You may experience ongoing symptoms after a COVID-19 diagnosis, even if the illness was mild. According to current research, your chances of having ongoing symptoms after COVID-19 are higher if:
These risk factors may change as we learn more about COVID-19.
Alberta Health Services COVID-19 Scientific Advisory Group.(2020, November 23rd). COVID-19 Scientific Advisory Group Rapid Evidence Report. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-chronic-symptoms-of-covid-rapid-review.pdf
Shortness of breath (feeling out of breath) may also be called breathlessness.
It is common to feel out of breath more easily after having COVID-19. Learning the best way to manage your shortness of breath will help. Shortness of breath should get better as you use the positions, exercises, and strategies listed on this website. Slowly becoming more active can also help.
There may be several reasons why you are having trouble breathing during your recovery:
AND
The following strategies and exercises have been shown to help improve breathlessness. You can pick and choose which ones work best for you based on the reason why you are feeling breathless.
Relaxed breathing
Also known as diaphragmatic breathing, this can help you to relax and get control of your breathing. This is helpful when you are feeling anxious. This is also helpful to build your breathing strength after you have been unwell for some time.
Paced breathing
This may help you control your breathing when you are doing activities that take more effort or make you breathless (such as making your bed, climbing stairs, etc.).
Different positions
These positions may help you breathe easier. Try each one to see what helps you most.
Use a Symptom Tracker to record how you are feeling over time.
There are other breathing exercises that can help to decrease breathlessness which you may also find helpful. These can be found under the Resources and Supports tab above.
Some of this material, including images, has been adapted from an original work Support for Rehabilitation Self-Management after COVID-19 Related Illness. Geneva: World Health Organization (WHO); 2020. Licence: CC BY-NC-SA 3.0 IGO. This adaptation was not created by WHO. WHO is not responsible for the content or accuracy of this adaptation. The original edition shall be the binding and authentic edition.
Neuroscience, Rehabilitation & Vision Strategic Clinical Network. Post COVID Task Force.(2021). How to Support Your Recovery and Rehabilitation after COVID-19. British Columbia: Provincial Health Services Authority. http://www.phsa.ca/health-info/post-covid-19-care-recovery
NHS England.(2021). Breathlessness. Your COVID Recovery. Retrieved July 9, 2021, from https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/breathlessness/
Post-COVID-19 Interdisciplinary Clinical Care Network (n.d.). Managing Breathlessness in Post COVID--19 Recovery. Alberta: Alberta Health Services. https://www.saot.ca/wp-content/uploads/2021/03/if-ppih-covid-19-support-recovery-rehabilitation-after-covid-19.pdf
Professional Practice Coordinators, IPPL, Central Zone (2021). Supporting your recovery from COVID-19. Patient & Family Guide. Halifax: Nova Scotia Health Authority. https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2219.pdf
World Health Organization(2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Ofice for Europe. https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness
Coughing is common after having COVID-19. Your cough might be dry, or you might find you are coughing up mucus or phlegm (this is called a productive cough). This is normal after a respiratory (breathing) illness like COVID-19.
Coughing is how your body tries to get rid of mucus, but coughing uncontrollably can make you feel worse and very tired.
If your cough is making you feel short of breath and you have wheezing (a high-pitched whistling sound), your primary health care provider may prescribe medication to help.
Try these strategies:
To manage a dry cough
To manage a productive cough (coughing up mucus or phlegm)
Use a Symptom Tracker to record how you are feeling over time.
Some of this material has been adapted from an original work Support for Rehabilitation Self-Management after COVID-19 Related Illness. Geneva: World Health Organization (WHO); 2020. Licence: CC BY-NC-SA 3.0 IGO. This adaptation was not created by WHO. WHO is not responsible for the content or accuracy of this adaptation. The original edition shall be the binding and authentic edition.
NHS England.(2021). Cough. Your COVID Recovery. Retrieved July 9, 2021, from https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/cough/
Professional Practice Coordinators, IPPL, Central Zone (2021). Supporting your recovery from COVID-19. Patient & Family Guide, WC85-2219. Nova Scotia: Nova Scotia Health Authority. https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2219.pdf
World Health Organization(2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Ofice for Europe. https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness
Fatigue is very common after viral infections, such as COVID-19. Fatigue means feeling tired or like you do not have energy. It is different than being overtired or sleepy. It does not get better if you get more sleep or have a day of rest.
Fatigue symptoms after COVID-19 can get worse after activity or effort. Your fatigue may keep getting worse for 12 to 48 hours after an activity. Because of this, you may not be aware that you are overdoing it in the moment.
Fatigue can be caused by many things:
Everyone's recovery is different. Some people still have fatigue 3 months after having COVID-19.
Try these strategies:
Plan to rest
Planning to rest before you start to feel exhausted can help your recovery. Stopping only when you feel exhausted can lead to more fatigue. Planned rests can lower your need for longer periods of rest (often called a "crash").
For example: If you are exhausted and usually have to nap by 2 p.m. daily, consider planning to rest by 1 p.m. each day.
Rest effectively
A rest should be a break for your body, brain, senses, and emotions. A rest should either give you energy or pause the drain of energy.
Think of a cell phone -- in order to have battery power, you need to plug it in to recharge, turn it off so the battery stops draining, or close some apps or programs so that the battery does not drain as quickly. A rest is your time to recharge.
Consider how and where you rest. Do you need a quiet or dark room? Is your brain resting as well as your body?
Do-Rest-Do
Break your activities into smaller parts. Complete 1 part, followed by a rest. This “Do – Rest – Do” plan can help you complete a task with less frustration, support your recovery, and help you do more throughout the day. You can spread parts of an activity throughout the day, or do them over a number of days.
For example:
Time of day
Each of us has a time of day when our energy level is highest. This is true, even when you have fatigue. For most people, this is the time of day when their brain and body work best. Use your best hours each day for your most important or challenging tasks.
For example:
Consider the environment
Your surroundings will change how much energy you need to do an activity. Think of the amount of energy needed to have a one-on-one conversation in a quiet room, compared to a busy or loud environment.
Reduce stimulation
Try to lower stimulation by:
Think about your body
Poor posture and position use more energy. They can also increase your risk of pain and injury. Consider how to lift, reach, and work safely.
For example:
Use tools and equipment
Tools and equipment can help save energy.
For example:
Be kind to yourself
You may not be able to do as much as usual because your health has changed. This is OK. Take it slow and do not try to do too much.
Other people may expect you to feel better or be able to do more than you are ready for. This can be stressful. You may feel angry, sad, frustrated, scared or discouraged. This can affect both your physical and mental health.
Use a Symptom Tracker to record how you are feeling over time.
Integrated Chronic Care Services(2020).Welcome to the Integrated Chronic Care Service (ICCS).Patient & Family Guide,WX85-2060. Nova Scotia: Nova Scotia Health Authority.https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2060.pdf
NHS England(2021). Fatigue. Your COVID Recovery. Retrieved July 9, 2021 from https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/fatigue/
Cognition is how effectively your brain is working. Cognitive (thinking) tasks include memory, attention, concentration, planning, and organizing. Cognitive trouble after COVID-19 is common. It may include:
Mental or emotional distress, fatigue, trouble sleeping, anxiety, sadness or depression can all affect our ability to think, concentrate and remember.
It is common to have trouble thinking and concentrating after a long illness and hospitalization, especially after being sedated. Being sedated (having medication to help you relax or go to sleep) or medicated can affect how awake or aware you feel. If you are taking medication(s), ask your pharmacist or primary health care provider if your medication(s) may be affecting your energy and ability to focus and think clearly.
Other things that can affect cognition include:
Research to better understand how COVID-19 affects our brains, memory, attention and focus is still being done.
Try these strategies:
Do one thing at a time
Multitasking (doing more than 1 thing at a time) requires more energy to complete a task. For example, you may be able to follow a recipe when alone, in silence. But, you may struggle to remember the next step of the recipe if you are having a conversation while you cook.
Paying attention to details and sensory experiences (what you see, hear, smell, feel and taste) can help.
For example:
Set up your environment to help you succeed
Remove distractions and avoid too much stimulation. Noise, lights, clutter, and other people moving or being active nearby can make it harder to think and remember.
For example:
Use your brain and body without overdoing it
Keeping both your brain and body active can help you recover after having COVID-19. This can be hard if you have fatigue or brain fog. Add cognitive activities slowly over time. Start by doing activities you are familiar with that are not too challenging. Plan to do a cognitive task for a short time. This can help you keep your brain active without making your symptoms worse.
For example:
Avoid feeling overwhelmed
It can be stressful to have trouble with concentrating, brain fog and memory. It can be overwhelming to plan, understand, organize and start a task. You cannot think clearly when you are overwhelmed. To avoid this, break down activities into small steps.
For example:
Remember to adjust your expectations during your post-COVID recovery. You may not able to do as much each day, as you could before having COVID-19. Set realistic goals and expectations based on your current energy and cognitive abilities.
Use supports, tools and reminders
Use supports, tools and reminders that make thinking and remembering easier. These supports may include lists, timers, calendars, reminders on your phone and extra help from family and/or friends.
Use lists, notes and alerts (like a phone alarm) to remind you of things you need to do. Accept offers of support and let people know what they can help you with (like shopping, carpooling, cooking or errands).
Calm your brain
Our brains work best when our bodies, thoughts and emotions are calm. There are many strategies to help with relaxation and lowering stress, while improving your focus and ability to pay attention and think more clearly. These calming approaches include mindfulness, meditation practices, gentle stretching, yoga, reflective journalling, breathing practices and other self-soothing activities.
Learning how to manage your emotions is an important step in your physical recovery. Not only can it lower stress, anxiety, heart rate and blood pressure, it can improve concentration and memory, and lower brain fog. When your brain is relaxed, your body is relaxed.
Consider your "brain battery"
Your brain is always working, but some activities use more brain power than others. Activities that need longer periods of focus or learning can be especially challenging when recovering from COVID-19. Prioritize tasks to make sure you have the brain energy you need to do the most important tasks each day. Plan to do these tasks when you feel best. This may be after a rest, early in the morning or on a certain day of the week. Remember to plan a brain break after doing a cognitive activity.
Use a Symptom Tracker to record how you are feeling over time.
Integrated Chronic Care Services(2020).Welcome to the Integrated Chronic Care Service (ICCS). Patient & Family Guide,WX85-2060. Nova Scotia: Nova Scotia Health Authority.https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2060.pdf
NHS England(2021). Memory and concentration. Your COVID Recovery. Retrieved July 9, 2021, from https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-mind/memory-and-concentration/
Royal College of Occupational Therapists(2020). A quick guide for occupational therapists: Rehabilitation for people recovering from COVID-19. https://www.rcot.co.uk/files/guidance-quick-guide-occupational-therapists-rehabilitation-people-recovering-covid-19-2020
World Health Organization(2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Ofice for Europe. https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness
We all feel stressed, anxious, or worried at times, especially when dealing with difficult situations, like illness and consequences of the COVID-19 pandemic. Some stress and anxiety is normal. If it lasts for a long time or affects your ability to do daily activities, it can be a problem.
People who have had COVID-19 report an increase in symptoms of anxiety.
You can learn more about Feeling Stressed, Anxious or Worried (symptom) and Anxiety (condition) on Nova Scotia Health’s mental health and addictions website. Resources include:
Many things can contribute to anxiety symptoms, like traumatic events, genetics, medical issues, or medications. It is too early to say exactly why people who have had COVID-19 have an increased chance of anxiety. We do know that having COVID-19 and the stress of the pandemic both affect the brain. About 1 out of 5 people who recover from COVID-19 report mental health concerns within the first 3 months.
Remember:
For many people, mild to moderate symptoms go away on their own, especially if you are experiencing them for the first time.
If your stress is intense (very strong), is not going away, or interferes with your daily life:
If you are in crisis, or think you may hurt yourself or attempt suicide:
Try these strategies:
If you are in crisis, or think you may hurt yourself or attempt suicide:
Mayo Clinic Staff.(2018). Anxiety Disorders. Mayo Clinic. Retrieved July 9, 2021 from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
We all feel sad sometimes, especially when we experience loss, disappointment, or deal with difficult situations, like illness or the pandemic. It is normal to feel sad, or what we sometimes call “depressed” at times. If your sadness is very intense (strong), does not go away, or affects your daily life, it can be a problem.
About 15% of people who have had COVID-19 report an increase in symptoms of depression.
You can learn more about Feeling Sad or Depressed (symptom) and Depression (condition) on Nova Scotia Health’s Mental Health and Addictions website. Resources include:
Many things can contribute to depression, like genetics, stressful life events, medications, and medical problems. It is too early to say exactly why COVID-19 increases the risk of depression. We do know that having COVID-19 and the stress of the pandemic both affect the brain. About 1 out of 5 people who recover from COVID-19 report mental health concerns within the first 3 months.
Remember:
For many people, mild to moderate symptoms often go away on their own, especially if you are experiencing them for the first time.
If your sadness is intense (very strong), is not going away, or interferes with your daily life, it may be a symptom of post-COVID-19 related depression. If you feel depressed:
Try these strategies:
Collier, S.(2021).Could COVID-19 infection be responsible for your depressed mood or anxiety? Harvard Health Publishing. Retrieved July 9, 2021, from https://www.health.harvard.edu/blog/could-covid-19-infection-be-responsible-for-your-depressed-mood-or-anxiety-2021041922391
Nasserie, T., Hittle, M.,& Goodman, S.N..(2021). Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19 A Systematic Review.JAMA Network Open, 4(5):e2111417. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780376
Ries, J. (2020, November 12). People with COVID-19 more likely to develop depression, anxiety, and dementia. Healthline. Retrieved July 9, 2021, fromhttps://www.healthline.com/health-news/people-with-covid-19-more-likely-to-develop-depression-anxiety-and-dementia
Taquet, M., Luciano, S., Geddes, J.R., & Harrison P.J. (2020). Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62,354 COVID-19 cases in the USA. The Lancet Psychiatry, 8(2), 130-140. https://doi.org/10.1016/S2215-0366(20)30462-4
What causes depression?(2019, June 24). Harvard Health Publishing. Retrieved July 9, 2021 from https://www.health.harvard.edu/mind-and-mood/what-causes-depression
Even the most social person sometimes needs time alone to recharge. For some of us, it is normal to prefer being alone rather than being around people. The pandemic has changed our habits in terms of self-isolating, staying home more and keeping our distance from others. As restrictions lift, it may take time for us to get back to our regular social activities.
If the following symptoms are affecting your life, they may be signs of a more serious concern, like depression or anxiety:
About 15 to 20% of people who have had COVID-19 report an increase in symptoms of depression and anxiety.
Try these strategies:
COVID-19 can affect your ability to fall and stay asleep, as well as the quality of your sleep. Recovering from COVID-19 takes a lot of energy. It is normal to need more sleep while you recover.
When recovering from an illness like COVID-19, your body may be less able to recharge while sleeping. This means that you may wake up after a full night of sleep, but not feel rested. You may also have changes in your sleep schedule and routine after having an illness or being in the hospital.
Common symptoms after having COVID-19 can also affect your sleep:
While recovering after having COVID-19, there may be times when you are not able to fall asleep (insomnia) or wake up overnight. This may last from a few days to a few weeks and can make rest and recovery more challenging.
Your ability to sleep changes based on how active you are during the day. Fatigue and other symptoms that get worse after activity, can make it harder to be active. If you do not move, think or socialize as much while you are awake, it can make it harder to sleep.
Try these strategies:
Keep a regular sleep schedule
Try to go to sleep and wake up at the same time each day, even on weekends. It can help to nap when recovering from COVID-19, but napping for too long or late in the day can affect your sleep at night. If you nap, try to do it earlier in the day. Do not nap within 4 hours before your bedtime. If napping makes it hard for you to fall asleep at night, take short naps (no more than 20 to 40 minutes) or rest instead of napping. Everyone is different, and you may have to try different sleep strategies to find what is right for you.
Changing your schedule takes time
An illness like COVID-19 can affect your body’s rhythms and routines, including sleep. There may be even more greater effects after a long illness or hospital stay. If your sleep schedule is “mixed up”, there is hope. Start slowly and be patient. Change your bedtime and wake-up time by no more than 15 to 30 minutes a day. Stay at the new time for 2 to 3 days, before shifting by another 15 to 30 minutes.
For example:
Consider your environment
Your environment can affect the quality of your sleep. Try the following:
See the Resources and supports tab for more ideas on how to get a more restful sleep.
Increase your activity during the day
When you have fatigue and are not sleeping well, you may feel tired, but not be able to sleep. Being more active throughout the day can help. Slowly add a bit more activity each day. Activities can be physical, social or mental. Remember: do not do too much.
For example:
Slow down before bedtime
To fall asleep, our bodies and brains must slow down. Make a plan to help calm your body and brain before bedtime. Start 2 hours before you plan to go to sleep. Do not eat or do intense (hard) exercise, difficult tasks or activities that cause emotional distress during this time. Calming strategies (like meditation, gentle stretching or yoga, journalling and deep breathing) can help.
Limit frustration
You cannot force yourself to sleep. If you are having trouble falling asleep, or are waking up overnight, it can be frustrating to lay in bed trying to sleep. This frustration can make it harder to sleep. If you are not able to fall asleep after 30 to 45 minutes:
Ask yourself why you cannot sleep
Many things can affect your sleep. Understanding these can help you, your family, and your health care team find the best ways to work toward better sleep. Using medication(s) and/or supplements for a short time may help.
Use a Symptom Tracker to record how you are feeling over time.
Action for M.E.(n.d.).Managing your symptoms: Sleep Management. https://www.actionforme.org.uk/get-information/managing-your-symptoms/sleep-management/
Integrated Chronic Care Services(2020). Welcome to the Integrated Chronic Care Service (ICCS).Patient & Family Guide,WX85-2060Nova Scotia: Nova Scotia Health Authority.https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2060.pdf
Mayo Clinic(2021). Sleep disorders.Clinical Guidelines - Long COVID-19 Retrieved Dec 10, 2021, from https://www.ohsu.edu/sites/default/files/2021-04/Long-COVID-19-Clinical-Guidelines-English-April-21-2021.pdf/
NHS England(2021). Sleeping well. Your COVID Recovery. Retrieved July 9, 2021, from https://www.yourcovidrecovery.nhs.uk/your-wellbeing/sleeping-well/
World Health Organization(2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Office for Europe.https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness
You may have less of an appetite after having COVID-19. You may be less hungry or have less desire to eat. You may also find that you get full quickly and cannot eat the same amount of food that you used to.
This can happen for many reasons:
Loss of appetite and feeling full quickly can become a problem when they affect how much you are able to eat. If you are not meeting your nutritional needs with food or supplements, you may lose weight over time. It is important to eat well while recovering from COVID-19. Good nutrition will help with your recovery.
Try these strategies:
Alberta Health Services. (2021, February). Post-COVID-19: Nutrition for Recovery and Rehabilitation (Adults). Government of Alberta. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-post-covid-19-nutrition-for-recovery-and-rehab-adults.pdf
Nausea (upset stomach) and vomiting (throwing up) are common with COVID-19 infection. You may have nausea with or without throwing up. You may also have nausea and vomiting while you recover.
We do not know how often this happens or who is at a higher risk. There are many reasons you may continue to have nausea and vomiting after having COVID-19.
COVID-19 causes changes in your digestive tract that can cause nausea and vomiting. Other reasons include immune system activity, stress, anxiety about your condition or side effects from medication(s).
Nausea and vomiting become a problem when they affect how much you are able to eat. If you are not meeting your nutritional needs with food or supplements, you may lose weight over time. It is important to eat well while recovering from COVID-19. Good nutrition will help with your recovery.
Try these strategies:
Alberta Health Services. (2021, February). Post-COVID-19: Nutrition for Recovery and Rehabilitation (Adults). Government of Alberta. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-post-covid-19-nutrition-for-recovery-and-rehab-adults.pdf
Zhang, T., Liu, D., Tian, D., & Xia, L. (2020). The role of nausea and vomiting in COVID-19: Did we miss something? Elsevier Public Health Emergency Collection, PMCID:PMC7568482. doi: 10.1016/j.jmii.2020.10.005
Up to 90% of people who have had COVID-19 have lost part or all of their sense of smell. This can affect your sense of taste. Foods may taste different or have no taste at all.
Losing your sense of smell and taste can affect your appetite. It is important to keep eating and drinking even though you may not feel like it.
Most people's sense of smell comes back within 2 months. For some people, it may take longer.
Sometimes, changes in your senses of smell and taste can affect your mood. You may feel more sad or anxious.
Try these strategies:
If the smell of cooking food is affecting your appetite:
If food has no taste:
If food tastes metallic:
Use a Symptom Tracker to record how you are feeling over time.
Addison, A. B., Wong, B., Ahmed, T., Macchi, A., Konstantinidis, I., Huart, C., Frasnelli, J., Fjaeldstad, A. W., Ramakrishnan, V. R., Rombaux, P., Whitcroft, K. L., Holbrook, E. H., Poletti, S. C., Hsieh, J. W., Landis, B. N., Boardman, J., Welge-Lüssen, A., Maru, D., Hummel, T., & Philpott, C. M. (2021). Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction. The Journal of allergy and clinical immunology, 147(5), 1704–1719. https://doi.org/10.1016/j.jaci.2020.12.641
Alberta Health Services. (2011, June). Eating well when you have taste and smell changes. Government of Alberta. https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-eating-well-when-you-have-taste-and-smell-changes.pdf
BC Cancer. (2020). Food Ideas to Help with Taste and Smell Changes. http://www.bccancer.bc.ca/nutrition-site/Documents/Patient%20Education/Food-ideas-to-cope-with-taste-and-smell-changes.pdf
Greenhalgh, T., Sivan, M., Delaney, B., Evans, R., & Milne, R. (2022). Long covid - an update for primary care. BMJ;378:e072117 http://dx.doi.org/10.1136/bmj-2022-072117
Lechien, J., Chiesa-Estomba, C., Beckers, E., Mustin, V., Ducarme, M., Journe, F., Marchant, A., Jouffe, L., Barillari, M., Cammaroto, G., Circiu, M., Hans, S., Saussez, S. (2021). Prevalence and 6-month recovery of olfactory dysfunction: a multicentre study of 1363 COVID-19 patients. Journal of Internal Medicine. https://doi.org/10.1111/joim.13209
Speth, M.M., Singer-Cornelius, T., Oberle, M., Gengler, I., Brockmeier, S.J., & Sedaghat, A. (2020). Mood, anxiety and olfactory disfunction in COVID-19: Evidence of central nervous system involvement? The Laryngoscope, 130(11), 2520-2525. https://doi.org/10.1002/lary.28964
Yaylacı, A., Azak, E., Önal, A., Aktürk, D. R., & Karadenizli, A. (2022). Effects of classical olfactory training in patients with COVID-19-related persistent loss of smell. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 1-7. Advance Online Publication. https://doi.org/10.1007/s00405-022-07570-w
After having COVID-19, you may have:
Diarrhea:
Constipation:
These changes may happen because:
Diarrhea and constipation can become a problem if they do not go away.
Try these strategies:
To manage diarrhea:
To manage constipation:
Use a Symptom Tracker to record how you are feeling over time.
Alberta Health Services. (2021, February). Post-COVID-19: Nutrition for Recovery and Rehabilitation (Adults). Government of Alberta. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-post-covid-19-nutrition-for-recovery-and-rehab-adults.pdf
Headaches are one of the most common symptoms experienced after having COVID-19. Headaches may cause pain in your head, face, skin, bones, eyes, ears, nose, mouth and sometimes in the upper neck. Headaches are caused by muscles and blood vessels swelling or tightening. This sends messages through the nerves to the brain and creates a sensation of pain.
Headaches after COVID-19 are thought to be related to the immune system. Your immune system can become inflamed (irritated) in response to the infection. This inflammation can cause issues with headaches. Research in this area is still being done.
Headaches can range from a mild inconvenience to a major disruption in your day. Talk to your primary health care provider if you are having headaches every day that are affecting your ability to do daily tasks or things you enjoy. They may prescribe medication to help manage your symptoms. For most people, headaches go away over time. If your headaches do not go away, you may need to be referred to a neurological (nervous system) specialist.
Ongoing headaches can affect your mental and emotional health. They may contribute to feelings of anxiety, depression and fatigue.
Try these strategies:
Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group. (2020). Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603–605. doi:10.1001/jama.2020.12603
Centers for Disease Control and prevention. (2021, April 8). Post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html
Marshall, M. (2020). The lasting misery of coronavirus long-haulers. Nature, 585, 339-341. https://doi.org/10.1038/d41586-020-02598-6
Mazza, M. G., Palladini, M., De Lorenzo, R. (2021). Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: Effect of inflammatory biomarkers at three-month follow-up, Brain, Behavior, and Immunity. Brain, Behavior, and Immunity, 94, 138-147. https://doi.org/10.1016/j.bbi.2021.02.021
Nova Scotia Health Authority. (2021). Care and supports for patients with post-acute/Long COVID-19. Rapid Review May 26, 2021.https://library.nshealth.ca/ld.php?content_id=35919290
Poncet-Megemont, L., Paris, P., Tronchere, A. (2020). High prevalence of headaches during COVID-19 infection: a retrospective cohort study. Headache, 60(10), 2578-2582. https://doi.org/10.1111/head.13923
Professional Practice Coordinators, IPPL, Central Zone (2021). Supporting your recovery from COVID-19. Patient & Family Guide; WC85-2219. Halifax: Nova Scotia Health Authority. https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2219.pdf
Chest pain, tightness or heart palpitations (heart races or skips a beat) can be common after having COVID-19. These symptoms are usually not serious and will get better over time.
Palpitations may happen when you are exercising, anxious or after having a caffeinated drink. Palpitations may last for a few seconds or minutes. Sometimes these symptoms are caused by a heart arrhythmia (irregular heartbeat) related to heart disease or an injury. Tell your primary health care provider if you have any of these symptoms.
There may be several reasons you are having chest pain, tightness or palpitations:
Try these strategies:
Greenhalgh, T., Knight, M., Buxton, M. & Husain, L. (2020). Management of post-acute COVID-19 in primary care. BMJ, 370. doi: https://doi.org/10.1136/bmj.m3026
Public Health Ontario. (2021, April 19)..Persistent Symptoms and Post-Acute COVID-19 in Adults – What We Know So Far.. Retrieved May 10, 2021 from https://www.publichealthontario.ca/- /media/documents/ncov/covid-wwksf/2020/07/what-we-know-covid-19-long-term-sequelae.pdf
Royal Australian College of General Practitioners. (n.d.). Caring for adult patients with post-COVID-19 conditions. https://www.racgp.org.au/clinical-resources/covid-19-resources/other-health-issues/caring-for-adult-patients-with-post-covid-19
You may have joint, muscle or nerve pain after having COVID-19. One or more areas of your body may ache or burn, or you may feel tired, stiff, or sore. Muscle pain can feel like a deep ache, or a sharp pain with movement. Nerve pain can feel more like a shooting or burning sensation, or pins/needles
There are many reasons why you may feel muscle and joint pain:
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A slow gradual return to movement is one of the best ways to help reduce joint or muscle pain. Try these movement strategies:
When lying down:
When sitting:
When standing/walking:
Other strategies can also help you with your joint and muscle pain. For example, some people find that heat or ice can help manage their joint or muscle pain. If you want to try this:
There are medications that may also help with your pain. Talk to your primary health care provider about taking over-the-counter pain medicine if that is something that you are considering doing.
Use a Symptom Tracker to record your muscle and joint pain symptoms over time.
When your pain is unresolved or persistent:
Pain is complicated, and there are many reasons why you may have pain. If your pain does not feel like muscle pain, or if you have tried the strategies listed above and you continue to have pain, please reach out to a physiotherapist, occupational therapist or your primary health care provider for more guidance.
Neurosciences, Rehabilitation & Vision Strategic Clinical Network,& Allied Health Professional Practice and Education, Health Professions Strategy and Practice(2021, March 23rd). Symptoms: Joint and muscle pain. After COVID-19. MyHealth.Alberta.cahttps://myhealth.alberta.ca/after-covid/symptoms/joint-and-muscle-pain
NHS England (2021). Musculoskeletal, shoulder and back pain. Your COVID Recovery. https://www.yourcovidrecovery.nhs.uk/managing-the-effects/effects-on-your-body/musculoskeletal-shoulder-and-back-pain/
This may also be called Post Exertional Malaise or Post Exertional Symptom Exacerbation.
It is important to get active again after having COVID-19. This can be hard. It is normal to feel tired, short of breath and weak after having COVID-19. After physical activity, you may feel extreme (very bad) tiredness or your other symptoms may get worse. This can be worse with physical activity that is too hard or fast. You may feel these symptoms 12 to 48 hours (half a day to 2 days) after doing an activity. This is sometimes called a “crash.”
Activities that cause your symptoms to get worse after physical activity may include things that were easy before having COVID-19, like:
You may have been given a small device called a pulse oximeter. This measures the percentage of oxygen in your blood, also called oxygen saturation or “O2 sats.” Place the device on your finger and read the percentage (%) on the screen. Your oxygen saturation may drop as you become more active, even if you do not feel short of breath or unwell. Talk to your primary health care provider to find out what is normal for you.
Note: Your oxygen saturation may be different if you had a lung condition before having COVID-19.
If you were not given a pulse oximeter, you do not need to get one unless your primary health care provider tells you to. Paying attention to your body is another way to monitor your response.
The following are some strategies that may help you manage your symptoms that get worse after physical activity. You may need to try one or all of the strategies. For more ideas, please click on the Resources and Supports tab above.
Add activity slowly over time
Monitor your effort
Pace yourself
Remember, everyone’s recovery is different. Be kind to yourself.
BonES Lab. (2021).A Focus on Breath.. Retrieved Dec 10, 2021 from https://www.youtube.com/watch?v=5ux5rwDQT8U
Johns Hopkins Activity and Mobility Promotion (2021). Mobility Matters: Recovering from COVID-19. Baltimore: Johns Hopkins Medicine. https://www.hopkinsmedicine.org/physical_medicine_rehabilitation/education_training/amp/everybodymoves/covid-resources.html
Post-COVID-19 Interdisciplinary Clinical Care Network (n.d.). Managing Breathlessness in Post COVID--19 Recovery. Alberta: Alberta Health Services. https://www.saot.ca/wp-content/uploads/2021/03/if-ppih-covid-19-support-recovery-rehabilitation-after-covid-19.pdf
Professional Practice Coordinators, IPPL, Central Zone (2021). Supporting your recovery from COVID-19. Patient & Family Guide. Halifax: Nova Scotia Health Authority. https://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/2219.pdf
World Health Organization (2020). Support for Rehabilitation: Self-Management after COVID-19 Related Illness. Copenhagen: World Health Organization Regional Ofice for Europe. https://www.who.int/publications/m/item/support-for-rehabilitation-self-management-after-covid-19-related-illness
World Physiotherapy (2021a). Information sheet 3: Fatigue and post-exertional symptom exacerbation. London, UK: World Physiotherapy. https://world.physio/toolkit/world-pt-day-2021-information-sheets-english
World Physiotherapy (2021b). World Physiotherapy Response to COVID-19 Briefing Paper 9. Safe rehabilitation approaches for people living with Long COVID: physical activity and exercise. London, UK: World Physiotherapy. https://world.physio/sites/default/files/2021-06/Briefing-Paper-9-Long-Covid-FINAL-2021.pdf
Grief is a normal reaction to loss. This may be the loss of a loved one, a relationship, your health, your job, or a dream. The pandemic has disrupted our lives and most of us have suffered losses. If you have ongoing symptoms after having COVID-19, your loss of health can add to your feelings of grief.
You may experience difficult and unexpected emotions, like shock, anger, guilt or deep sadness. The pain of grief can disrupt your physical health, making it hard to sleep, eat or think clearly.
Feelings of grief usually get better over time. We learn to accept our loss and move forward. Grief can become a problem if your emotions are very strong, do not go away over time or affect your ability to do your daily activities.
If you are in crisis, or think you may hurt yourself or attempt suicide:
Try these strategies:
If you are in crisis, or think you may hurt yourself or attempt suicide:
Centre for Addiction and Mental Health.(n.d.).Loss, grief, and healing. https://www.camh.ca/en/health-info/mental-health-and-covid-19/loss-grief-and-healing
Johnson, K.(2007). Grief - Complicated? Or not?.Visions Journal, 3(3), 14-15 https://www.heretohelp.bc.ca/visions/trauma-and-victimization-vol3/grief-complicated-or-not
There are many types of hair loss. Hair goes through growing and shedding cycles. The growth cycle lasts between 2 to 6 years, while the shedding cycle can last 3 to 4 months. It is normal to lose up to 100 hairs a day in this cycle. When hair falls out, new hair grows back in the same hair follicle and the growing cycle begins again.
Hair loss is common after having COVID-19. It can also happen:
While it is commonly called hair loss, it is actually hair shedding. Shedding happens when more hairs than usual go into the shedding cycle. You may notice clumps of hair coming out when you shower or brush your hair. This may cause bald spots (spots with no hair at all).
Shedding usually starts 2 to 3 months after having an illness or being under stress.
There is no treatment for hair shedding caused by a fever, illness, or stress. It normally gets better on its own, after 6 to 9 months.
If you are not sure what is causing your hair to shed, or it is not getting better over time, talk with your primary health care provider. You can also call 811 for advice from a registered nurse.>
Learn more about stress and how to manage it: Feeling stressed, anxious, or worried
American Academy of Dermatology Association. (2022). Can COVID-19 cause hair loss?. https://www.aad.org/public/diseases/hair-loss/causes/covid-19#:~:text=Temporary%20hair%20loss%20is%20normal,loss%2C%20it's%20actually%20hair%20shedding
Government of Alberta. (2022).. Types of hair loss. https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=ug2799&lang=en-ca#ug2799-Bib
Provincial Health Services Authority. (2022).. Hair loss in post COVID-19 recovery. http://www.phsa.ca/health-info-site/Documents/post_covid-19_Hair_Loss.pdf
Sharquie, K., Jabbar, R.I.(2021). COVID-19 infection is a major cause of acute telogen effluvium. Irish Journal of Medical Science. Aug 31, 1-5.https://doi.org/10.1007/s11845-021-02754-5