Long covid's strange symptoms: a GP explains

Chris Smith spoke to Oxford-based GP Helen Salisbury, who said she's been seeing patients with these ongoing COVID-19 symptoms...

Helen - Absolutely. And I would say the most common symptom is fatigue, just not being able to do stuff. I've got patients who previously have been really fit; they'll be the sort of people who would go running several times a week. And so actually they weathered the initial illness not so badly. Certainly they didn't need to go and get oxygen or go to hospital or anything like that. And as a consequence, they never had a swab, so they never got a proper diagnosis. But now months down the line they still get absolutely exhausted if they walk a quarter of a mile to the local shop, and then have to rest. I've got patients who say "I was okay this morning, but after I had my shower, I had to sit down for an hour and a half". That's no way of getting back to life.

Chris - And how quickly after people - I don't want to say recover, because they haven't - but how quickly after the acute symptoms do people notice that they're getting these bizarre constellations of symptoms, and particularly this fatigue?

Helen - I think it's a little bit difficult to know, because for many of my patients, they didn't ever contact me. Particularly the people who were ill in April 0- there was a big message going out which was saying, don't call anyone unless you're really, really, really sick. It's a different pattern for each patient, I think. And they each have a different set of symptoms. For some, the thing that's really bothering them still is being out of breath. I've got one patient who's having fevers, persistent fevers all the time; which is really difficult because everyone thinks she's still infectious, which she isn't, but she's still really affected by those fevers. And it's stopping her doing things.

Chris - When you say that you know she's not still infected - how do you know that? The reason for asking this question is Paul Garner, who we were hearing from just now - the infectious diseases doctor who described his experience - he said he had an antibody test and it was positive, but he was interested in whether or not he still had virus in him.

Helen - It's really difficult to tell. This particular person I think has had swab tests that prove she's not carrying the viral RNA anymore. And some of the patients have positive antibody tests, but not all of them. And that's also a really difficult thing for people because if they didn't have a swab in the first place, although they had symptoms that came on the right time and they had a really convincing set of symptoms - you think, yeah, that's definitely COVID - they don't now have any antibodies because we know that some people's antibodies wane very quickly. So it's actually really difficult to tell. And I think somebody else was talking about how difficult it is if GPs don't understand what's going on, and if you have no swab to start with and no antibodies now, and that collection of really weird symptoms, it's unfortunate that quite a few patients are not getting a fully sympathetic or empathetic response from their GPs.

Chris - We'll dwell a little bit more on testing a bit later in the program to explore some of those deficiencies that you've highlighted, Helen. Have you noticed, though, in the patients that come to see you with these symptoms, are there any general trends of the kinds of people who are presenting like this, and you can say they fit a particular group? Or is it just all and sundry, all ages, both sexes, young, old, no difference?

Helen - All and sundry. I've probably got more slightly younger patients, actually; not so many patients in their sixties and seventies, but more patients in their thirties and forties, I would say. I mean, that may just be the group of patients I'm seeing. One of the good things is that I'm just beginning to see some of these patients saying, "do you know what, I feel a bit better; and it's not just for a day or two, I've actually felt better for a whole week".