Misattribution of unusual clinical syndromes to psychological causes is not uncommon or new. If you have been around long enough you will remember when gastric ulcers were thought to be entirely stress (and smoking) related, or when chronic fatigue syndrome was “all in their heads”. Any newly identified illness that there are no laboratory tests to confirm is vulnerable to being considered a psychological problem. People with illnesses that are multisystemic and medically unexplained often find themselves on a mental health practitioner’s doorstep. Long Covid is a perfect example.

Here’s a summary of the (Centre for Disease Control (CDC)’s definition of Long Covid – there may be aspects of the definition that surprise you:

Long COVID is broadly defined as signs, symptoms, and conditions that

• continue or develop after initial COVID-19 or SARS-CoV-2 infection.
• are present four weeks or more after the initial phase of infection
• may be multisystemic
• may present with a relapsing– remitting pattern and progression or worsening over time, with the possibility of severe and life-threatening events even months or years after infection.

Teasing out the actual symptoms of “long covid” has been difficult, but researchers have recently been able to categorise the clinical presentations into four main groups:

1. Those who have something that looks a lot like chronic fatigue syndrome with fatigue, headache and memory loss
2. Those who have persisting respiratory symptoms such as cough and shortness of breath
3. Those who experience chronic pain
4. Those who have persistent loss or distortion of taste and smell

These sets of symptoms are not mutually exclusive and that makes diagnosis tricky. The other confusing thing is that while long Covid is commoner in people who have had severe illness it is not particularly uncommon for it to occur in people who have had no documented Covid infection or whose tests during the illness have been persistently negative.

These days I don’t think mental health practitioners will see the people with the sensorineural issues because everybody knows about the connection between Covid and altered taste and smell (don’t they?). We may however see people with the other three clinical presentations when the person will have mental health problems secondary to their chronic symptoms or disability. They may also be  seeking our help because someone has decided that they were depressed or anxious and overlooked the possibility of a physical cause such as long Covid.

At the moment, mental health professionals are central to long Covid care. Psychological support and symptom management are key. We can validate, motivate and reassure them; we may also be helpful with practical matters such as applications for financial support via NDIS.

Don’t forget that digital resources can be useful here too.  Whilst there are no comprehensive and specific digital resources for long Covid (because of the vast range and variation of symptoms) there are many resources that might be helpful in areas such as sleep management, mood management, anxiety and pain management.

There is a lot of work going on around pharmacological interventions for Long Covid. Immune therapy with monoclonal antibodies is looking positive; Paxlovid, the combined antiviral that is used in acute Covid infections, looks like it may be helpful; anti-inflammatory drugs are being investigated as are SSRIs. Another development is the recognition of a strong link between long covid and Postural Orthostatic Tachycardia (POTS) Syndrome. It’s important because directly treating the symptoms of POTS has a big impact on the wellbeing of people experiencing long covid.

Long Covid treatment is a work in progress, but the syndrome is getting more easily identifiable as we have time to observe it more closely.

Mental health professionals have a clear part to play in care.