What is the current situation with COVID-19? What kind of virus is it now?

We registered a larger number of cases around Christmas and at the beginning of the year. After several weeks of decline, epidemiologists expect further growth in the number of cases in February and March. According to the January report of the National Institute of Public Health, the most common variant in the Czech Republic is JN.1(JN.X), which is extremely infectious.

Many patients do not get tested, so no one knows about them. How do you know how many people are currently infected?

The current statistics are based on data reported to the Infectious Disease Information System. Unfortunately, only PCR tests and antigen tests carried out at healthcare facilities are entered into the system. Of course, sick people who take a home antigen test or don’t get tested at all are not included in the statistics. However, the statistics make it possible to estimate the actual number of infected people with a high degree of accuracy.

Many sick people consider COVID to be an ordinary cold; they don’t even wear a mask. Is that okay?

No, that is not okay. No one wants to catch even an “ordinary cold”, let alone COVID. Despite the fact that its severity has declined significantly, several people still die from COVID in the Czech Republic every day. Regardless of the cause of illness, wearing a mask when one has symptoms of a “cold” is a sign of basic decency and considerateness.

Information about new symptoms, particularly neurological symptoms (headache, anxiety), has appeared. Can you confirm that?

I’m not sure if we can talk about new symptoms here. COVID has been accompanied by headache and psychological problems – particularly depression, anxiety, difficulty concentrating and sleep disorders – since the very beginning. The statistics more frequently show digestive problems, especially diarrhoea, which, as I recall, was more common in children at the very beginning of the pandemic.

 After we have recovered from COVID-19, how much time can pass until we can sick again? Is it possible to get infected multiple times in a season?

There are a lot of variables at play here. The virus mutates, so recurring infections are possible, especially if a new variant appears.  Whether we get sick and with what symptoms depends mainly on the condition of the immune system, previous infections and the number of vaccinations, the variant of the virus in the population, the patient’s age, whether the last infection was with or without symptoms, and so on.

Some people continue to have problems after having the disease. When do we call that post-COVID syndrome?

The definition of post-COVID syndrome/long COVID is continuously developing and isn’t uniform. According to the CDC, “long COVID” is the equivalent of “post-COVID conditions” and a duration of four weeks after infection is indicated. According to the Czech National Health Information Portal, “long COVID” means problems persisting longer than four weeks after infection and we refer to “post-COVID syndrome” in the case of problems lasting longer than twelve weeks.

What if patients have symptoms of post-COVID syndrome, but they aren’t aware that they had COVID?

A proven infection at the onset of the problem is in the definition of the syndrome. Due to the range of symptoms involved, almost anything can, with a bit of exaggeration, be included in “post-COVID”. And who can say with certainty that they haven’t had (symptomless) COVID in recent months? We are not talking about a patient with respiratory difficulties after a severe case of COVID-related pneumonia, but in the overwhelming majority of cases, there is no laboratory test or imaging examination that would clearly tell doctors that the problems being examined are in fact due to COVID-19.

What are the most common problems?

There are a lot of them. The most common general symptoms are general fatigue or rapid-onset fatigue to the point of exhaustion after normal physical or mental exertion. Pulmonary symptoms include coughing and shortness of breath. Difficulty concentrating and memory disorders (“brain fog”), sleep disorders, headache, depression and anxiety are very common. Among other symptoms, I would mention heart palpitations, digestive problems (particularly diarrhoea), tingling in the extremities, balance disorders, high temperature and disruptions of the menstrual cycle and erectile dysfunction. As you can see, there is a truly broad range of problems.

Is it possible to identify groups of people who are more likely to be afflicted with post-COVID syndrome? Does it depend on the course of the disease or does it not matter, i.e. can someone who had a mild case of COVID-19 still have problems afterwards?

According to the World Health Organisation, post-COVID syndrome can affect anyone regardless of gender or age or the severity of the infection. However, post-COVID syndrome is statistically more likely in the case of patients who had a more severe infection. Others at higher risk include the unvaccinated, smokers, obese people, those who have been repeatedly infected, the elderly and, of course, patients with various chronic illnesses.

But how can you distinguish these problems from other, “normal” problems, such as coughing, shortness of breath, headache?

We had these problems even before the pandemic and it would be a major mistake for us as doctors to blame everything on COVID. We thus still rule out the same causes as we did before and if we don’t come up with anything, then we can start to consider COVID as the cause. 

If someone who had COVID-19 still coughs continuously several weeks after the illness, what would be the ideal course of action?

They should definitely visit their general practitioner, who will assess whether their problem is due to COVID or a different cause.

What should you do if you have had COVID and you are constantly tired? What experience do you have with that?

Again, visit your general practitioner, who – just like with a cough – will rule out whether the fatigue is caused by a different illness. Typical post-COVID exertion-related fatigue occurs 24-72 hours after even a small physical or mental effort and leads to extreme exhaustion that takes the patient several days or, in rare cases, even weeks to recover from.

Is there any way at all to prevent post-COVID syndrome?

Statistically, vaccination is unequivocally the best way to prevent post-COVID syndrome. General recommendations include strengthening the immune system through regular exercise, a balanced diet, cold exposure and sauna, among other things. If one has a high-quality diet with enough fruits and vegetables, it doesn’t make sense for an otherwise healthy person to take various multivitamins, vitamin C infusions and so on. Their effect has never been proven and these things are mainly about doing good business. And, of course, not smoking.

If you have COVID, how long after you recover can you start exercising and doing sports?

Again, it very much depends on your condition prior to infection, the severity of the infection, your age and any chronic illnesses that you may have. On a general level, it’s true that in the case of a mild course of the disease, you can start with physical effort 2-3 days after the symptoms have subsided and gradually increase your level of exertion to your previous level over the course of 2-3 weeks. If, even after the acute phase has subsided, you still have persistent shortness of breath, chest pain, heart palpitations, a high heart rate, swelling in the lower extremities or a high temperature, it is necessary to visit your general practitioner, who will assess particularly the risk of a viral infection of the heart muscle, i.e. myocarditis, before you start exercising.