By Dominika Kwasnicka, University of Melbourne, Australia and Rizmina Rilwan, Independent Researcher from Sri Lanka
COVID-19 after the acute phase: what we’re still learning
While the acute phase of COVID-19 has been the focus of global attention, its long-term consequences are increasingly recognised in clinical practice. WHO identifies certain populations as being at higher risk of developing post-COVID-19 conditions following SARS-CoV-2 infection. This includes women, older adults, smokers, people who are overweight or obese, those with pre-existing chronic health conditions, and people with disabilities.
Many individuals continue to experience symptoms weeks or months after infection, while others develop new or worsening chronic conditions. Understanding these longer-term effects is essential for providing effective, patient-centred care, particularly for older adults and those already at risk of chronic disease. For healthcare professionals, this requires a shift from acute management to ongoing monitoring, prevention, and coordinated care planning.
What is Long COVID? Understanding a complex, evolving condition
Long COVID, also known as post-COVID-19 condition, is defined as the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation (this is a WHO definition; definitions vary slightly across organisations). Common symptoms include fatigue, shortness of breath, cognitive difficulties (“brain fog”), chest pain, and sleep disturbances. These symptoms can fluctuate and often affect multiple organs. Clinicians should be aware that symptom presentation is often non-specific and may require a broad, systems-based assessment.
Prevalence estimates vary, but Long COVID appears to be more common among older adults, individuals with pre-existing conditions, and those who experienced more severe initial illness. However, it can also affect people who had mild or even asymptomatic infections, making it a broad and unpredictable condition.
How COVID-19 is reshaping chronic disease risk
Emerging evidence shows that COVID-19 has been associated with the development or worsening of chronic diseases. For example, some patients develop new-onset diabetes following infection, possibly due to viral effects on pancreatic function or inflammation-related metabolic changes. Similarly, cardiovascular complications such as myocardial injury, arrhythmias, and increased risk of heart failure have been observed even after recovery from the acute illness. Ongoing monitoring of cardiometabolic risk factors is therefore an important component of post-COVID care.
These associations highlight the need to view COVID-19 not only as an acute respiratory infection but also as a condition with systemic and long-lasting health implications. For patients already living with chronic diseases, COVID-19 may accelerate disease progression or complicate disease management.
Older adults after COVID-19: Navigating recovery, decline, and resilience
Older adults have been disproportionately affected by both the acute and long-term impacts of COVID-19. People aged 65 and older are more likely to experience long COVID-19 symptoms and complications than younger adults. Additionally, COVID-19 can both trigger and worsen existing chronic conditions, such as cardiovascular and respiratory diseases, and neurodegenerative disorders.
Beyond medical complications, many experience functional decline, including reduced mobility, muscle weakness, and loss of independence. Social isolation during and after illness can further contribute to cognitive decline and mental health challenges such as depression and anxiety. Quality of life is often significantly affected. Even after apparent recovery, older patients may struggle to return to their previous level of functioning, requiring additional support from healthcare providers, caregivers, and community services. Routine assessment of functional status, mental health, and social support is particularly important in this population.
Why Long COVID demands a team-based, long-term care approach
Given the wide range of post-COVID complications, a multidisciplinary approach to care is essential. This may include input from general practitioners, specialists (cardiologists or endocrinologists), physiotherapists, psychologists, and social workers. Regular follow-up allows for early identification of new or worsening conditions and supports timely intervention. Establishing clear referral pathways and communication channels between services can improve continuity of care.
Importantly, care should be individualised. Patients with long COVID often present with diverse and overlapping symptoms, and their recovery trajectories can vary widely. Integrating Long COVID considerations into existing chronic disease management plans can improve outcomes and reduce the risk of further complications. Shared decision-making and goal setting can help align care with patient priorities and capacities.
Moving forward: Building awareness, confidence, and continuity in practice
Healthcare professionals play a key role in recognising and addressing the long-term impacts of COVID-19. Raising awareness among patients, validating their symptoms, and providing clear guidance can help reduce uncertainty and improve engagement with care. Building confidence in discussing Long COVID with patients is an important component of clinical practice.
As research continues to evolve, it is important to remain informed and adaptable. The long-term burden of COVID-19 is likely to persist, making it a critical component of chronic disease management for years to come. Ongoing professional education (including this training) and integration of emerging evidence into practice will be essential to optimise patient outcomes.
Practical recommendations
- Ask proactively about persistent symptoms
During routine consultations, ask patients about ongoing symptoms following COVID-19, even if the initial infection was mild. Fatigue, breathlessness, and cognitive changes are commonly underreported. Targeted questions allow early recognition, timely assessment, and referral where needed. - Screen for new or worsening chronic conditions
Monitor for signs of new-onset diabetes, cardiovascular complications, or deterioration in existing conditions. This may include checking blood glucose levels, blood pressure, and cardiac symptoms. Integrating this screening into post-COVID follow-up can help detect complications early. - Support functional recovery in older adults
Encourage gradual return to physical activity, tailored to the patient’s capacity. Rehabilitation and activity planning should be individualised, as some patients experience symptom exacerbation following overexertion. Referral to physiotherapy or rehabilitation services can support mobility, strength, and independence. Also consider cognitive and mental health screening, particularly in patients who experienced prolonged isolation. - Adopt a multidisciplinary approach
Coordinate care across disciplines where possible. Patients with complex or persistent symptoms may benefit from combined input from medical, allied health, and psychosocial services. Clear communication between providers is key to avoiding fragmented care. - Provide reassurance and set realistic expectations
Recovery from Long COVID can be slow and variable. Acknowledge patient concerns, validate their experiences, and provide clear information about what to expect. Supporting self-management strategies and regular follow-up can help patients feel more in control of their recovery.