Main complaints
The manifestations are varied, and one person usually has several of them at once. A characteristic feature is undulation: several good days are followed by a setback, often after physical or emotional stress.
- Chronic fatigue, disproportionate to the load, does not go away after sleep
- Shortness of breath during normal activities, feeling of incomplete inspiration
- Brain fog: decreased concentration, forgetfulness, difficulty finding words
- Heart palpitations, irregular heartbeats, rapid pulse when standing up
- Sleep disorders, anxiety, depression
- Headaches, dizziness
- Persistent changes in the sense of smell and taste, including distortion of odors
- Pain in muscles and joints, hair loss, skin rashes
- Digestive disorders, abdominal discomfort
A separate difficulty of this condition is that it is almost invisible from the outside. The person looks healthy, tests are often normal, and those around him sincerely do not understand why he cannot work a full day or walk to the store without stopping. This gives rise to a secondary problem - a feeling of guilt and attempts to “pull yourself together,” which end in another setback.
Why is this happening
A single reason has not been found, and, most likely, there is none: several different mechanisms are collected under one name, which manifest themselves differently in different people. The leading directions being studied look like this.
- Persistent inflammation and dysregulated immune response after infection
- Dysfunction of the autonomic nervous system - this explains heart palpitations, pressure surges, poor tolerance of an upright position
- Violation of microcirculation and the functioning of the internal lining of blood vessels
- Damage to mitochondria and decreased efficiency of energy production in cells
- Reactivation of previously acquired herpes viruses
- Consequences of a severe course: fibrotic changes in the lungs, detraining after prolonged bed rest
It is important that post-Covid syndrome is also possible after a mild form of infection that does not require hospitalization. The severity of the acute period increases the likelihood, but does not completely determine it.
Which examination makes sense?
The purpose of the examination is not to confirm post-Covid syndrome as such, but to exclude conditions that are treated and often disguised as it. Many patients are helped not by “post-Covid therapy”, but by discovered iron deficiency or newly diagnosed hypothyroidism.
- Общий анализ крови, ферритин и железо — анемия и латентный дефицит железа дают ровно ту же усталость и одышку.
- ТТГ — гипотиреоз проявляется утомляемостью, отёчностью, туманом в голове и легко лечится.
- Глюкоза, гликированный гемоглобин, липидный профиль, витамин D, электролиты.
- ЭКГ, а при жалобах на сердцебиение — суточное мониторирование и эхокардиография.
- Пульсоксиметрия и спирометрия, при значимой одышке — КТ органов грудной клетки.
- При одышке с болью в груди и факторах риска — исключение тромбоэмболии по назначению врача.
- Ортостатическая проба: измерение пульса и давления лёжа и стоя выявляет вегетативную дисфункцию.
What really helps
There is no magic pill for post-Covid syndrome, and any remedy that promises to cure it in a course should be viewed with skepticism. But there is an approach that works for most: a slow, carefully dosed expansion of activity combined with treatment of everything that was found during the examination.
- Дозированная активность по принципу удержания в пределах доступной энергии: нагрузка планируется так, чтобы после неё не наступало ухудшение. Ориентир — заканчивать занятие с ощущением, что можно было бы сделать ещё немного.
- Постепенное наращивание объёма, не чаще одного шага в 1–2 недели, с откатом назад при появлении отката в самочувствии.
- Дыхательные упражнения и работа над диафрагмальным дыханием — при чувстве неполного вдоха они дают заметный эффект.
- Коррекция выявленных нарушений: восполнение железа, лечение щитовидной железы, подбор терапии при аритмии.
- Питьевой режим и достаточное поступление соли при склонности к падению давления в вертикальном положении, если это согласовано с врачом.
- Гигиена сна: стабильное время подъёма, отказ от дневного сна дольше часа, ограничение экрана перед сном.
- Работа с тревогой и настроением — не потому, что проблема «в голове», а потому, что хроническое состояние истощает психику и это тоже нужно лечить.
What not to do
Some of the popular post-Covid solutions are not only useless, but set back recovery. Below are what you see regularly and what you should avoid.
- Forcing yourself to train through force: with post-exercise deterioration, this sets back recovery
- Taking antibiotics and hormonal drugs without indications in the hope of eliminating inflammation
- Going through endless rounds of examinations without a plan and without a doctor to interpret them
- Buy IVs and vitamin cocktails that promise to cure post-Covid: they have no proven benefits
- Consider that since the tests are normal, it means you just need to endure it - the examination should be expanded purposefully
- Refuse the help of a psychotherapist if anxiety and sleep disturbances come to the fore
Forecast and timing
For most people, symptoms gradually decrease over 3–12 months, with the most noticeable changes occurring in the first six months. Recovery usually does not proceed in a straight line, but in steps: improvement, plateau, sometimes a rollback, improvement again. Understanding this trajectory eliminates the feeling that “nothing is working.”
Separately, it is worth mentioning the return to work and study. A sharp start to full load after several months at home almost always ends in a breakdown. It is much safer to agree on part-time work or a remote format for the first weeks, distribute the most difficult tasks in the morning, when there is more energy, and build in breaks. This is not an indulgence, but a way to return faster and not end up on sick leave again in two weeks.