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COVID-19 recovery and Long COVID-19

Recovering from COVID-19

There is considerable variance in the expected recovery time for people who have had COVID-19. Most people will recover quickly and be able to return to everyday living. Some may still experience symptoms four to twelve weeks after infection, which can be considered as “ongoing symptomatic COVID-19”. A small percentage may continue to experience symptoms beyond twelve weeks which is known as Post-COVID-19 condition or “Long COVID” (see below).

Key messages for patients include:

  1. Everybody recovers differently. While most people will recover quickly, some may feel like their recovery takes several weeks or months. This is not unusual, and a longer-than-expected recovery can happen with other viruses (long symptom syndromes were also observed in SARS and MERS). Most people fully recover in time.
  2. Take time to recover. It is best that people ease back into their daily routines and activities and avoid immediately returning to the same levels of pre-COVID activity and intensity.

Longer Recovery from COVID-19 (and “Long COVID”)

When reviewing a patient experiencing a longer recovery, the following three cohorts need to be considered in order to plan their management:

  1. Patients who have experienced critical illness or a prolonged period of moderate to severe disease with resulting deconditioning, respiratory, cardiac and cognitive complications. For example, those with Intensive Care Unit (ICU) related complications and Post Intensive Care Syndrome (PICS);
  2. Patients with pre-existing chronic medical conditions or disability that has been exacerbated by their COVID illness and may require significant intervention to regain baseline function;
  3. Patients with Post-COVID-19 Condition, or “Long COVID”. Guidance and advice on this cohort is provided below.

Definition and symptoms

Definitions of Post-COVID-19 Condition vary across agencies and studies. Patients experiencing prolonged recovery can be considered as follows:

  • ongoing symptomatic COVID-19 (4 – 12 weeks)
  • post COVID-19 condition or “Long COVID” (12 weeks or more).

The “Long COVID” official case definition from the World Health Organization (WHO) is:

Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of COVID-19 with symptoms and that last for at least two months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning.

There are a wide range of symptoms associated with Long COVID, ranging from physical, psychological, and cognitive health which cannot otherwise be explained by an alternative diagnosis. However, most common are fatigue, breathlessness and cognitive problems.

To meet the criteria for Long COVID-19, symptoms need to be:

  • unable to be explained by an alternative diagnosis; and
  • impacting on the patient’s function (i.e., affecting their ability to perform everyday functions).

However, WHO has advised that the definition and criteria for Long COVID may change over time as more data and evidence emerges.

Risk factors are not yet settled in the literature, but current case studies are suggesting women and people aged 40-50 years of age are commonly represented.

Prevalence in Australia

The prevalence of Long COVID or post-COVID condition in Australia is unclear where Omicron is the predominant variant, as most of the data relates to Delta and earlier strains. However, patients are likely to present with self-diagnosed Long COVID regardless of whether they meet the above criteria.

Red flag symptoms

Patients with red flag symptoms could indicate the need for emergency assessment. These red flag symptoms include:

  • severe, new onset or worsening breathlessness/hypoxia
  • syncope
  • unexplained chest pain, palpitations, or arrhythmias
  • new delirium or focal neurological signs or symptoms.

Functional impairment

To inform management options, it is important to understand and compare the patient’s pre- and post-COVID-19 functional ability to undertake routine daily activities.

To explore the degree of functional impairment, the patient can complete the simple and validated Post-COVID Functional Status (PCFS) Scale, either via a flowchart (option A in the link) or as self-rating (option B).

The patient can also access other free tools to identify symptoms and quantify functional impacts across multiple health domains. These are more detailed and some patients may require support to complete these tools.

Assessment

Assessment will be required to differentiate exacerbation of chronic disease or complications from infection (such as Post Intensive Care Syndrome, deconditioning, pain, treatment-related symptoms, sleep disturbance or Post Traumatic Stress Disorder). Recovery management and planning is separated into three main groups:

  • COVID-19 patients with immediate complications and acute recovery needs
  • people with pre-existing disability and/or chronic conditions recovering from COVID-19 with greater rehabilitation needs (which are unlikely to be self-managed)
  • people with persistent or new symptoms relating to COVID-19 infection that are impacting everyday function.

In addition, people’s rehabilitation for conditions other than COVID-19 which have been interrupted by service disruptions because of the pandemic should also be considered.

Treatment guidelines

Most Omicron variant cases can be successfully self-managed in the community with the appropriate tools (see resources below). Clinicians are encouraged to assess and treat patients on the basis of their symptoms and degree of impairment, and follow their usual referral pathways for further management of these conditions as required. This may include allied health referral, sub-specialist medical review, or multidisciplinary rehabilitation program. Refer also to your relevant HealthPathways website (see below) for any guidance and referral pathways unique to your region.

Self-management

For relevant patients reporting a protracted recovery, there are a range of self-management approaches and resources that can be recommended.

The Three Ps Principle

A useful approach to recovery is recommending the Royal College of Occupational Therapists’ online resources on the “three Ps principle” to enable patients to undertake essential daily activities:

  • Pace: saving energy by breaking up daily activities into smaller, more manageable tasks. For example, break up a long staircase into five steps, then have a rest.
  • Plan: planning ahead with regular activities, and where possible spread out those activities that need more energy. For example, do the laundry on one day, and food shopping on a different day (or organise food delivery, or ask friends for help).
  • Prioritise: focusing on doing essential or important activities. Use the plan to identify what could be put off to another day or whether family or friends can help.

Self-managing symptoms

Several free self-management resources are available for patient use. They include the following web-based and downloadable/printable PDF resources:

For the primary care sector, additional information regarding long-COVID can be accessed on HealthPathways (see below) including clinical decision support frameworks.

The Queensland Health Asset Library has a range of materials to help consumers recover from COVID-19 including breathing exercises and steps to recovery. Please download and share as required – do not share the link directly with patients.

HealthPathways: If you are not a current user of HealthPathways, please contact your local HealthPathways group to obtain a generic login:

Other resources

Last updated: 6 September 2022