What symptoms are involved?

Understanding of ongoing symptoms comes from a range of research studies including large-scale surveys and in-depth qualitative research to explore the patient experience in detail. The most common symptoms are fatigue and breathlessness, but a large range of other symptoms are also recognised and the list has been growing. 

A recent editorial in the BMJ (April 2021) listed fatigue, cognitive dysfunction, wheeze, inappropriate tachycardia and gastrointestinal disturbance as frequently reported symptoms of long-Covid. The main symptoms reported in the NICE guideline are shown in Figure 1 above. 

Quantitative data cannot tell us how it feels to be a patient with ongoing Covid-19 symptoms. This is where qualitative research comes in. Patients have described multiple, unpredictable symptoms which sometimes fluctuated over time. Some often have periods of relative wellness before relapses.

One patient reported being “fatigued to the point of having to sleep in the day, inability to exercise, continued shortness of breath both motionless and when exerting, small waves of anxiety, considerable depression, continued loss of smell”. Another commonly reported symptom is ‘brain fog’ and its effects can be debilitating, with difficulties in focusing and concentrating and experiencing headaches.

Listening carefully to patients is an important part of tackling potential biases against long-Covid. Asking about the nature, severity, timing and duration of symptoms will help pharmacy professionals with their decision-making. It is also useful to understand what experience the individual had with acute symptoms, and the severity of their condition. A stay in hospital, for example, may have been a traumatic experience.