Long Covid: symptoms, duration, contagious?

If the Covid-19 pandemic is behind us, the disease is not. In addition to one-off cases which can now occur seasonally, people have suffered from long Covid since 2020 or 2021. For them, the symptoms of the disease have never disappeared. They even escalated into other complications, lastingly affecting their quality of life. According to figures from Public Health France, 2 million French people would suffer from Long Covid, i.e. 4% of the adult population. THE women are more affected than men, especially between 45 and 54 years old. What is long Covid? How recognize your symptoms? How long does it last? Definitions official and numbers available.

What is the definition of long Covid?

Long Covid refers to an infection with the Covid-19 virus (Sars-Cov-2) which causes symptoms prolonged beyond 4 weeks after the acute phase of the disease and which cannot be explained by another disease, according to the definition of the High Authority of Health. For the WHO, we speak of long Covid from 3 months of prolonged symptoms.

What are the symptoms of long Covid?

Typically, “patients are out of breath at the slightest effortfor example after walking up a floor, they headache when they become a little active, in the rib cage, the ribs, the sternum, the neck, they have the head spinningsensations of chest tightness and they are tired” describes Dr Nicolas Barizien, Head of the Physical Medicine and Rehabilitation department at Foch hospital (Suresnes). The High Authority of Health has listed the most common symptoms of long Covid as:

• fatigue
• dyspnea
• anosmia-ageusia
• concentration problems
• memory disorders
• headaches
• joint and muscle pain
• sleep disorders
• chest tightness

Recent recommendations add that many patients also describe palpitations, dizziness, chest pain, digestive disorders (abdominal pain, diarrhea, loss of appetite) as well as “post-exercise malaise”, that is to say a marked worsening of symptoms after physical or mental activity. Psychiatric disorders are regularly described (post-traumatic stress syndrome in cohorts of hospitalized patients, anxiety, depression). Symptoms of long Covid can fluctuate over time, with phases of exacerbation and recovery.

Long Covid or relapse of Covid?

“No, people who have long Covid do not relapse, replies Dr. Barizien. They no longer have a fever, they are no longer in an acute infection, it is not the virus which is starting to develop again in the body, the PCR is also negative.” Likewise, it is not a remote complication of the infection: “They are doing something strange which manifests itself in an increase in symptoms which interfere with their daily life.”

How long does long Covid last?

Symptoms tend to persist for several weeks, even months and even years. A survey carried out by Santé Publique France in 2022 on 10,615 people, 55% of whom were infected with the Covid-19 virus, showed that, among people suffering from post-COVID-19 conditions, 31% had been there for more than 12 monthsAnd 22% for more than 18 months. A French study carried out using data from 968 people indicates that 85% people with a long form of Covid had still have symptoms after a year. For 60%, the impact of long Covid was “very significant”in their personal, professional and social lives. There fatigue persisted the most while cough, smell disturbance and taste disturbance gradually diminished. Globally, the rhythm of patients’ symptoms and “attacks” evolves, with progressive spacing over time.

Are we contagious when we have long Covid?

“Normally no”, replies our interlocutor. Contagiousness is greatest around the start of symptoms, with possible transmission from 48 hours before. So, in “long Covid”, the person is in principle not contagious… unless they have another acute episode (new infection). “It is the inflammation caused by the virus which is responsible for the symptoms which persist but there is no more virus so there is no need to worry” confirms our interlocutor.

What to do if you think you have a long Covid?

Faced with symptoms that last, which prevent us from getting back on track, The first doctor to see is the attending physician. And without delay: “These symptoms must be taken care of within 6 months following the acute infection, recommends Dr. Barizien. If we wait too long, things will get worse and it will be much more complicated to treat them.” The doctor will be able to carry out an initial examination and, if necessary, refer you to specialists (physiotherapists, dietitians, etc.). Consulting the general practitioner also helps to avoid the risk of a Covid complication. “The first complication to check for the medical profession is that the patient does not have pneumonia., specifies Dr Barizien. Let him not make a embolism pulmonary or pneumonia with a common germ which can degenerate in a lung which has been weakened, whether it does not cause pulmonary fibrosis or a cardiac complication such as heart attack or myocarditis. They are rare but there are a few.” Below is the care pathway updated by the High Authority of Health in 2024 for patients suspecting long-term Covid:

How is long Covid treated?

There majority of patients can be supported by the general medicineif necessary with paramedical professionals (physiotherapists, speech therapists…). THE patients in a very complex situationpoly-symptomatic, for example following after-effects of resuscitation may need a hospital recourse notably via a day hospital rehabilitation-rehabilitation. The attending physician can also refer people to “long Covid support and coordination cells”, there are several in France (Map on Sante.fr). There is no ALD (Long-Term Affection) “specific to long-term Covid”, but Health Insurance points out that recognition as an ALD is possible “in certain situations”, upon request from the attending physician and after advice from the medical advisor.

What are the treatments for long Covid?

To date, there is no curative treatment for long Covid. Treatment remains symptomatic, personalized and progressive.

→ Against fatigue : “There’s not much to do apart froma healthy lifestyle that is to say: eat a balanced diet, avoid alcoholic drinks, respect your sleep schedule…”

→ Against weight loss: consult a dietician. “Many patients say that, without having been hospitalized in intensive care, they lost 4, 5 or even 10 kilos during their coronavirus infectiontestifies Dr. Barizien. However, during periods of rapid weight loss, we lose muscle. which intensifies fatigue. By getting back to exercise, they will rebuild their muscle mass.

→ Against shortness of breath : “We must first eliminate a complication of Covid and the possibility of having deconditioning during exercise” says Professor Andrejak. Specialists emphasize one point: in certain patients, exercise can worsen symptoms, sometimes several hours or days later. It is therefore not a question of “forcing yourself”, but of resuming an activity very gradually, while respecting the body’s limits. Referring to a physiotherapist is essential to implement appropriate rehabilitation, with gentle exercises, rest periods and slow progression. For breathing disorders, breathing exercises can help slow the ventilatory rate. “Cardiac coherence, such as the 3-6-5 method (6 breathing cycles in 5 minutes, 3 times a day.), can be useful. If the person cannot control their breathing or hyperventilates during exercise, a physiotherapist must be consulted, capable of making the diagnosis and offering targeted exercises”advises Dr. Barizien.

→ Against hyperventilation : Some people suffer from hyperventilation following a Covid infection. Concretely, as soon as they make an effort, they breathe quickly, have the feeling of being out of breath and therefore breathe faster which is unsuitable for the effort required.. “You must consult the doctor to be sure that the fact of breathing “rapidly” during exercise is not linked to something else such as pneumonia or respiratory after-effects for example. If there is no explanation, it is only hyperventilation so you must see a physiotherapist to relearn how to breathe calmly.”

→ Against a smell or taste disorder: Smell disorders can benefit from a olfactory rehabilitation.

→ Psychological support may prove useful. “This disease can cause anxiety and cause discomfortexplains Professor Andrejak. We experience it more or less well but our way of reacting also means that we will perhaps have a few more symptoms when normally we would not have paid attention to them. There are patients who have persistent symptoms and on scans or other tests, there is nothing. A normal assessment is therefore not necessarily synonymous with the absence of symptoms. It is important to also look for post-traumatic stress syndrome in these patients. Having had a Covid infection and being hospitalized may have been experienced as a trauma.” Not to mention the very significant mental load of certain patients “especially women as they are the mistresses of the home, they take care of the children more, they worry a little more about their family than men” explains Dr. Barizien, which reinforces fatigue.

The Haute Autorité de Santé does not recommend food supplements, vitamins or unevaluated alternative treatments, due to lack of evidence of effectiveness and due to possible risks in self-medication.

Thanks to Professor Claire Andrejak, pulmonologist at Amiens University Hospital (France) (comments collected in 2021) and to Dr Nicolas Barizien, Head of the Department of Physical Medicine and Rehabilitation, Sports Traumatology at FOCH Hospital in Suresnes (92), President of the Île-de-France Regional Society of Sports Health Medicine (SIFMED Sport Santé) whose comments were collected in 2020.