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Long COVID refers to a group of persistent symptoms that continue for weeks or months after the initial COVID-19 infection has ended.

For many, it is not simply a prolonged recovery but the onset of new, sometimes disabling symptoms that significantly impair daily functioning.

 

 

These can range from:

  • crushing fatigue
  • brain fog
  • breathlessness
  • heart palpitations
  • joint pain
  • digestive issues
  • sleep disturbances

 

Long COVID appears to affect multiple systems at once—immune, neurological, cardiovascular, and respiratory—and is thought to be driven by a mix of lingering viral fragments, immune system overactivation, dysautonomia and possibly microclots or endothelial damage.

One of the hallmark features of Long COVID is post-exertional malaise (PEM), where even small amounts of physical or mental effort can lead to a dramatic worsening of symptoms for hours or days afterward.

This makes exercise and conventional rehabilitation approaches risky for some patients. People often describe this as feeling like they’ve hit a “wall,” experiencing a sudden energy crash along with worsened pain, brain fog, and shortness of breath.

This isn’t just about deconditioning—it’s often about a disrupted balance in the autonomic nervous system and breathing regulation.

Breathlessness, or a sense of not getting enough air, is another commonly reported symptom of Long COVID—even in people who have normal oxygen saturation and lung imaging.

This sensation is often the result of dysfunctional breathing patterns rather than structural damage to the lungs. Many patients develop rapid, shallow or erratic breathing during and after their infection, and this can become habitual. Over time, it can affect oxygen-carbon dioxide balance, increase fatigue, and keep the body in a sympathetic (‘fight or flight’) state, which further perpetuates symptoms like insomnia, anxiety, and pain sensitivity.

Another key element in Long COVID is dysautonomia—an imbalance in the autonomic nervous system, particularly involving poor vagal tone and an overactive sympathetic response. This can present as orthostatic intolerance (trouble standing upright), racing heart, digestive issues, and temperature regulation problems.

Breathing—especially slow, nasal, and diaphragmatic breathing—can be a way to tap into the parasympathetic nervous system and help regulate these imbalances. Through breathing retraining, patients can sometimes improve heart rate variability, reduce sympathetic overdrive, and gradually stabilize their system.

Cognitive dysfunction, often referred to as “brain fog,” is another deeply frustrating symptom for many with Long COVID. This includes memory lapses, word-finding difficulties, slowed processing and difficulty concentrating.

While research into this area is ongoing, some evidence suggests that it may be linked to both inflammation and poor cerebral blood flow—potentially worsened by dysfunctional breathing and autonomic dysregulation.

Strategies that involve pacing, breath awareness, and gentle nervous system regulation, like those used in Integrative Breathing Therapy, can help reduce cognitive strain and improve clarity over time.

Ultimately, Long COVID represents a complex interplay of biological systems that aren’t functioning in harmony.

Breathing is not just a symptom but a central piece of this puzzle—it reflects the state of the nervous system, influences inflammation, and can either drain or support energy depending on how it’s used. While there is no universal cure for Long COVID, interventions that help recalibrate core systems like respiration, autonomic regulation, and sensory processing may offer meaningful relief and a pathway to recovery for many.

If you interested in more – here is Dr Courtney’s article on Treating Long COVID: The Potential Role of Osteopaths