As Health Professionals, how do we treat fatigue caused by long-tail COVID-19?

We asked VRA member (and the VR Team of 2020 in our recent awards!) Vitality 360 to tell us more about long-tail Covid and their recent work supporting people with it.

As a rehabilitation provider known for treating persistent fatigue and pain, we are now being approached by clients suffering from long Covid to help them with the range of ongoing symptoms they have been experiencing. Fatigue is by far the most common long Covid symptom, followed by breathlessness, then joint and chest pain. We have quickly realised that, although Covid is a new illness and there is still much to learn, we do have the skills gained as specialist clinicians to be able to make a difference. Through attending webinars and assimilating various sources of information to learn more about Covid, we were able to develop a screening process and set of rehabilitation principles that we have been using with our clients.


Post-acute symptoms: Some Client experiences

We are seeing people in a post-acute phase, where most are still seeking medical and therapeutic answers to explain their sometimes frightening and bizarre symptoms. One of our clients has had to contend with waking up with blue toes (which remain unexplained), whilst another is still plagued by flashbacks of the time they couldn’t breathe and the paramedics wouldn’t admit them to hospital. Another client is trying to come to terms with the fact her distressing and severe chest pain is currently defying medical explanations and has had to completely give up work to be cared for by her partner.


Many are scared they might not recover, and some feel they have had (and may still be having) a very real brush with mortality, or that they might get re-infected. A number have been over-consulting Dr Google and online peer support groups and have ended up in a cycle of anxiety and avoidance, or a fear they may have CFS/ME. We are finding some have access to good long Covid NHS care, but for others it is much patchier with gaps in medical testing and individualised therapeutic support in their onward journey of recovery.


Step by step rehabilitation programmes

Despite the very real uncertainties and highly unusual current context, we are finding that people are making good progress and have been very reassured by having a therapist to reflect with and guide them. By setting realistic routines, we have been able to help anchor people and stabilise their symptoms. We have explored the factors they can control and created step-by-step plans that address the factors that are most likely to help them individually. We have been able to advise on a return to work, or a gradual and careful return to activities that are important to them. We have been able to help people to put weight back on and enjoy food again and taught them meditation and breathing techniques to control any anxiety, breathlessness or disordered breathing they might be experiencing. With our experience of recognising medical deteriorations, we’ve been able to discuss their symptoms and advise whether or not they should seek medical advice or intervention.


In addition to support with physical symptoms, we’ve worked with clients to reflect on their use of social media or news consumption to help them manage their anxiety, as well as problem-solving and signposting to help them with concerns about their finances and social circumstances. Listening, validating, and simply being with them on their journey at a time of social isolation and lack of full access to healthcare has also proven to be very valuable for clients.


Our Research Study

We have just secured ethics approval for a study in partnership with the University of East Anglia, which will explore the impact of our approach and contribute to the evidence base as knowledge around the world grows. People have also been asking us about our experiences, so we have been putting on a series of 3-hour workshops for Health Professionals to explore some of our key learnings to date.


Rehabilitation tips drawn from topics covered in our long-COVID course

In the meantime, we have summarised our main tips below:

1. Trust you have clinical skills that are transferable to this client group.
2. Complete a full assessment of the physical, social and psychological impacts.
3. Follow the principles of pacing.
4. Symptoms can change and vary so problem solve as issues come up.
5. Liaise with other professionals if an issue falls outside your scope or comfort zone.
6. Learn how to recognise signs of medical deterioration and trust your clinical judgement. If something feels wrong, it probably is.
7. Be patient; recovery for some is taking a number of months.


Find out more about Vitality 360’s long Covid course here.