Long Covid (Post-Covid Syndrome)

and Christiane Fux, medical editor Updated on

Maximilian Reindl studied chemistry and biochemistry at the LMU in Munich and has been a member of the editorial team since December 2020. He will familiarize himself with medical, scientific and health policy topics for you in order to make them understandable and comprehensible.

What is Long Covid?

Long Covid patients have (clinically) recovered from a Sars CoV-2 infection. This means that they (usually) no longer have any detectable coronaviruses in their bodies. However, they still suffer from severe complaints. So they are not healthy.

If health complaints persist for longer than twelve weeks, doctors speak of the so-called post-Covid syndrome. In English-speaking countries, those affected are also referred to as "long hauler" - that is, as patients who "drag around" symptoms for a long time.

Alternative terms can be found in medical jargon - such as the acronym PASC (from English: "post-acute consequences of Covid-19") or CCS - in German "chronic Covid syndrome".

With a mild course, a corona infection lasts on average two to three weeks. In the case of more severe courses, the acute phase of the illness can double. But in many cases that is not the end of the disease.

A significant proportion of those affected develop symptoms that persist well beyond the acute disease stage. Often these are patients who were previously seriously ill with Covid-19. Around 80 percent of the inpatients treated suffer from long-term effects.

But it also often affects people whose disease course was mild or symptom-free: Around a third of the patients who have cured an infection in their home environment also suffer from Long Covid.

What are the symptoms of Long Covid?

Long Covid causes very different complaints. The variety of documented symptoms makes it difficult, even for experts, to assign them to a clearly defined clinical picture.

The following symptoms are often observed with Long Covid:

Difficulty breathing, coughing, or shortness of breath
Exhaustion and tiredness (fatigue)
Loss of smell and taste (anosmia)
Headache, muscle and joint pain
Concentration and memory problems
Dizziness and problems with balance (vertigo)
Nerve disorders (neuropathies)
Cardiovascular complaints
Depression and anxiety disorders
sleep disorders
Skin disorders and hair loss

According to a preliminary analysis by the Barmer Institute for Health System Research (bifg) on incapacity for work for the period from November 2020 and March 2021, the symptom complex "fatigue and fatigue" occurs more frequently in women than in men. This trend increases with age. Headaches, as a possible long-term consequence of Covid-19, are also apparently overrepresented among younger women.

Men, on the other hand, show persistent coughing and shortness of breath as primary long covid symptoms. It mainly affects middle-aged and older men. The bifg authors see the higher number of smokers in this age group as the reason for the observed breathing difficulties.

Causes of Long Covid

How Long Covid will develop has not yet been conclusively clarified. Because as individual as every Covid 19 patient is, the Long Covid symptoms are just as varied - or their causes:

Long-term tissue damage: Covid-19 itself is a multi-organ disease in which almost any body tissue can be affected. Either through direct damage that the virus itself causes, or through downstream damage processes that are a result of the body's own pathogen defense - such as excessive inflammation (hyperinflammation) in the acute phase of the disease or misdirected (chronic) inflammation caused by infection, as well as autoimmune phenomena or coagulation disorders ( E.g. blood clots).

Persistence of viruses: Some studies have shown that after infection in some immunocompromised patients, viruses or virus components were excreted via the respiratory or gastrointestinal tract for several months. Doctors attribute this to insufficient virus elimination. This means that in these cases the immune response is not strong enough on its own to render the virus completely harmless in the body.

Consequences of intensive care treatment: If Covid-19 takes a severe course, the function of the respiratory system can be so severely impaired that independent breathing is no longer possible for those affected. Doctors must give artificial respiration in such cases to save the lives of those affected. This invasive form of ventilation is usually associated with severe physical and psychological stress and long-term effects.

Long covid of the lungs

In most cases, the coronavirus initially causes a respiratory infection. If the disease is more severe - usually from the second week of illness - it can cause pneumonia.

Covid 19 disease can trigger or worsen cognitive and psychological disorders.

Possible are:

Psychological complaints such as depression, anxiety disorders, or post-traumatic stress disorder (PTSD)
Cognitive disorders such as concentration problems, forgetfulness, language difficulties, problems with understanding the content of texts

diagnosis

A psychological post-Covid-19 examination includes various tests that record possible cognitive complications as well as emotional (affective) symptoms. This includes:

Attention and concentration tests
Tests for mental disorders such as depression and anxiety disorders

therapy

Short psychological interventions can often help. Depression, anxiety or concentration disorders can usually be treated well. It is important to seek professional help quickly so that the problems do not become entrenched.

To be able to help:

Therapeutic procedures such as cognitive behavioral therapy or depth psychological methods
Appropriate medication that relieves fears
Special concepts for treating PTSD
Specialized training programs that improve cognitive impairment

Skin changes at Long Covid

In (very) rare cases, a Covid 19 infection can also trigger dermatological abnormalities. This shows a varied picture of skin changes. It ranges from rashes with redness, wheals (hives), blisters to punctiform skin bleeding. In some cases, the affected skin areas also take on a characteristically marbled skin structure.

In addition, vascular occlusions or damage to the vascular walls can lead to bluish thickenings on the fingers and toes ("Covid toes"). Increased hair loss over a period of a few weeks to months after infection is also reported more frequently.

In the vast majority of cases, these abnormalities heal spontaneously within a week. In the event of long-term irritation of the skin, treatment is carried out in accordance with the accepted dermatological standards - for example, by administering antihistamines, cooling, moisturizing and greasy ointments or, in rare cases, short-term administration of corticosteroids.

Dermatology specialists decide on the best possible treatment path on a case-by-case basis after a corresponding investigation.

In the increased reports of hand eczema, dermatologists currently see no connection with a Covid-19 infection - rather, they see frequent hand washing and the frequent use of disinfecting lotions as a possible cause. In this context, the best way to prevent cracked, reddened and itchy skin on your hands is by regularly applying greasy and moisturizing hand creams.

Forecast: will Long Covid regress completely?

The symptoms of Long Covid usually subside after a few weeks. In some cases, however, they can last for months, become chronic and thus significantly reduce the quality of life and ability to work. This also applies after supposedly mild, symptom-free courses of the disease.

It is currently not clear to what extent persistent or recurring symptoms persist, subside or can be treated as part of a therapy process after the infection has been overcome. The Covid-19 disease and the subsequent long-term consequences are still too novel to allow an accurate prognosis. Knowledge of how to best treat patients and their various complaints is also only gradually developing.

Your doctors can already draw on many years of experience in the treatment of chronic pain syndromes, states of exhaustion and mental disorders and derive appropriate treatment approaches from them. These can also help long covid or post covid patients.

Healthcare professionals assume that the vast majority of symptoms in most people will resolve over time.

The sooner you take action and seek help, the better your chances of a full recovery!

Rehabilitation programs

Depending on your health condition, your doctor can help you with the following treatments:

Inpatient or outpatient treatment in a suitable rehabilitation facility ("rehab")
Special aftercare and rehabilitation measures
Professional reintegration after a long period of inability to work
Close check-ups and follow-up care
Prescription of drug therapies
Psychotherapeutic support
Help with the coordination of non-medical offers (physiotherapy, nutritional advice, nursing service, etc.)

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