Fatigue, concentration problems, muscle weakness and sensory overload: many people still experience persistent symptoms after a coronavirus infection. This is known as post-covid. Recovery remains uncertain and is rarely complete. New research shows that people with post-covid value recognition and support at least as highly as medical treatment itself. In addition, nutrition can play a supportive role in recovery. PhD candidate Anne Slotegraaf describes these findings in the doctoral thesis she defends today.
Slotegraaf proudly holds up her thesis. The cover features the spike protein-covered virus that everyone knows today: SARS-CoV-2. White lines form a recognisable maze, a reference to how people with post-covid (or long covid) often lose their way in the healthcare system. "This does not only apply to patients, but also to healthcare professionals," says Slotegraaf. Post-covid does not present as a single, clearly defined disease with one solution. Instead, it is a multisystem condition that manifests itself differently in each individual. That complexity makes post-covid particularly challenging, for both patients and healthcare providers.
Plateau in recovery
In 2020, the Dutch government introduced a scheme to provide people with post-covid symptoms with additional reimbursed care (Paramedical recovery care). But an important question was: does this care actually help? To help answer that question, Slotegraaf followed 1,451 people with post-covid for one year. All participants used the paramedical recovery care scheme and received treatment from professionals such as physiotherapists, occupational therapists, speech therapists and dieticians. Participants performed fitness tests and filled in detailed questionnaires every three months.
"People's surroundings sometimes dismiss their symptoms as exaggeration," says Slotegraaf. "That makes recognition by a healthcare professional all the more important."
- Anne Slotegraaf
The data showed that patients made some progress. "At the start of treatment, 95 per cent of participants experienced extreme physical or mental fatigue," Slotegraaf explains. "After one year, 70 per cent still felt severely exhausted." Most improvement occurred during the first three months. After that, recovery levelled off. At the same time, a cohort study by the National Institute for Public Health and the Environment (RIVM) showed that the same recovery pattern applied to people with post-COVID without care. Based on these findings, the government decided to discontinue the paramedical recovery care scheme. Slotegraaf adds an important caveat: "The people we followed experienced severe symptoms and urgently needed care. Their starting point may therefore have been worse than that of the control group in the other study."
Not imagined
Interviews with thirty participants also revealed something that is difficult to capture in graphs and figures: the importance of support, coaching, trust and recognition during treatment. Patients indicated how valuable it felt to meet a healthcare professional who took their symptoms seriously and who had experience with other post-covid patients. The participants experienced this as a relief after a period of incomprehension and misunderstanding. People around them, such as colleagues, family and neighbours, sometimes dismiss post-covid symptoms as exaggeration, malingering or confuse them with burnout. That is precisely why recognition from a healthcare professional matters so much. "Feeling recognised and heard helped people accept their situation and reorganise their lives," Slotegraaf says.
Muscle loss and nutrition
Slotegraaf also demonstrated the importance of a healthy dietary pattern for people with post-covid. In a separate study involving over 200 patients, the majority had lost weight unintentionally after the first covid wave. Symptoms such as reduced appetite, early satiety and changes in taste and smell likely contributed to this weight loss. "Losing weight may sound positive in a country with a fairly high rate of overweight and obesity," says Slotegraaf, "but in many cases people did not lose fat, but muscle mass." This loss leads to reduced strength and stability, faster exhaustion and lower physical resilience: precisely the symptoms that already characterise post-covid.
Dietitians therefore play an important role in post-covid care, Slotegraaf emphasises. "They can guide patients by developing a dietary plan, for example with extra protein to preserve muscle mass," she explains. The study showed clear benefits: before treatment, 20 per cent of participants faced a high risk of malnutrition; after treatment, this dropped to 12 per cent. The risk of reduced muscle strength and muscle mass (sarcopenia) also declined: from 31 per cent to 22 per cent.
The way out of the complex post-covid maze remains unclear. A crucial first step involves recognising patients' symptoms and offering adequate support. Slotegraaf also advocates for closer collaboration between healthcare professionals. "Post-covid can manifest as physical complaints, energy problems or nutritional issues. A dietitian, for example, can provide insights for a patient who already receives physiotherapy. Collaboration makes care more effective and more coherent, not only for post-covid, but for many conditions."
Anne Slotegraaf obtained her PhD on 5 March 2026 at Human Nutrition & Health.
