Outing my own assumptions

I joined the Leeds Long Covid team on my final placement with a collection of subconscious assumptions about how these patients would present, and in many ways I couldn’t have been more wrong. I previously had private thoughts about Long Covid mostly being due to deconditioning, affecting people with multiple comorbidities, psychosomatic symptoms, and even an epidemic of the worried well, and I wasn’t alone in this¹. 

In reality there is an undeniable physiological response to post-Covid-19 infection with conditions such as postural orthostatic tachycardic syndrome (POTS) and dysautonomia common in clinic, with emerging evidence about hormone levels – linking the menopause with symptom exacerbation. Patients often present with few to no comorbidities, and pre-Covid high fitness (marathon runners aren’t unusual). There are also links to high responsibility professions – teachers, nurses, doctors – people used to working very hard, long hours.  

There are numerous research projects ongoing within the team, as well as nationally and globally, and treatment pathways in the Long Covid service are a direct result of this. The MDT approach is crucial and the team is made up of OTs, dieticians, psychologists, and a GP. Physio treatment is typically focused around managing dysautonomia through diaphragmatic breathing exercises, fatigue management through pacing of activity, and addressing MSK pain and mobility problems.  

There are multiple theories under investigation about the driving factors behind Long Covid, and as physios we can use the emerging evidence to influence what we can at this stage. When it works, it works – I’ve seen some quite rapid, unexpected turnarounds from patients who were able to engage with treatment and reach their goals within six weeks.

Generally though, recovery is happening but it is slow and timelines vary hugely. Typically, patients are recovering up to 80 per cent of their pre-Long Covid capacity.

⁽¹⁾ The mythology of Long Covid-19 common misconceptions