Long COVID (also called post-COVID syndrome or PASC — Post-Acute Sequelae of SARS-CoV-2) refers to a wide range of symptoms that continue or develop after the initial COVID-19 infection and persist for more than 12 weeks. The ONS estimates that around 1.9 million people in the UK were experiencing Long COVID as of early 2024, with approximately 1.3 million reporting their symptoms were adversely affecting their daily activities. Long COVID is now one of the most common chronic conditions affecting working-age adults in the UK.
What Is Long COVID?
The NHS defines Long COVID as 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. The NICE definition uses 4 weeks as the threshold for “ongoing symptomatic COVID-19” and 12 weeks for “post-COVID syndrome.” Long COVID can occur after any COVID infection — including mild initial illness — and across any age group.
Long COVID Symptoms
Long COVID is characterised by more than 200 documented symptoms affecting virtually every organ system. The most commonly reported include:
Most Common Symptoms
- Fatigue — the most prevalent symptom; often described as an overwhelming exhaustion far beyond normal tiredness; may fluctuate unpredictably
- Post-exertional malaise (PEM) — worsening of symptoms after physical or mental activity; the hallmark of Long COVID and ME/CFS-like presentations; can be delayed by 12–48 hours after activity
- Breathlessness — shortness of breath on mild exertion, sometimes even at rest
- Brain fog — cognitive dysfunction including difficulty concentrating, memory problems, word-finding difficulties, and slowed thinking
- Persistent cough
- Chest pain or tightness
- Heart palpitations — often related to POTS (postural tachycardia syndrome)
- Joint and muscle pain
- Headaches
- Sleep disturbance
- Loss of smell (anosmia) and/or taste (ageusia) — often among the first and most persistent symptoms
- Anxiety and depression
- Dizziness — particularly upon standing (orthostatic intolerance/POTS)
- Tinnitus
- Pins and needles (paraesthesia)
POTS (Postural Orthostatic Tachycardia Syndrome)
POTS has emerged as a common and frequently missed Long COVID complication. It causes a significant heart rate increase (≥30 bpm) upon standing, resulting in dizziness, palpitations, breathlessness, and fainting. It is more common in women. A simple 10-minute standing test (NASA lean test) performed by your GP can screen for POTS.
Who Gets Long COVID?
Long COVID can affect anyone who has had COVID-19, regardless of initial illness severity. Risk factors for developing Long COVID include:
- Female sex — women are approximately 50% more likely to develop Long COVID than men
- Age 35–69 — peak incidence; not primarily a condition of older adults
- Obesity
- Asthma — independent risk factor
- Pre-existing anxiety or depression
- Unvaccinated status at time of infection — vaccination reduces (but does not eliminate) Long COVID risk by 40–50%
- High symptom burden in the first week of acute illness
- Reinfections — each reinfection increases cumulative Long COVID risk
Seeking Help: NHS Long COVID Services
If you have symptoms lasting more than 4 weeks after COVID-19, see your GP. Your GP can:
- Rule out other conditions with blood tests (FBC, CRP, thyroid, ferritin, D-dimer, troponin, autoimmune screen)
- Refer to an NHS Long COVID clinic — specialist multidisciplinary services exist in most NHS regions; they include physiotherapy, occupational therapy, clinical psychology, and specialist physician input
- Refer for cardiac assessment (if palpitations, chest pain, or breathlessness) — including ECG, echocardiogram, and cardiac MRI
- Refer for pulmonary function tests and CT chest if persistent breathlessness
- Consider referral for autonomic testing if POTS is suspected
To find your nearest NHS Long COVID service, visit england.nhs.uk/long-covid or ask your GP for a referral.
Management of Long COVID
Pacing — The Most Important Strategy
Pacing is the most critical management strategy for anyone experiencing post-exertional malaise (PEM). It involves staying within your “energy envelope” — the amount of activity that does not trigger a crash. The NHS and NICE now strongly advise against pushing through fatigue in Long COVID (unlike previous “graded exercise therapy” advice which has been removed from guidance).
- Track your activities and symptoms to find your personal limits
- Break all activities (including cognitive work and social interaction) into small chunks with rest periods
- Plan rest periods before and after activities — not just after
- Reduce or stop immediately if symptoms worsen
- Only increase activity very gradually and only when stable — not during a flare
Breathing Exercises
Many Long COVID patients develop dysfunctional breathing patterns. A physiotherapist (ideally via an NHS Long COVID clinic) can assess and treat these. Techniques include diaphragmatic breathing, pursed-lip breathing, and breathing pattern retraining.
POTS Management
- Increase salt and fluid intake (2–3 litres of fluid, 6–10g of salt daily) — after medical confirmation of POTS
- Wear compression garments (abdominal binder, compression stockings)
- Avoid prolonged standing; elevate head of bed
- Medications: beta-blockers, ivabradine, fludrocortisone — specialist-prescribed
Anosmia Recovery
Smell training is recommended for persistent anosmia — a twice-daily structured programme of sniffing four distinct scents (rose, lemon, eucalyptus, clove) for 20 seconds each, for at least 3 months. Available OTC as smell training kits or made at home. AbScent (abscent.org) provides excellent resources and a support community.
Cognitive Rehabilitation
For brain fog: reduce cognitive demands (pacing applies to mental activity too), use written lists and reminders, break tasks into small steps, avoid multitasking. Occupational therapy (available via Long COVID clinics) can provide specific strategies. Some patients benefit from neuropsychological assessment.
Sick Pay, Benefits, and Employment
Long COVID is now recognised as a disability under the Equality Act 2010 if it has a substantial, long-term effect on daily activities. This means employers must make reasonable adjustments — such as working from home, phased return to work, or reduced hours. Key supports:
- Statutory Sick Pay (SSP) — up to 28 weeks if you cannot work
- Employment Support Allowance (ESA) or Universal Credit — if SSP has ended or you are self-employed
- PIP (Personal Independence Payment) — if Long COVID significantly affects daily living or mobility
- Access to Work — government scheme for workplace adaptations and support workers
Support and Community
- Long COVID SOS (longcovidsos.org) — advocacy and research support
- Long COVID Support (longcovid.org) — community and resources
- NHS Long COVID app — available on the NHS app for self-management support
- Your COVID Recovery (yourcovidrecovery.nhs.uk) — NHS online rehabilitation programme
This article is for informational purposes only and does not constitute medical advice. If you are experiencing symptoms more than 4 weeks after COVID-19, please see your GP. Long COVID is a real, recognised medical condition — do not accept dismissal of your symptoms.
Related Health Guides on YourHealthXpert
Explore these related NHS-aligned health guides:
- Asthma Guide — Long COVID can cause persistent breathlessness; understand the overlap with asthma and NHS breathing support pathways.
- Anxiety & Depression Guide — Neurological and psychological symptoms are common in long COVID; learn about NHS mental health support.
- Heart Attack Guide — Long COVID increases cardiovascular risk; know the warning signs and NHS emergency pathways.
- Stroke Guide — Understand the link between post-COVID inflammation and stroke risk, plus FAST recognition.
- Chronic Kidney Disease Guide — COVID-19 can affect kidney function; learn about monitoring and NHS CKD care.
- Dementia & Alzheimer’s Guide — Brain fog and cognitive symptoms in long COVID share features with early dementia; understand the differences.