Long COVID: assessment, treatment and rehabilitation in the UK

Long COVID is not one organ-based disease, so it is not owned by a single specialty. Assessment is usually led by a GP or a post-COVID service, and brings together physicians in respiratory medicine, cardiology, neurology and rehabilitation medicine as needed, together with physiotherapists, occupational therapists, psychologists, dietitians and specialist nurses.

The NHS says tests and assessment may be carried out by a team of different specialists at a post-COVID syndrome service. The NICE guideline describes the condition as new or ongoing symptoms 4 weeks or more after the start of acute COVID-19, and is a joint guideline with the Scottish Intercollegiate Guidelines Network and the Royal College of General Practitioners.

Symptoms can differ greatly between people and may come and go. Besides fatigue, breathlessness, joint and muscle pain and brain fog, the NHS lists a high temperature, cough, chest pain or tightness, palpitations, headaches, dizziness, sleeping difficulty, changes in smell or taste, tummy pain and diarrhoea, pins and needles, anxiety and depression. Symptoms can get worse after stress or more activity, and new ones may appear.

Some people with long COVID meet the criteria for myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), and others have a pattern similar to fibromyalgia. The NHS describes the main symptoms of ME/CFS as extreme tiredness, sleep problems, problems with thinking and memory, and symptoms getting worse after physical or mental activity, sometimes taking weeks to settle. These overlaps are important because they shape pacing and energy management advice.

There is no specific test for long COVID. The NHS says a GP asks about symptoms and their duration, and may arrange blood pressure and heart rate checks, blood tests, and tests to measure oxygen levels in the blood. Further tests, such as an ECG or chest X-ray, may help diagnose and monitor symptoms and exclude other causes.

Specialist assessment may add spirometry or full lung function testing for breathlessness, an echocardiogram or cardiopulmonary exercise test for heart or lung limitation, and autonomic testing if there are palpitations on standing or dizziness. These tests are used to look for treatable conditions rather than to confirm long COVID itself. A symptom diary is often suggested to track triggers.

The NHS says treatment aims to ease symptoms, with a plan that may include advice on managing fatigue, physiotherapy and exercises for breathing and muscle pain, cognitive behavioural therapy for anxiety, depression and fatigue, cognitive rehabilitation for memory and concentration, help with smell, support with diet, symptom-tracking tools and social prescribing for practical, emotional and social support.

Rehabilitation should be paced. Doing too much too soon can make symptoms worse, so goals are set with specialists and increased gradually. The NICE research recommendations highlight that evidence is still being gathered on the most effective interventions, including multidisciplinary rehabilitation and exercise, so claims of a guaranteed cure should be treated with caution.

On the NHS, you start with a GP, who assesses symptoms, arranges initial tests and may refer you to a post-COVID service or other specialists. Support may also include occupational health, social prescribing and the GOV.UK long COVID resources that the NHS signposts.

Privately, long COVID clinics and consultants in respiratory medicine, neurology, cardiology or rehabilitation offer assessments, tests and programmes. Costs vary with the number of tests and sessions. Ask which tests are planned and why, how progress will be measured, what evidence supports any proposed treatment, and how information will be shared with your GP.

• Bring a symptom diary showing what makes symptoms better and worse, and a list of medicines and supplements.

• Ask which other conditions have been considered and ruled out, such as anaemia, thyroid problems, heart or lung disease.

• Ask how activity and exercise should be paced, and who will oversee rehabilitation.

• Ask about support with work, including a phased return and adjustments, and whether occupational health can help.

• See a GP if symptoms are new, worsening or affecting work or sleep.

• Call 999 for sudden severe chest pain, severe breathlessness, signs of a stroke such as face drooping, arm weakness or slurred speech, or collapse. Long COVID should not be assumed to explain these symptoms.