Most people recover from COVID-19 within a few weeks, but for some, the illness does not end when the infection itself has passed. Symptoms may linger, disappear and return, or change over time. They can affect breathing, energy, concentration, sleep, work and everyday life.
This is commonly known as Long COVID. It can happen after a severe infection, but it can also follow a relatively mild illness that was managed at home. The symptoms are real, can be disabling and may require support from several different healthcare professionals.
This guide explains the symptoms of Long COVID, how it is assessed, what treatment may involve and where people in the UK can find help.
This article is for general information and is not a substitute for individual medical advice. New, severe or rapidly worsening symptoms should not automatically be assumed to be Long COVID.
What is Long COVID?
Long COVID is an informal term for symptoms that continue or develop after a COVID-19 infection. It is sometimes also called post-COVID syndrome, post-COVID-19 condition or post-acute COVID-19 syndrome.
UK clinical guidance separates longer-lasting COVID symptoms into two broad periods:
- Ongoing symptomatic COVID-19 means symptoms continuing from four to 12 weeks after the infection began.
- Post-COVID-19 syndrome means symptoms that develop during or after COVID-19, continue for more than 12 weeks and cannot be better explained by another diagnosis.
People often use “Long COVID” to cover both periods. The distinction is mainly useful to healthcare professionals; you do not have to wait exactly 12 weeks before speaking to a GP about symptoms that are troubling you.
Long COVID is a multi-system condition. This means it can affect several parts of the body rather than behaving like a single lung or respiratory illness. One person may mainly experience fatigue and brain fog, while another may have breathlessness, palpitations and digestive symptoms.
Symptoms can also fluctuate. You may have a relatively good day followed by a marked worsening, sometimes after physical activity, concentrated mental work, emotional stress or poor sleep. This unpredictable pattern can be one of the most difficult parts of living with the condition.
The NHS Long COVID guidance provides an up-to-date overview of the condition and the help available.
What are the symptoms of Long COVID?
There is no single set of symptoms experienced by everyone. Some people have one or two persistent problems, while others have symptoms affecting several body systems. Symptoms may be continuous, or they may come and go in episodes.
Commonly reported Long COVID symptoms include:
- extreme tiredness or fatigue that is not fully relieved by rest;
- shortness of breath, an altered breathing pattern or a persistent cough;
- difficulty concentrating, slower thinking, forgetfulness or “brain fog”;
- aching muscles, joint pain, headaches or chest discomfort;
- heart palpitations, a fast pulse or dizziness when standing;
- poor-quality sleep or insomnia;
- changes to smell or taste;
- anxiety, low mood or feeling emotionally overwhelmed;
- tinnitus, pins and needles or changes in sensation;
- nausea, reduced appetite, abdominal discomfort or diarrhoea;
- skin rashes or increased hair shedding;
- feeling feverish or having difficulty regulating body temperature.
Fatigue associated with Long COVID can be very different from ordinary tiredness. It may make showering, cooking, walking a short distance or following a conversation feel unexpectedly demanding. If tiredness is your main symptom, our guide to persistent fatigue and common causes explains some of the other conditions a doctor may consider.
Breathlessness may occur during activity or, in some cases, while resting. It deserves medical assessment, particularly if it is new, worsening or accompanied by chest pain. You can also read our guide to shortness of breath and when to seek urgent help.
Post-exertional symptom worsening
Some people experience a delayed increase in symptoms after activity. This is often called post-exertional malaise or post-exertional symptom exacerbation. The activity does not have to be strenuous: shopping, housework, a busy social occasion or prolonged concentration may be enough to trigger it.
The worsening may begin immediately or several hours later and can last for days. Symptoms may include heavier fatigue, muscle pain, brain fog, flu-like feelings, poor sleep and increased sensitivity to light or noise.
This matters because simply trying to push through the fatigue or following a standard exercise programme can make some people feel worse. Activity and rehabilitation should be adjusted to the individual, particularly when there is a clear pattern of delayed symptom worsening.
When should you seek urgent medical help?
Long COVID can produce frightening symptoms, but having had COVID does not mean every later symptom is caused by it. Heart attacks, blood clots, strokes, severe infections and other urgent conditions still need to be considered.
Call 999 or go to A&E if you have:
- severe difficulty breathing, gasping, choking or being unable to speak normally;
- sudden chest pain or pressure, particularly if it spreads to the arm, back, neck or jaw;
- blue, grey, very pale or blotchy lips or skin;
- sudden weakness on one side, facial drooping or difficulty speaking;
- coughing up blood, fainting or becoming suddenly confused;
- thoughts of seriously harming yourself or an immediate mental health crisis.
Chest discomfort and noticeable heartbeats can occur with Long COVID, but they should not be self-diagnosed. See our separate guides to chest pain and heart palpitations for more detail.
If you are unsure how urgently you need help, contact NHS 111. In Scotland, use NHS 24 on 111; in Wales, NHS 111 Wales; and in Northern Ireland, follow the advice provided by your local health and social care trust.
Who can develop Long COVID?
Long COVID can affect adults, teenagers and children. It can occur after a severe infection requiring hospital treatment, but it is not limited to people who were seriously ill. Someone who had mild initial symptoms—or did not realise at the time that they had COVID—may later experience persistent problems.
Research has identified factors associated with a greater likelihood of Long COVID, including having multiple symptoms during the initial illness and having certain existing health conditions. However, risk factors do not reliably predict what will happen to an individual.
Vaccination reduces the risk of severe acute COVID and appears to reduce the likelihood of developing some longer-term symptoms, but vaccinated people can still develop Long COVID.
A previous positive test can be useful information, but it is not always required for assessment. Testing was not consistently available earlier in the pandemic, and a test may have been taken too late or produced a false-negative result. The clinical history, pattern of symptoms and exclusion of other possible causes are important.
How is Long COVID diagnosed?
There is currently no single blood test, scan or examination that confirms Long COVID. Diagnosis is based on your history, symptoms, how they affect your life and whether another condition could explain them.
Your GP may ask:
- when your original infection or suspected infection occurred;
- which symptoms have continued or appeared since then;
- whether symptoms are constant or fluctuate;
- what happens after physical or mental activity;
- how your sleep, mood, work and daily activities have been affected;
- whether you had health problems before COVID.
It can help to keep a simple symptom diary before the appointment. Include your activities as well as your symptoms, as this may reveal delayed reactions or patterns that are difficult to remember during a consultation.
Tests you may be offered
Tests are chosen according to your symptoms rather than using one standard package for everyone. An assessment may include heart rate, blood pressure, temperature and blood oxygen measurements. Depending on the clinical picture, a GP may arrange blood tests, an electrocardiogram (ECG), a chest X-ray or tests of lung function.
Blood tests may help check for problems such as anaemia, thyroid disease, inflammation, diabetes, vitamin deficiencies, kidney or liver conditions. Normal results do not mean the symptoms are imaginary; they may simply make certain alternative explanations less likely. Our guide to understanding blood test results explains why results need to be interpreted alongside symptoms and medical history.
Some people may need further investigation by cardiology, respiratory medicine, neurology or another specialist. The assessment should also consider anxiety, depression and trauma, without assuming that unexplained physical symptoms are purely psychological.
The detailed clinical approach is set out in the NICE guideline on managing the long-term effects of COVID-19.
What treatment is available?
There is currently no single cure or standard medicine that removes Long COVID. Treatment is usually directed at the person’s most troublesome symptoms, with the aim of improving function, comfort and quality of life while recovery continues.
A care plan might involve:
- support with fatigue and activity management;
- breathing-pattern assessment and respiratory physiotherapy;
- treatment for pain, headaches, sleep problems or digestive symptoms;
- assessment of palpitations, dizziness or changes in heart rate;
- cognitive rehabilitation for memory and concentration difficulties;
- dietetic advice if appetite, weight or nutrition has been affected;
- smell training for persistent changes to smell;
- psychological support for anxiety, depression or distress;
- help with returning to work, education or normal daily activities.
Treatment should be personalised. Advice that helps one person may not suit another, particularly when symptoms worsen after exertion. Before starting a new exercise programme, speak to your GP, physiotherapist or Long COVID team. The NHS advises people with Long COVID not to restart exercise without first discussing it with a healthcare professional.
Cognitive behavioural therapy may sometimes be offered to help someone cope with fatigue, anxiety, low mood or the practical effects of long-term illness. It is not a claim that Long COVID is “all in the mind”, nor does it replace investigation or treatment of physical symptoms.
Be cautious about supplements, private test packages and treatments promoted as cures. Long COVID research is developing, but “natural” or experimental products can still cause side effects, interact with medicines and cost a significant amount without good evidence that they work.
Managing fatigue, activity and brain fog
Many people find that managing their available energy is more helpful than trying to force a rapid return to their previous routine. This is sometimes called pacing.
Pacing means balancing activity and rest so that essential tasks can be completed without repeatedly triggering a major deterioration. It is not the same as avoiding all movement, and it does not mean giving up on recovery. It is a practical way to work within current limits while symptoms are assessed and managed.
Try looking at physical, cognitive, emotional and social demands together. A work meeting, a long telephone call or a noisy family gathering may use as much energy as a physical task. On a better day, it can be tempting to catch up with everything at once, but this may contribute to a “boom and bust” cycle in which several busy hours are followed by days of more severe symptoms.
Helpful approaches can include:
- breaking larger jobs into smaller stages;
- planning rest before and after demanding activities;
- sitting down for tasks such as showering or preparing food;
- alternating physical and concentration-based activities;
- using reminders, notes and calendar alerts for brain fog;
- stopping before you are completely exhausted;
- recording delayed symptom changes after activity.
Sleep routines, regular meals and adequate fluids may also help, although they are not cures. If dizziness or a racing heart is worse when you stand, tell your doctor rather than simply trying to exercise through it.
Brain fog can make reading, decision-making and conversation unexpectedly tiring. Reducing distractions, tackling one task at a time and scheduling demanding work for the part of the day when you are usually clearest may make things more manageable.
Living with Long COVID at home and at work
An illness that fluctuates can be hard for other people to understand. You may look well while struggling with exhaustion, pain, dizziness or concentration. It can help to explain that your abilities may change from one day to the next and that overdoing things can cause a delayed setback.
At home, focus first on essentials such as food, medication, washing and rest. Accepting help with shopping, childcare or housework is not a failure. If you are having difficulty caring for yourself safely, ask your GP or local authority whether an occupational therapy or care needs assessment may be appropriate.
If Long COVID is affecting your job, speak to your employer sooner rather than waiting until the situation becomes unmanageable. Possible adjustments include a phased return, shorter shifts, changed duties, more breaks, home working, a quieter workspace or temporarily reduced targets.
Depending on its duration and effect on normal daily activities, Long COVID may meet the definition of disability under the Equality Act 2010. This is based on the individual impact of the condition rather than the diagnosis alone. The Acas guidance on Long COVID at work explains sickness absence, workplace discussions and reasonable adjustments.
People whose health condition affects their ability to work may also be able to apply for Access to Work. The scheme can sometimes provide practical support beyond the reasonable adjustments made by an employer.
Emotional wellbeing
Living with persistent and unpredictable symptoms can lead to frustration, grief, loneliness and fear about the future. Some people also experience anxiety, depression or distress linked to their original illness or hospital admission.
These feelings deserve support, whether they are part of Long COVID, a response to being unwell or both. Speak to your GP if your mood is persistently low, anxiety is becoming difficult to manage or you feel unable to cope. Our guide to accessing mental health services in the UK explains NHS, charity and urgent support options.
How to access NHS Long COVID support
Your GP is usually the first point of contact. You can make an appointment if symptoms have lasted four weeks or more, or earlier if they are worrying, severe or interfering significantly with daily life. You do not need to wait until the 12-week point to ask for help.
The GP can assess your symptoms, arrange initial tests, treat specific problems and decide whether you may benefit from referral. If arranging an appointment is difficult, see our practical guide to getting a GP appointment.
In England, specialist post-COVID services can provide physical, cognitive and psychological assessments, diagnostic tests, rehabilitation and onward referral. Access is generally through a healthcare professional rather than direct self-referral. The services available and referral criteria can vary by area.
NHS England publishes information about post-COVID services, including services for adults and specialist support for children and young people. Arrangements differ in Scotland, Wales and Northern Ireland, so ask your GP or local health board what is available where you live.
You may also find practical information and peer support through organisations such as Long COVID SOS and Asthma + Lung UK. Peer support can reduce isolation, but treatment recommendations shared in online groups should still be discussed with an appropriate healthcare professional.
Recovery and outlook
There is no reliable timetable for Long COVID recovery. Some people improve over weeks or months, while others have symptoms for much longer. Recovery may be uneven: a setback does not necessarily mean that all previous progress has been lost.
Because Long COVID can describe several different symptom patterns, the outlook is not identical for everyone. A person whose main difficulty is a lingering change in smell may have a different course from someone with severe fatigue, post-exertional symptom worsening and heart-rate problems.
Regular review is important if symptoms change, new problems appear or your ability to manage everyday activities declines. A previous Long COVID diagnosis should not prevent a clinician from considering a new or unrelated condition.
Research into causes, subtypes and treatments is continuing. For now, good care usually means taking symptoms seriously, excluding other illnesses, treating specific problems, avoiding harmful overexertion and providing practical support while recovery develops.
Frequently asked questions about Long COVID
Can you have Long COVID without a positive COVID test?
Yes. A previous positive test may support the history, but it is not always essential. Some people were infected when testing was unavailable, did not test at the right time or had a false-negative result. A clinician will consider the timing and pattern of symptoms while also checking for other possible causes.
How long does Long COVID last?
There is no fixed duration. Some people recover within a few months, while others continue to have symptoms for years. Different symptoms may improve at different rates, and progress can fluctuate.
Is there a blood test for Long COVID?
No single blood test confirms or excludes Long COVID. Blood tests are often used to look for other explanations, such as anaemia, thyroid problems, inflammation, diabetes or vitamin deficiencies.
Can mild COVID cause Long COVID?
Yes. Long COVID can develop after an infection that seemed mild and did not require hospital treatment. The severity of the initial illness does not perfectly predict whether longer-term symptoms will develop.
Should I exercise if I have Long COVID?
Do not assume that pushing yourself will speed up recovery. The NHS recommends speaking to a GP or specialist before restarting exercise. This is particularly important if activity causes delayed or prolonged worsening of fatigue, pain, brain fog or other symptoms.
Can children get Long COVID?
Yes, although children and young people may describe or display their symptoms differently. Persistent fatigue, headaches, breathlessness, concentration problems and difficulty attending school should be discussed with a GP. NHS England has established specialist paediatric post-COVID hubs to support local children’s services.
Can Long COVID affect mental health?
Long COVID can be associated with anxiety, depression, sleep problems and trauma-related symptoms. The strain of living with a prolonged illness can also affect emotional wellbeing. Mental health support can form part of treatment without dismissing or replacing care for physical symptoms.
Can I be referred to a Long COVID clinic?
Potentially. Your GP or another healthcare professional will assess whether referral to a specialist post-COVID service is appropriate. Availability and referral criteria vary by location, and some symptoms may be managed through other local or specialist services.
When should I contact my GP?
Contact your GP if symptoms persist for four weeks after COVID, return after the infection or interfere with normal life. Seek advice sooner for worrying or worsening symptoms. Severe breathlessness, sudden chest pain, signs of a stroke, coughing up blood, fainting or an immediate mental health crisis require urgent help rather than a routine appointment.
