Recovering from COVID-19’s acute symptoms is only the beginning for many. From 10% to 30% of people who contract the coronavirus experience long COVID-19 symptoms for more than 12 weeks.

Common post-viral long COVID-19 symptoms for these patients are fatigue, concentration difficulty, headache, muscle and joint aches, fever, sleeping difficulty, depression, anxiety, rapid pulse, chest pain, and night sweats.

“We think long COVID-19 is similar to post-viral syndrome related to other viruses like mononucleosis,” said Candice Y. Gray-Cunningham, APRN, a nurse practitioner with Norton Infectious Diseases Institute Long-term COVID-19 Care Clinics.

“After having mono, one may feel fatigued or experience other symptoms for two to three months after the acute illness,” she said during a recent “COVID Comeback” presentation for patients and health-care providers.

In the year since the Norton Infectious Diseases Institute Long-term COVID-19 Care Clinics opened at Norton Medical Plaza I – Brownsboro and Norton Healthcare Pavilion in downtown Louisville, the clinics have seen 687 patients at 923 appointments. Most are female, with the average age around 50.

There doesn’t appear to be a correlation between the severity of the acute illness and the long COVID-19 symptoms, according to Candice. Some patients report a seemingly quick acute illness with long symptoms developing later.

Obesity and long COVID-19 symptoms

A Cleveland Clinic study suggests COVID-19 patients who have moderate or severe obesity may have a greater risk of experiencing long-term effects of the disease compared with patients who are not obese.

“Unfortunately, there are no magic pills or therapies to specifically treat long COVID-19 symptoms. With my patients, I return to the basics of well-being to help guide them through their symptoms,” said Candice, who is also a registered dietician.

The basics are adequate rest, balanced diet, regular intentional exercise, and stress and anxiety management.

To improve nutrition, Candice recommends the Mediterranean diet and encourages patients to plan ahead and practice food preparation.

“It’s harder to make a good decision when we are hungry and in a hurry,” she said.

Regular exercise is also difficult for many long COVID-19 patients. Candice advocates an activity her patients enjoy and can stick with, such as walking, yoga, chair yoga, tai chi or swimming. She encourages her patients to involve a friend or family member to make it more fun and to establish a consistent schedule to develop a routine.

Even committed patients often face challenges trying to get their strength and endurance back.

“Many people report a cyclical component in fatigue symptoms. They may feel well one day and try to catch up on all the things they haven’t done, and then be exhausted for three days,” Candice said, adding that patients may need to adjust their expectations and activities.

Combating ‘coronasomnia’

Getting a good night’s sleep appears to particularly challenging for long COVID-19 patients, according to Candice. They report not being able to fall asleep and not being able to stay asleep.

The term “coronasomnia” is being used to describe the phenomenon of COVID-19-related sleep disorders, including insufficient sleep, poor sleep quality, insomnia, and disturbances of sleep/wake cycles associated with physical and emotional morbidity in the COVID-19 pandemic.

For better sleep, Candice stresses the importance of good sleep hygiene: setting a sleep/wake schedule, creating an environment conducive to sleep, avoiding screens before bedtime and avoiding caffeine in the afternoon. She also makes sure patients with sleep apnea are using their continuous positive airway pressure (CPAP) machines and reviews their medication list, since diuretics and steroids can interfere with sleep.

Behavioral health as part of long COVID-19

“Recovery from COVID-19 is long and slow for some people,” she said.

Stress, anxiety and depression are also major long COVID-19 symptoms, according to Candice.

“Unmanaged, they can lead to poor concentration, feeling overwhelmed, mood swings, irritability, depression, low self-esteem, use of alternate coping tools like alcohol or food, and physical symptoms like pain, nausea, dizziness, or increased heart rate and poor sleep,” she said.

Candice recommends her patients practice deep breathing and meditation, avoid taking on too many obligations, seek help through friends, family, and behavioral health professionals, and focus on a positive attitude.

“It’s my goal to help people live healthier lives, not only to heal, but to prepare the body to defend itself in the future,” Candice said.