Post-COVID and other PAIS in general practice

Post-COVID Patients most frequently experience: debilitating fatigue, difficulty concentrating, forgetfulness, brain fog, hypersensitivity to light and sound, shortness of breath, headache, sadness/irritability, poor sleep, muscle pain, and dizziness. On average, post-COVID patients suffer from 10-15 symptoms simultaneously. A total of 200 symptoms have been described. See also the extensive information about post-COVID and about the risk factors for adults and adolescents.

Commonly heard long-term complaints after COVID-19 vaccination are: fatigue, concentration and memory problems, difficulty processing stimuli, shortness of breath, and headaches. Other complaints are also common. On average, people suffer from 10 different complaints. There is also a group of patients who present with one or a few very specific complaints. See also the facts and figures about complaints after vaccination and / or onderzoeken about this.

Common complaints with QOL are: debilitating fatigue, concentration problems, mental fatigue, anxiety and depression symptoms, neurocognitive complaints, sleep problems, pain complaints (muscles/joints), and shortness of breath (during exertion). Patients have an average of 19 to 20 health complaints, and the severity of these complaints remains fairly constant over the years. Chronic Q fever often has very few symptoms; known ones are: slow weight loss, some fever in the evening, coughing, and upper abdominal discomfort. However, this variant is life-threatening due to the live bacteria in the body. Also view the extensive information about QOL en chronic Q fever.

Symptom clusters are also common, such as post-exertional malaise (PEM) and postural orthostatic tachycardia syndrome (POTS), a manifestation of dysautonomia. In addition, people with a post-infectious condition may also suffer from mast cell activation syndrome (MCAS).

In just 2 minutes, you can read one of our fact sheets about this:

Definition of post-COVID from NASEM ((American) National Academies of Sciences, Engineering, and Medicine): Post-COVID is an infection-associated chronic condition that occurs after a SARS-CoV-2 infection and persists for at least three months as a continuous, recurrent, or progressive disease affecting one or more organ systems.

Characteristics:

1. Post-COVID can follow an asymptomatic, mild, or severe SARS-CoV-2 infection. Previous infections may or may not have been recognized.
2. Post-COVID can be continuously present from the acute SARS-CoV-2 infection or occur with a delay, within weeks or even months after an apparent complete recovery from the acute infection.
3. Post-COVID can affect both children and adults, regardless of health, disability, socioeconomic status, age, sex, gender, sexual orientation, race, ethnicity, or geographic location. (source: comprehensive guidance)

A positive COVID test is not necessary to make the diagnosis. However, it can contribute to faster recognition of post-COVID. The diagnosis is based on the medical history, characterized by a decline in functioning. There is (yet) no test or biomarker available to diagnose post-COVID. Other conditions as the cause of the symptoms must be sufficiently ruled out.

• Occupational therapist: focused on energy management, recognizing pitfalls, dealing with physical and cognitive complaints (Occupational therapists with experience with post-COVID)
• Dietitian: help with a healthier diet, advice on reactions to food
• Speech therapist: for voice problems, diaphragm problems, breathing
• Physiotherapist: exercising under supervision, various specializations
• Psychosomatic physiotherapist: learning to recognize body signals, the connection between complaints and psychological aspects
• Psychologist: long-term complaints often lead to grief (see Factsheet living loss), frustration, guilt, anxiety. Traits such as persisting and ignoring symptoms often backfire. Acknowledgment helps; emotions consume a lot of energy and affect recovery.
• Sports physician: for reduced load capacity or exercise intolerance. Supervised build-up, at or around the first acidification threshold, with monitoring of, for example, heart rate. Goal: to improve fitness without worsening of symptoms (PEM).

Young people with a PAIS

• Youth doctor: contact the youth doctor
• Pediatrician: refer to a pediatrician to rule out underlying conditions.
• Pediatric Occupational Therapist: focused on energy management, recognizing pitfalls, and dealing with physical and cognitive complaints
• Pediatric physiotherapist: guided movement, various specializations

Tips:
1) Adapt your waiting room to sensory sensitivity
2) Schedule appointments at times with a limited chance of running over.
3) For severely disabled patients, a visit to the practice is not possible. A home visit may be necessary.

Since April 2022, R83.04 is the ICPC code for post-COVID
Good registration:
– Provides insight into prevalence
– Increase knowledge about characteristics and risk groups
Document post-COVID, possibly as a probable diagnosis.

Post-COVID care takes time. Are you struggling with a complex case? Unburden your GP practice and consult with our medical advisors. You can turn to us for collegial consultation and expert advice regarding post-COVID patients. Our team of medical advisors (physicians) shares specific knowledge regarding biomedical, psychosocial, and content-related aspects.

Fill out this contact form and one of our medical advisors will contact you personally.

Would you like to delve deeper into post-COVID?

• Follow this free medical training for one accreditation point ABC1 (2025).
• View the training from Stichting KOH: “Post-COVID at the GP: what can you do?” (2025)
• Schedule post-COVID in the FTO and use the FTO module of the IVM. (2025)
• Look at one of the PAIS masterclasses Jojanneke Kant returns from 'The Questioning Doctor'. (2026)
• follow the E-learning zoonoses a two-part series on pets and wild animals (2025/2026)
• Ask a tailored training contact C-support or Q-support.

More and more research is being conducted both in the Netherlands and internationally. On our page About Long COVID A selection of interesting studies and papers is listed. Use the buttons below to go to web pages with information about ongoing and completed research:

• The available guidelines and manuals post-COVID.
• Updated VSG advice on movement and recovery in post-COVID and PAIS.
• Stay up to date with the latest developments via the post-COVID journals from IVM and C-support.
• Understood Complaints Foundation for case discussion for critically ill patients

Q fever

• The available guidelines and manuals Q fever.
• Risk groups, diagnosis and treatment of chronic Q fever and QVS with flowcharts for general practitioners.
• Possible interventions in chronic Q fever and QVS.
• Results of a four-year study in QVS patients – public summary
• Recognize the symptoms: view our information sheets regarding Q fever: general, medical, regarding work and income, and psychosocial.