Symptoms lasting beyond 12 weeks. How mild your original infection was tells you nothing about your risk.
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Long COVID means symptoms that started during or after a COVID-19 infection, have continued for more than twelve weeks, and are not explained by anything else. It affects a substantial number of people in the UK, many of whom were previously fit and working full time.
The single most important thing on this page concerns exercise, and it is the thing most often got wrong.
If effort makes you worse a day or two later — not during, but afterwards — that is post-exertional malaise, and it changes everything. The instinct is to push through, build up gradually, get your fitness back. For people with this pattern, that approach causes harm, and NICE no longer recommends graded exercise therapy for it. The approach that works is pacing: staying inside your limit rather than repeatedly testing it.
The second thing: how ill you were at the time tells you very little about your risk. Plenty of people with long COVID had a mild infection they barely noticed. Being told "but you weren't even that ill" is both common and wrong.
Most people improve over months to a couple of years. A minority remain severely affected, and they deserve to be believed rather than managed.
More than two hundred symptoms have been described. These are the ones that matter most in practice.
Feeling faint, dizzy, foggy or breathless on standing, with a heart rate that jumps, may be PoTS — postural orthostatic tachycardia syndrome. It is common in long COVID, badly under-recognised, and there are practical things that help a great deal. It is worth asking about specifically.
Symptoms fluctuate, often unpredictably. A good week followed by a bad fortnight is characteristic — and it is a genuine problem, because people are judged on the day they looked well.
Research is ongoing and no single mechanism explains everything. The leading candidates:
What it is not is a psychological condition, and the biological abnormalities found in research studies are real. Anyone still being told this is deconditioning or anxiety is being given outdated information.
Vaccination before infection reduces the likelihood of developing long COVID, and remains the clearest preventive measure available.
There is no blood test or scan for long COVID. The diagnosis rests on symptoms starting with a COVID infection, continuing beyond twelve weeks, and not being explained by something else.
You do not need a positive test from the time to qualify. Many people were infected when testing was unavailable, and NICE does not require confirmation.
Not to prove long COVID, but to find the treatable things that mimic it:
Normal results do not mean nothing is wrong. They mean the treatable alternatives have been excluded, which is a useful thing to have established.
Lie down for ten minutes, record your heart rate, then stand and record it again at intervals over ten minutes. A sustained rise of 30 beats per minute or more — 40 in adolescents — with symptoms, suggests PoTS. You can do this at home and bring the numbers.
Many people with long COVID meet the criteria for ME/CFS, and post-exertional malaise is the shared feature that matters most. The management approach is largely the same.
Iron deficiency, thyroid disease, coeliac disease, diabetes, sleep apnoea, depression, an autoimmune condition, heart failure, or a persisting lung problem after severe infection. All are worth excluding rather than assuming.
This suits a longer remote consultation particularly well, because what people most need is time — and because almost everything useful can be done without an examination.
Prescribe unproven treatments. There is a substantial private market in blood-cleaning procedures, high-dose supplement regimens and anticoagulation for long COVID. None has good evidence, some carry real risk, and they are expensive. We will tell you that plainly.
Once you have the label, there is a real risk that a new problem gets filed under it. Anaemia, thyroid disease, heart problems and cancers do not stop happening to people who have long COVID.
If a symptom is new or different in character, it deserves assessing on its own merits. Say so directly if you feel that is not happening.
Pacing means staying within your limit rather than repeatedly finding it. It is not giving up; it is the strategy with the best evidence behind it.
If you have post-exertional malaise, do not follow a graded exercise programme. NICE withdrew that recommendation for good reason, and evidence of harm was part of it.
If you do not have post-exertional malaise, gentle gradual activity is reasonable and helpful. The distinction is the whole point, and it should be established before anyone gives you an exercise plan.
Long COVID has attracted a considerable amount of expensive treatment with no good evidence — blood filtration, hyperbaric oxygen, anticoagulation, large supplement protocols and stem cell treatments. Some carry genuine risk, and the costs run to thousands.
Desperation is understandable and it is being exploited. Ask what randomised evidence exists before paying for anything, and we will give you a straight answer about any of them.
This page follows NICE guideline NG188 on managing the long-term effects of COVID-19, NICE guideline NG206 on ME/CFS for the post-exertional malaise guidance, and NHS England long COVID service specifications.
NICE withdrew its previous recommendation for graded exercise therapy in 2021, following review of the evidence and reports of harm. Activity advice should now be individualised, with pacing as the approach where post-exertional malaise is present.
Reviewed against NICE NG188, NICE NG206 and NHS England guidance current at the date shown above.
Not if effort makes you worse a day or two later. That pattern is post-exertional malaise, and pushing through it causes harm.
NICE no longer recommends graded exercise therapy for this, and pacing is the approach with evidence behind it. If you do not get that delayed crash, gentle graded activity is reasonable.
Yes, and this is one of the commonest things people are wrongly told. Most cases follow mild infection.
How ill you were at the time predicts very little about your risk.
No. Research has identified real immune, vascular and autonomic abnormalities in long COVID.
Low mood and anxiety are consequences of being ill and disbelieved, not the explanation for the illness.
That may be PoTS — a jump in heart rate on standing, common in long COVID and frequently missed.
Measure your heart rate lying and then standing over ten minutes and bring the numbers. Fluids, salt, compression and sometimes medication help considerably.
Most people improve over months to a couple of years, usually gradually and with fluctuation rather than in a straight line.
A minority remain severely affected, and we would rather tell you that honestly than promise a recovery timeline nobody can guarantee.
That delay is exactly what post-exertional malaise looks like, and the gap is why the pattern is so hard to spot.
An activity diary makes it visible, and once you can see it, pacing becomes much easier to do.
You need a specific set of blood tests to exclude the treatable things that mimic it — iron deficiency, thyroid disease, coeliac disease, diabetes and B12 deficiency among them.
No test confirms long COVID, and normal results do not mean nothing is wrong.
Blood filtration, hyperbaric oxygen, anticoagulation and large supplement protocols do not have good evidence, and some carry real risk.
Costs run into thousands. Ask what randomised trial evidence exists before paying for anything, and we will give you a straight answer.
Vaccination before infection reduces the risk of developing long COVID, and staying up to date reduces the chance of a reinfection setting you back.
Responses among people who already have long COVID vary, and it is worth discussing your own situation rather than following a general rule.
Yes, and this is often the most useful thing we do. Sick notes, phased return plans, and detailed letters supporting workplace adjustments.
Long COVID may count as a disability under the Equality Act, which entitles you to reasonable adjustments — worth knowing before you have that conversation with an employer.
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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