Long Covid is a form of post viral fatigue. The symptoms of Covid-19 infection may persist for weeks or months after the original infection. There does not appear to be a link between the symptoms of long covid and the severity of the original infection experience. Even people who were assymptomatic or only had mild symptoms may go on to develop long covid.
Although the science is not well understood, it's thought that the vagus nerve (which controls involuntary body functions like heart rate and digestion) may be responding to inflammation found in the body, due to persistent viral growth in the gut, lungs or on the vagus nerve itself. In other cases, Covid 19 infection can reactivate a dormant virus in the body, such as Epstein Barr Virus (infectious mononucleosis or glandular fever). Some people may experience microscopic blood clots which reduce the oxygen flow to the tissues.
It is estimated that 10% of positive covid cases will still have symptoms at 12 weeks post infection. A diagnosis of long covid does not typically occur until symptoms have been present for more than 3 months. You do not need to wait until you have this diagnosis to begin rehabilitation. The sooner you start, the better!
Common symptoms of long covid:
extreme fatigue dizziness shortness of breath pins and needles chest pain or tightness joint pain brain fog depression/anxiety insomnia tinnitus/earache extreme thirst nausea/gut upset palpitations headache rashes high fevers changes to taste and smell sore throat cough reduced appetite
There is a huge range of symptoms of covid 19, because it effects our body on a cellular level. The most common symptoms of long covid are fatigue and brain fog. Post Exertional Malaise (PEM) is when symptoms worsen after doing too much. PEM is not instant and is commonly delayed by 1-3 days after the exertion.
What is the best management of long covid?
The symptoms persist to remind your body to stop what you are doing and rest. The body is trying to preserve your available energy to recover from the virus. It is important to listen to these warning signs. REST: frequently and well. Every 90 minutes or so, try to schedule 10 minutes of pure rest without any distractions. It is important to remember that not only physical tasks require energy. It is obvious to think of limiting daily chores and exercising, but we must also consider mental tasks (reading, scrolling social media, watching tv, working at a computer) and social interactions which all use considerable energy and may need to be limited while recovering. PRIORITISE AND PACE YOURSELF: Prioritise necessities and learn to say 'no' to less important engagements. Schedule regular rest breaks and don't over commit yourself while you recover. Keeping an activity log can help you understand the relationship between your energy expenditure and your symptoms. You can find printable logs further down this page. BREATHE WELL: Breathing well has a plethora of positive affects on the body. It can lower your heart rate, blood pressure, reduce anxiety, increase mental acuity, and improve your general health. Book an appointment with Nina or another Bradcliff breathing practitioner to optimise your breathing. MONITOR YOUR HEART RATE: Try to keep your heart rate below your anaerobic threshold (see calculations further down this blog post). HYDRATION: Drinking 2-3 litres of water per day will help hydrate all the cells in the body and help them produce energy. It will also help your liver detoxify. NUTRITION: Eat a healthy balanced diet. Antioxident rich foods can help your body recover from viruses. Try to limit sugars and alcohol while recovering. DO THINGS YOU ENJOY: Stay positive and try to prioritise some things you enjoy into your week.
Want some help with your rehabilitation?
If you decide to attend rehabilitation to help overcome symptoms of long covid, we aim to educate you on how to reduce the post exertional symptoms and create balance as your body recovers. We will teach you to use pacing strategies and insure you are using a correct breathing pattern and provide advice regarding sleep, caffeine and guidelines for a phased return to work/activity. We may utilise heart rate monitors and diaries to understand how the symptoms are affecting your daily life. Appointments can be online via telehealth or in person at the clinic.
This is not an exact science and trial and error is involved. You have to expect to take some steps forward and some steps backward. Once you are able to get through a week or so without any post exertional symptoms, you can try increasing your heart rate maximum by 10 beats per minute. Remember that it may be 2-3 days before your body reacts and gives you post exertional symptoms, so keep a diary so you can check how your body is responding.
Understanding your anaerobic threshold
This is the point when the body switches from the aerobic system to the anaerobic system. The aerobic system uses oxygen and is extremely efficient. The body can continue using the aerobic system for long periods of time. This is the system our bodies use most of the time. The anaerobic system is much less efficient and is dependent on glucose rather than oxygen. The body can only sustain this system for a short time (1-2 minutes maximum). Unfortunately, in many cases of post viral fatigue, the anaerobic threshold can drop as low as 50 % of it’s normal value.
Why is this so important?
For clients with post viral fatigue, every day tasks like walking to the mail box, doing the dishes and getting dressed can push them into this threshold and depletes the bodies energy. They may not feel these effect until 1-3 days later. It is important to stay below this threshold to avoid post exertional malaise (getting exceptionally tired after doing too much).
For moderate symptoms, we recommend that you try to keep your heart rate under 55% of your maximum heart rate to avoid worsening your long covid (PEM) symptoms. It is important to be aware that everyone's threshold will be different and these calculations are purely estimates.
(220 – your age) x 0.9 = estimated anaerobic threshold (220 – your age) x 0.55 = adjusted anaerobic threshold for post viral fatigue
If you have severe fatigue symptoms, try not to let your heart rate rise more than 15 beats per minute above your resting heart rate. When it rises above this level, you must stop and bring your heart rate back down to your resting rate before you continue. A heart rate monitor is a good investment if you are struggling to recover from covid 19 infection. I recommend any monitor where you can view the result quickly (i.e a watch) and one which has the facility to set a heart rate alarm to alert you when you go above your set limit.
Postural Orthostatic Tachycardia Syndrome
What is POTS and what does it mean? Postural Orthostic Tachycardia Syndrome (POTS) may be diagnosed if your heart raises more than 30 beats per minute when you go from lying to standing. POTS is a form of dysautonomia, which is when the vagus nerve (that controls non-voluntary body functions) notices changes and responds by altering things like heart rate, blood pressure or sweating. Although the science is not well understood, it's thought that the vagus nerve may be responding to inflammation found in the body due to persistent viral growth in the gut, lungs or on the vagus nerve itself following Covid-19 infection. Dysautonomia can affect any of the bodies organs, and explains why people can experience such a range of symptoms of long covid. In this case, the heart is involved, but in most cases there is no defect found within the heart itself.
Having POTS along side post viral fatigue is common and it impacts significantly on post exertional symptoms. Often as soon as sufferers get to their feet, their heart rate may immediately spike above their anaerobic threshold, causing worsening symptoms in 1-3 days time.
Ways to manage POTS: Drink lots of water Add a little salt to your meals Avoid too much standing Try to avoid getting too hot. Keep showers brief and avoid spa pools. Exercise in sitting or lying if possible, rather than standing (to keep your heart rate lower). Compression stockings can help Breathing exercises can lower your heart rate Some medications may be prescribed to manage heart rate.
The following links provide short video's made by Castle Dene Physiotherapy in the UK, with plenty of information to help you on your post viral journey to wellness. I encourage clients to watch these to gain a clearer view of how to manage long covid.