’t know why some people get long Covid and others don’t, and we do not know the longer-term implications, though it is reassuring to see that the majority of children and young people who are affected seem to show signs of gradual improvement and certainly not decline as time goes on.

How do I get more support if I or my family is suffering from suspected long Covid?

8. Do you have any advice for how to approach dealing with health care professionals who do not believe in long Covid in children and will not refer to paediatricians or the children's long Covid clinics? 

Long Covid does exist in children, and there is sufficient evidence and research available to back this up nowadays. If there is a particular resource that you would like your doctor or nurse to see it may be best to send an email or an e-consult form, and you can share the link. And if you feel that your consultation with an individual has not been helpful you are always entitled to ask to speak to a different healthcare professional.

In an ideal world if a child has symptoms lasting for more than 12 weeks after the initial infection and those symptoms are severe enough to be impacting on the child or young person’s life, they would be seen by a specialist team. However, availability of long Covid clinics varies and they tend to have very few spaces available, meaning that sometimes it’s only the most severe cases that will have their referrals accepted. Referral protocols will vary from place to place, but they often have a long list of criteria that need to be met in order for a child to be referred. It might be worth exploring this with your GP and looking at the form together.

9. Are GPs going to be trained to deal with the effects of long Covid? Are ongoing respiratory conditions going to be taken seriously and will previous Covid infections or possible long Covid be factored into diagnosis and treatment? 

Online training is available to GPs on the topic of long Covid and it is something that we tend to discuss with our colleagues, especially as the management is not straightforward because long Covid can affect people in so many ways. There are no specific drugs for long Covid, but we do have access to some rehabilitation interventions and can advise self-management techniques, which sometimes focus on reducing symptoms but may also concentrate on improving quality of life while living with the symptoms.

How can I help my body to recover from Covid quickly?

10. Does relaxation aid recovery from Covid? As a parent, the natural inclination is to keep going. Should we be trying to relax more and not rush back to all activities once we are out of self-isolation? 

It’s important to try to manage stress to keep ourselves healthy every day and it may aid recovery from illness too, so relaxation techniques and taking time for self-care are important ways to look after ourselves, even though it can be a challenge to find the time.

11. As a breastfeeding mum, can I do anything to help us recover? Or should I freeze milk in case we get it again? 

The World Health Organisation (WHO) recommends that mothers with suspected or confirmed Covid-19 should continue to breastfeed. This is based on studies which conclude that the benefits of breastfeeding substantially outweigh the potential risks for transmission. So, it is absolutely fine to start or continue breastfeeding your baby if you have Covid-19. This can be from the breast or from a bottle using expressed milk, whichever you find easiest and more achievable.

12. If you have Covid asymptomatically, is it safe to exercise (at home!) or should you rest even if you don't feel sick? 

If you are asymptomatic but have tested positive for Covid-19 there’s no reason to hold off your usual level of exercise. If you feel more tired than usual, or find the workout more challenging, this could be a sign to ease off slightly. But if you’re feeling absolutely fine – go for it!

13. I'd also like to know about post-viral fatigue. What measures do you advise to combat this? Are vitamin or mineral supplements recommended to speed recovery?

Post-viral fatigue is when you have an extended period of feeling unwell and fatigued after a viral infection. Covid-19 is just one type of virus that can cause it. Common symptoms are sleeping more, feeling tired without having done much, feeling unsteady on your feet and being unable to stand for long periods or carry out activities you previously could. People sometimes describe having energy one minute and then feeling completely drained after minimal exertion.

When it comes to taking supplements, vitamin D is recommended for everyone in the winter months, and for many people all year round. You should take a 10-microgram supplement daily. Further supplement advice would depend on your diet. If you eat a healthy, varied diet which includes some meat and fish you are less likely to benefit from additional supplements. But if you have a vegan diet for example then some supplements would be advised, as it is difficult to get the full range of dietary nutrients from a vegan diet.

When recovering from illness, focussing on increasing fruit and vegetable intake, and having as wide a variety of healthy foods as possible is a good idea, and limiting alcohol and processed foods too.

14. Has Covid been known to affect periods? I know the vaccine has affected periods for some people.

There have been reports of disturbances in the menstrual bleeding pattern around the time of both Covid-19 vaccination and Covid-19 infection. Reassuringly these changes generally revert to normal after one or two cycles.  The available evidence does not confirm or exclude either Covid-19 infection or Covid-19 vaccination as causes of change in bleeding pattern. There isn't a clear indication of how the infection or vaccination would cause the change, so it may just be that these menstrual changes happened coincidentally around the time of Covid-19 illness or vaccination. There is no evidence to suggest that these temporary changes will have any impact on a person’s future fertility.

15. Two months after a very bad dose of Covid I still have trouble breathing with exercise. Will this last forever or is more time needed? What can I do to help?

We’re still learning how long the illness lasts and it varies between people. It’s important to note that lasting effects aren’t unique to Covid-19 – other viral illnesses can also have lasting effects - such as glandular fever for example. A study led by Leicester researchers suggests that among those who needed hospital treatment for the initial illness, it’s common for it to last five months or more, and there are separate reports of it lasting 12 months or more (this includes both people who didn’t need hospital treatment initially and those who did.) If your breathing problems continue beyond three months, then your GP would be the best place to seek help and ask them if there are community-based rehabilitation services in your area.

16. What do we know about possible long-term effects for babies six months and under who have had Covid?

Babies and young children appear to be at the lowest risk of Covid-19. Among the cases of confirmed Covid-19 in young children, most have experienced only mild or asymptomatic illness and there do not seem to be studies reporting long-term effects for infants.

17. If a child has had Covid, are there any known issues with reinfections? Could there be greater risk of long Covid or serious complications with multiple infections? 

It’s possible to have Covid-19 on more than one occasion, and while vaccination provides good protection, no vaccine gives 100% protection. It is not known if there is an association.

18. Is it usual for your O2 reading to be 94% after having Covid?

For someone who's healthy, the normal blood oxygen saturation level will be around 95–100%. If the oxygen level is below this, once fully recovered from the initial infection, it could be an indicator that there is a lung problem.

19. Will the Masimo product be connected to a HCP or alert the user to contact one?

The device provides escalating visual and audible alerts to the patient on the mobile app and at the bedside station, notifying designated emergency contacts if levels continue to decline. The app will first notify the user with a sound and light alert with intent to wake them up and the medical hub will also sound. If help is still needed, automatic texts will be sent to designated friends and family.

Covid symptoms and other illnesses

20. Do you know anything about how/why Covid affects mental health? I’ve been suffering with depression since having Covid. Also, I had lots of gastro symptoms, and these haven't fully cleared up. Is it harder to clear the virus from the gut than from the lungs, for example? 

We have seen how Covid-19 can affect practically every organ and system in the body, and this includes the brain and the gut. Scientists who study the brain have suggested that the virus can ‘hitchhike’ into the brain via the nerves that connect our noses to our brains, causing a direct effect on our brain.

Covid could also indirectly affect the brain. The virus can damage blood vessels altering the blood supply to the brain and it can also activate the immune system, and in some people, this triggers the production of toxic molecules which can reduce brain function.

Although research on this is still emerging, there are likely effects of Covid on nerves that control gut function too. This may impact digestion and the health and composition of gut bacteria, which are also known to influence the function of the brain.

21. Can you explain about the relationship between post-Covid symptoms and POTS (Postural tachycardia syndrome)? What understanding should a GP have of this (and what training is available to them)?

People who have Postural Tachycardia Syndrome (PoTS) experience an abnormal increase in heart rate that can happen after sitting or standing.  Typical symptoms include light-headedness, palpitations, and fatigue. It is a poorly understood group of disorders that usually afflicts younger women, and it seems likely that there are multiple possible causes.

Some researchers believe that coronavirus can be a trigger for POTS, as an increased number of people who recovered from Covid-19 are now experiencing POTS-like symptoms. There are training resources available for GPs on the Royal College of General Practitioners website.

About Dr Zoe Williams

"Dr Zoe Williams is a well-known and respected media medic who also has experience in health, fitness and wellbeing, alongside her role as a GP. She is a national advisor to the Office for Health Improvement and Disparities (OHID) GP clinical champion network and also leads on work to promote physical activity and healthy lifestyle with The Royal College of General Practitioners. She is also a new mum."

About Masimo

"Masimo is a global medical technology company that develops and manufactures innovative non-invasive patient monitoring technologies, medical devices, and a wide array of sensors. The MasimoSafetyNet Alert™ uses clinically proven technology to continuously monitor blood oxygen levels and vital signs- at home and provides escalating visual and audible alerts to the patient, notifying designated emergency contacts if levels continue to decline. Home monitoring is useful for those with acute or chronic respiratory conditions such as asthma and COPD, lung disease etc, people recovering from COVID-19 infection, or taking opioid painkillers to treat pain. The device features a disposable fingertip sensor, a Home Medical Hub, and an intuitive mobile app. It’s available to purchase from Masimo"