Managing Long COVID

There is no cure for long COVID yet. Management focuses on reducing symptom severity, protecting daily life, and adapting to the specific symptom pattern you experience.

Effective management is highly individual. What works for one person may not work for another, and the strategies that help depend on which symptoms dominate. Most people end up combining several approaches rather than relying on a single treatment.

For people with Long Covid whose symptoms include post-exertional malaise (PEM): a delayed, disproportionate worsening of symptoms after physical or mental activity, pacing is the most important management tool available.

Pacing means identifying how much energy you have on a given day, your ‘energy envelope’, and staying within it.

Stop before you feel tired
By the time tiredness arrives, you have often already pushed past your limit. If you think you can manage an hour of work, start with thirty minutes.

Build rest into your day
Rest is not a reward for completed tasks. It is part of managing a physical illness.

Track activity and symptoms
Patterns tend to emerge over several weeks. Knowing your personal triggers is the foundation of flare prevention.

Radical rest
Lying flat in a dark, quiet room with your eyes closed, no screens and no audio, for 15 to 30 minutes. Even brief periods several times a day help prevent a crash from building.

For a fuller guide, including how to find your baseline, see our ME/CFS pacing guide. The principles apply directly to long COVID where PEM is present.

Exercise-based rehabilitation programmes, including graded exercise therapy, can cause significant harm in people with long COVID who experience post-exertional malaise.

If a programme framed around steadily increasing activity leaves you feeling worse for days afterwards, it is not working, and continuing is not safe.

For people without PEM, gentle activity within tolerance may be beneficial. Where PEM is present, ‘pushing through’ is not a safe approach.

Because long COVID affects different body systems in different people, targeted symptom management often sits alongside the broader pacing approach.

Cardiovascular and autonomic symptoms

Orthostatic intolerance, including POTS, means standing brings on dizziness, a racing heart, or near-fainting. Compression garments, more fluid, and additional salt reduce symptoms for many people, and a GP or cardiologist referral may be appropriate.

Breathlessness responds to breathing retraining for some people, including diaphragmatic and cycle breathing techniques. A respiratory physiotherapist referral is worth asking about.

Palpitations are worse with caffeine and alcohol for some people. Ambulatory ECG monitoring can help rule out other causes.

Cognitive, sleep, and pain symptoms

Cognitive symptoms ease for many people when the load comes down: breaking tasks into small chunks, avoiding multitasking, and limiting screen time. Workplace adjustments can be requested under the Equality Act 2010.

Unrefreshing sleep is common. A consistent routine, a cool dark room, and fewer screens before bed help many people. Discuss medication with your GP if sleep remains disrupted.

Pain often responds poorly to standard over-the-counter painkillers. Heat, gentle movement within limits, and nerve pain medication may be more useful, so discuss the options with your GP.

In the UK, NICE NG188 sets the framework for long COVID care. GPs are the usual starting point for diagnosis and ongoing management, and for many people the GP remains the main point of contact throughout.

Specialised NHS long COVID clinics also exist, offering multi-disciplinary assessment across cardiology, respiratory, neurology, and rehabilitation, alongside support for pacing and symptom management.

Access has narrowed since the pandemic’s early years. NHS England’s national programme was stood down in 2024, and responsibility for commissioning passed to local integrated care boards. Many services have closed or reduced their provision since.

What is available now varies considerably by region. Some areas still have a functioning clinic and others have little or nothing, so a GP referral no longer guarantees a place. It is still worth asking your GP what exists in your area.

Private clinics offering long COVID treatment have also emerged. Some are reputable and many are not. Be particularly cautious of clinics offering expensive supplement protocols, unproven biological treatments, or programmes built around pushing through symptoms.

Acquiring a long-term illness involves real loss. Grief for the life and capacity you had before is a normal response, not a sign of not coping.

A therapist with experience of chronic illness can help with the emotional weight of the adjustment. Online support communities can also provide a sense of connection with people who understand the day-to-day reality. Neither replaces medical care, but both have a place in managing the full impact of long COVID.

Cognitive behavioural therapy (CBT) is sometimes offered as part of a long COVID management plan. Evidence and patient experience are mixed. If offered CBT, it is reasonable to ask what it is expected to achieve and to decline if it does not fit your circumstances.