Travelling with long COVID

When the COVID-19 pandemic started, all eyes were on the life-threatening emergencies and death rates. But as the months have gone by, a worrying new complication – long COVID – has emerged. The Office of National Statistics estimated in November 2020 that almost 200,000 people in the UK had problems that have lasted at least three months.

Given that over 30% of hospital admissions and possible half of infections in the first year of the pandemic occurred between December 2020 and January 2021, that figure is now likely to be much higher. It's thought that one in five people with symptomatic COVID-19 infection takes more than five weeks to recover and that one in 10 have symptoms lasting at least three months. NICE (the National Institute for Health and Care Excellence) defines long covid as having symptoms that last at least 12 weeks, 'are often overlapping, can fluctuate and change over time and can affect any system in the body'.

Long COVID – what are the symptoms?

According to the Zoe COVID symptom tracker, the most common problem encountered is crippling fatigue. But shortness of breath, cough, joint and chest pain, muscle aches, hearing and eyesight problems and diarrhoea and/or vomiting are also common. So too is sleep disturbance, affecting as many as three in four sufferers. And many also find themselves struggling with mood changes, anxiety or depression.

Long COVID can have a profound effect on all aspects of your life. I have seen it turn my patients from confident, active workers who spent their spare time training for marathons to shadows of their former selves, who cannot climb a flight of stairs or even get dressed without pausing for breath.

Help for long COVID

The NHS is slowly building up services for people with long COVID. There are now over 70 specialist-long COVID clinics available in England, where a team of doctors, nurses, occupational therapists and physiotherapists can offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services.

The NHS also offer general advice on a host of topics, from managing daily activity to returning to work. While some support groups have criticised it for expecting too much, too soon for some sufferers, they do work on the '3P' principles of 'Pace, Plan and Prioritise' – tailoring your activities to your symptoms.

And with so many people with long COVID desperate for a break, those principles also hold true if you're dreaming of getting away on holiday.

Planning is everything

Everyone's experience of long COVID is different, so it's worth sitting down before you even think of booking a holiday to work out what's feasible for you. It may be that you'll be feeling much more like your old self in six months' time, but you can't rely on that. So, try to make your travel plans around what you could manage when your symptoms are at their worst.

Don't just think about the holiday venue and activities – take into account getting there and back and getting around when you're there. A bargain trip which involves getting up at 3am to get to the airport and a three hour bus ride the other end (dropping off guests at every hotel en route) may leave you so worn out that your first few days (or whole holiday) will be ruined.

Tailor your trip to your symptoms – if you find that overdoing the physical activity leaves you bedbound for days, plan a trip where any exertion will be on your terms. If sleep disturbance is particularly troubling, avoid trips to countries with a time difference, where you would have to contend with jet lag. And if you struggle with breathlessness, cross anywhere at high altitude off your life.

Be realistic

If you've been struggling for months with your health, you're likely to be even more in need of a holiday than the rest of us. But your dream holiday could rapidly turn into a nightmare if you choose a holiday that leaves you exhausted or, worse still, in need of urgent medical care.

If your idea of the perfect holiday is a multi-centre tour with walking trips to the top of every mountain in sight, think again. For a first trip away after your diagnosis, think rest rather than adventure. If you're someone who finds the idea of a week lounging on a beach unthinkable, opt for a setting where you can book day trips on the day if you're up to it.

Build in rest days

If you're looking at a trip that involves sightseeing, build in rest days in case even gentle strolling around the area you're visiting takes its toll. But if you have managed some activity before you go, you may want to book a trip that offers a combination of activities and relaxation days.

Do bear in mind that features of long COVID include exhaustion that isn't improved with sleep – so don't assume a single night's rest will be enough to set you back on track. Another feature of long COVID for some people is the cycle of high-energy days, where you may be tempted to make up for your lack of activity, followed by overwhelming fatigue for several days afterwards. Never be tempted to overdo it on a good day.

Consider a cruise

Cruises can, in many respects, work well for people with long COVID. Of course, you need to get to the ship and get on board; allow plenty of time to get to the cruise terminal and make sure you inform the cruise company beforehand that you may need help getting on board and in the event of an emergency.

Of course on bigger ships there are often long walks involved between cabin and dining room or between decks. You'll also be paying for facilities – gym, shows, even water slides – that you may or may not be up to using. But a smaller ship will often allow you lots of flexibility if your energy levels are fluctuating dramatically.

For instance, on a cruise, the new places come to you. You can choose at short notice whether to take an organised tour at a given location; take a taxi from the harbour for a much shorter trip; or stay on board if you're too breathless or exhausted to venture out.

Check your insurance

Since Brexit, you can no longer assume that your healthcare needs will be covered when you're abroad, even in Europe. In January 2021, the government announced that UK residents will now be able to apply for a UK Global Health Insurance Card (GHIC). Your current EHIC card will remain valid as long as it's in date.

However, while this card will ensure your rights to emergency and medically necessary healthcare will continue when travelling in the EU, it's by no means comprehensive. Firstly, it doesn't guarantee free care – you're entitled to care at the same cost as a local resident with all the relevant insurance required in that country. Second, it doesn't cover all health conditions. And thirdly, it doesn't cover other costs such as repatriation if you're taken ill.

That's why it's essential to take out additional travel insurance, tailored to any medical conditions you have. This will avoid the risk of that holiday you've waited so long for turning needlessly into a nightmare.