Older age
The likelihood of severe illness rises with age, particularly in older adults and people living in care settings.
Specialist review for cough, breathlessness, fatigue, wheeze and persistent respiratory symptoms during or after COVID-19. Dr Ricardo José provides specialist assessment, investigation and follow-up for patients with acute concerns, recovery issues and longer-lasting post-viral symptoms.
Specialist clinic
Assessment for COVID-19 symptoms, long COVID and post-viral recovery concernsCOVID-19 is an infectious illness caused by the SARS-CoV-2 coronavirus. It most commonly affects the nose, throat and lungs, but it can also affect other parts of the body and may cause symptoms that vary considerably from person to person.
The virus spreads mainly through infectious respiratory particles released when an infected person breathes, speaks, coughs or sneezes, particularly during close contact or in shared indoor spaces. COVID-19 has changed over time as different variants have emerged, and symptoms can overlap with influenza, colds and other respiratory infections.
Common symptoms can include cough, fever or chills, sore throat, blocked or runny nose, headache, tiredness, muscle aches, altered taste or smell, and shortness of breath. Some people experience only mild symptoms, while others may develop more significant respiratory illness or complications.
Although COVID-19 is often thought of as a chest infection, it can be a multi-system illness. In addition to the airways and lungs, it may be associated with symptoms involving energy levels, sleep, concentration, the heart and circulation, digestion, muscles and joints, or the nervous system.
Most people recover over days or weeks. However, some continue to experience symptoms such as persistent cough, breathlessness, fatigue, chest discomfort, palpitations, reduced exercise tolerance or “brain fog” after the initial infection. When symptoms continue for longer and cannot be explained by another diagnosis, this may be described as long COVID or post-COVID condition.
Persistent symptoms should not automatically be assumed to be long COVID. A focused medical assessment can help identify whether ongoing symptoms relate to post-viral recovery, airway inflammation, asthma, breathing-pattern changes, sleep disturbance or another condition requiring treatment.
COVID-19 can cause no symptoms at all, a mild cold-like illness or more significant disease requiring medical care. Symptoms vary between people and can overlap with influenza, common colds and other respiratory infections.
COVID-19 may also cause reduced appetite, nausea, vomiting, diarrhoea, abdominal discomfort, dizziness, red or irritated eyes, skin rash, sleep disturbance, palpitations or changes in concentration.
A person may initially experience symptoms similar to a cold, such as a sore throat, runny nose or headache. Others develop cough, fever, fatigue or breathlessness later. The absence of one of the classic symptoms does not exclude COVID-19.
Cough, breathlessness, fatigue, chest discomfort, reduced exercise tolerance, altered smell or taste, and concentration difficulties can continue after the acute infection. Persistent symptoms should be assessed in context rather than automatically assumed to be long COVID.
Most people with COVID-19 recover without needing hospital treatment. However, the risk of severe illness is higher for some people, particularly when age, underlying health conditions and reduced immune protection overlap.
Severe COVID-19 can involve pneumonia, low oxygen levels, worsening breathlessness and complications that require hospital care. Risk is not determined by one factor alone.
It is often the combination of age, general health, long-term medical conditions, immune status and vaccination history that matters most.
Older age is the strongest risk factor. Having several health conditions can increase risk more than having one condition in isolation.
A person can be at increased risk even if they have previously had mild COVID-19. Previous infection does not guarantee that a future infection will be mild.
People at higher risk may be eligible for seasonal vaccination, early treatment or more urgent medical assessment if they develop COVID-19 symptoms. Eligibility and treatment options can change, so individual advice should be based on current NHS guidance and medical history.
The likelihood of severe illness rises with age, particularly in older adults and people living in care settings.
Risk may be higher for people with obesity, diabetes, high blood pressure, cardiovascular disease, chronic kidney disease, chronic liver disease or neurological conditions.
Asthma, COPD, bronchiectasis, interstitial lung disease and other significant respiratory conditions may increase the likelihood of complications, particularly when lung function is already limited.
People with cancer, organ transplants, blood disorders, immune conditions or treatment that suppresses the immune system may be less able to fight infection and may have reduced vaccine response.
Smoking, poor general health and having several medical conditions together can add to risk. Pregnancy and some disabilities or genetic conditions may also warrant individual clinical consideration.
Treatment depends on how unwell a person is, their risk of progressing to severe illness, and whether they need oxygen or hospital care. Most people recover with supportive care at home, while antiviral and hospital treatments are reserved for specific clinical situations.
COVID-19 treatment is not one-size-fits-all. The focus is on relieving symptoms, identifying deterioration promptly and offering targeted treatment to people most likely to benefit.
Most people with mild COVID-19 do not need a specific antiviral treatment. Rest, regular fluids and symptom relief can help while the illness settles.
People at the highest risk of severe illness may be assessed for antiviral treatment if they develop symptomatic COVID-19 and test positive. Treatment needs to start promptly, so early contact with the relevant NHS service, GP or hospital team is important.
A clinician must check important drug interactions and whether treatment is suitable for kidney function, liver function, pregnancy status and individual medical history.
People admitted with COVID-19 may need monitoring, oxygen therapy and treatment for complications. The exact approach is determined by oxygen levels, imaging, inflammation, other medical conditions and overall clinical trajectory.
Treatments that were widely discussed earlier in the pandemic are not automatically appropriate now. NICE does not recommend inhaled budesonide for COVID-19 outside a clinical trial, and advises against using azithromycin, doxycycline, colchicine, ivermectin or vitamin D specifically to treat COVID-19.
No single measure eliminates the risk of COVID-19 infection. The most effective approach is to layer practical measures that reduce exposure to infectious respiratory particles and reduce the chance of passing infection to others.
Small, practical actions can work together to reduce risk, especially during periods of higher respiratory virus circulation or when spending time with people who are more vulnerable to severe illness.
These measures are particularly useful before visiting someone who is older, immunosuppressed or at increased risk of severe COVID-19.
COVID-19 spreads mainly through respiratory particles in the air. Opening windows and doors where practical, improving airflow, meeting outdoors and avoiding crowded, poorly ventilated indoor spaces can reduce exposure.
If you have symptoms of a respiratory infection and have a high temperature or do not feel well enough for normal activities, try to stay at home and avoid contact with other people until you no longer have a high temperature or feel unwell.
A face mask can reduce the spread of respiratory particles from someone who is infected and may offer added protection in crowded, enclosed or poorly ventilated spaces. It can be particularly helpful when visiting healthcare settings or spending time near people at higher risk.
Wash hands with soap and water or use alcohol hand gel, especially after coughing, sneezing or touching shared surfaces. Cover coughs and sneezes with a tissue, dispose of it promptly and clean frequently touched surfaces when someone in the household is unwell.
Consider the setting, ventilation and whether anyone has respiratory symptoms. Choosing a well-ventilated space, postponing a visit when unwell and wearing a mask when appropriate can provide additional protection.
COVID-19 vaccination remains most important for reducing the risk of severe illness. Updated vaccines do not guarantee that you will not catch COVID-19, but they continue to provide meaningful protection against hospitalisation, serious complications and death, particularly in people at higher risk.
These vaccines use a short-lived genetic instruction to help the body produce the spike protein and build an immune response. In the UK, updated mRNA vaccines have formed the backbone of recent seasonal programmes.
These vaccines present a viral protein directly, together with an adjuvant to strengthen the immune response. They provide an alternative platform and may be useful in some settings or for selected patients.
Vaccine products are updated over time to better match circulating variants. In practice, the exact vaccine offered can vary by season, availability and national guidance.
Updated vaccination can reduce the risk of symptomatic or mild infection for a period after the dose, but this effect is more limited than protection against severe illness and tends to wear off more quickly.
This is where vaccination has its strongest and most consistent benefit. Updated vaccines continue to reduce the risk of needing hospital care, intensive care support or oxygen therapy, especially in older or medically vulnerable people.
Real-world evidence continues to show a reduction in mortality among people who stay up to date with vaccination, particularly those at greatest risk of complications from COVID-19.
Protection gradually wanes over time, which is why seasonal or periodic booster doses are used for higher-risk groups. Staying up to date matters more than simply counting how many doses you have had in the past.
Eligibility changes over time and should follow current national guidance. In the UK, seasonal COVID-19 vaccination is now targeted mainly at people at higher risk of severe disease. International guidance also continues to prioritise groups most likely to benefit from protection against severe outcomes.
For UK patients, current NHS programmes particularly focus on older adults, care-home residents and people who are immunosuppressed. If you are unsure whether you qualify, it is sensible to check the latest NHS eligibility criteria each season.
Overall, yes. Large real-world datasets and ongoing safety monitoring show that currently used COVID-19 vaccines have an acceptable safety profile. Most side effects are mild to moderate and short-lived, such as arm soreness, tiredness, headache, feverishness or muscle aches.
Serious side effects can occur but are uncommon. Anyone with a history of a severe allergic reaction to a previous COVID-19 vaccine or one of its ingredients should seek individual medical advice before vaccination.
Available guidance supports the safety of COVID-19 vaccination in pregnancy and while breastfeeding. These vaccines do not contain live coronavirus. If a pregnant woman is eligible under the current programme or is in a higher-risk category, vaccination can be an important way to reduce the risk of severe maternal illness.
Breastfeeding is not a reason to avoid vaccination. If you are pregnant, planning pregnancy or breastfeeding and would like tailored advice, it is reasonable to discuss this with your maternity team, GP or specialist clinician.
Long COVID, also called post-COVID condition or post-COVID syndrome, describes ongoing or new symptoms after a SARS-CoV-2 infection. Symptoms can affect energy, breathing, concentration, sleep, circulation and daily function, and they may fluctuate over time.
NICE uses the term long COVID for symptoms continuing for 4 weeks or more after acute infection. Post-COVID syndrome is generally used when symptoms continue beyond 12 weeks and are not explained by another diagnosis.
Anyone can develop long COVID after SARS-CoV-2 infection, including people who had a relatively mild initial illness. However, some factors are associated with a higher likelihood of persistent symptoms.
Hospital admission or intensive care during acute COVID-19 can increase later risk.
More detailA more severe acute illness may involve greater inflammation, organ stress and a longer recovery period, although long COVID can also follow milder infections.
Each new COVID-19 infection carries a further risk of post-viral symptoms.
More detailRisk can accumulate across infections, which is one reason reducing exposure and staying up to date with vaccination may remain relevant for people at higher risk.
Risk is reported more often in some groups, including women and people with long-term conditions.
More detailOlder age, smoking, obesity and chronic health conditions are associated with greater risk in population studies. Individual risk remains difficult to predict.
These are associations, not a diagnosis. Long COVID is possible after any infection, regardless of age or how unwell someone felt at the time.
Long COVID is not one single symptom or one single condition. It can involve overlapping respiratory, neurological, cardiovascular, sleep-related and musculoskeletal symptoms.
There is no single treatment that works for everyone. A good assessment looks for treatable causes of symptoms, checks for complications or alternative diagnoses, and creates a realistic plan around function, activity and recovery.
Persistent symptoms should be assessed in context. Depending on symptoms, this may include reviewing breathing, oxygen levels, heart rate, blood pressure, blood tests, ECG, chest imaging or onward specialist assessment.
The aim is not simply to label symptoms as long COVID, but also to identify conditions such as asthma, airway inflammation, anaemia, sleep disturbance, cardiac problems, autonomic dysfunction or other treatable causes.
Support may include breathing physiotherapy, fatigue management, pacing and energy-conservation approaches, rehabilitation for movement or pain, cognitive support, sleep advice and psychological support where needed.
Exercise should be individualised. People who develop a delayed flare in fatigue, breathlessness, pain or cognitive symptoms after exertion may need a more cautious pacing-based approach rather than pushing through symptoms.
Individual symptoms and conditions can often be treated directly. For example, inhaled treatment may help if asthma or airway inflammation is found, while palpitations, sleep problems, smell disturbance, pain or mood symptoms may each need their own management plan.
Persistent symptoms after COVID-19 can overlap with broader post-viral syndromes. Our post-viral syndrome page explains common patterns, investigations and the role of respiratory assessment in more detail.
