“It’s months since I had COVID but I’m still exhausted, breathless and foggy — and crashing whenever I push myself”

POST-COVID SYNDROME (long COVID) is symptoms continuing or developing more than 12 weeks after acute COVID-19 and not explained by an alternative diagnosis — commonly profound fatigue, breathlessness, "brain fog"/cognitive impairment, palpitations, chest tightness, sleep disturbance, and POST-EXERTIONAL malaise (crashing after activity) — and the first step is to recognise and VALIDATE it as a real, recognised condition, countering the patient’s fear that it is "in their head". Critically, do NOT attribute everything to long COVID without EXCLUDING alternative/serious causes and red flags: new or worsening breathlessness or chest pain should prompt exclusion of PE, cardiac disease and pneumonia, and fatigue should prompt basics per NICE NG188 (FBC, renal and liver function, CRP, ferritin, BNP, HbA1c, thyroid), with sats, an exercise-tolerance test such as a 1-minute sit-to-stand and lying and standing pulse and BP (which a practice nurse can record), a face-to-face chest and heart examination, an ECG, and a chest X-ray by 12 weeks if respiratory symptoms continue; refer urgently for hypoxaemia, desaturation on exercise, severe lung disease or cardiac chest pain, and consider PE (NICE NG158). Assess holistically across physical, cognitive, psychological and functional domains, screen mood, and understand the post-exertional pattern, which shapes management. Manage with supportive REHABILITATION centred on PACING/energy conservation (avoiding boom-and-bust, especially with post-exertional malaise — no pushing through and no fixed incremental graded exercise, NICE NG206 principles), symptom-specific management, sleep and breathing techniques, and psychological support, referring to a long-COVID/post-COVID rehabilitation service where available. Support function and return to work (phased return/adjustments, fit note, Equality Act 2010 reasonable adjustments), validate the experience and avoid dismissiveness, set realistic expectations of slow and fluctuating recovery, and safety-net for red flags.