What are the key symptoms to assess for in a patient suspected of having Long COVID?

When assessing a patient suspected of having Long COVID, key symptoms to evaluate include persistent fatigue characterized by low physical energy, cognitive fatigue, and post-exertional malaise where symptoms worsen after minimal physical or cognitive activity. Patients may report feeling flu-like symptoms such as sore throat, muscle aches, chills, and tender glands. Orthostatic intolerance symptoms like dizziness, palpitations, fainting, and nausea on standing should also be assessed, as these reflect autonomic dysfunction common in Long COVID. Additionally, neuromuscular symptoms including muscle weakness, twitching, and myoclonic jerks, as well as heightened sensory sensitivities to light, sound, touch, taste, and smell, are important to identify. Pain symptoms such as headaches, myalgia, abdominal pain, and joint pain without acute inflammation are frequently reported. Cognitive and psychological symptoms including memory loss, attention deficits, anxiety, depression, and post-traumatic stress symptoms should be considered. Respiratory symptoms like breathlessness and swallowing difficulties, as well as other physical impairments such as weakness and reduced mobility, may also be present. These symptoms often fluctuate, with flare-ups or relapses triggered by overexertion or other stressors. A comprehensive assessment should also consider the impact on daily functioning and social care needs to guide management and referral decisions NICE NG206 Lopez-Leon et al. 2021Yelin et al. 2022.