What We Know About Long-Haul COVID-19 Right Now

COVID-19 affects everyone differently. Some people who test positive are totally asymptomatic. Others deteriorate rapidly and end up in the hospital. And then there are those who recover from the initial infection, yet still have symptoms weeks or even months later.

In a recent study of more than 1,600 COVID-19 patients discharged from the hospital in Wuhan, China (where the coronavirus was first identified), more than three-quarters were still reporting at least one symptom six months later. This prolonged suffering can happen even with very mild cases. A study of 180 COVID-19 patients who were never hospitalized revealed that about half were still dealing with at least one symptom 18 weeks later.

Officially, this is called “post-acute COVID syndrome,” but you’ve probably heard it referred to as long-haul COVID. “It’s not something we have a complete handle on,” says Kathryn Boling, M.D., a family doctor with Mercy Medical Center in Baltimore. “The hallmark of this virus is that it hits different people in different ways, and that’s what happens with the long-haul syndrome, too. I’ve seen post-COVID patients with a variety of health problems, from a pulse that randomly speeds up and slows down, to deep fatigue, to extreme shortness of breath. They may have a tough time just walking up a flight of stairs.”

And though any virus can come with symptoms that linger after the initial infection is resolved, the effect seems to be worse with COVID-19. “Post-viral syndrome is nothing new,” Dr. Boling says. “Lots of people with a bad virus, like the flu, experience symptoms after they recover. But with COVID, it’s more severe. It lasts longer and the effects can be vicious.”

The medical community is still figuring out what this syndrome is — and how to treat it. “Even 10 months out, some people just aren’t functioning properly,” says Christian Sandrock, M.D., an infectious disease specialist at the UC Davis Health Post-COVID-19 Clinic. “COVID is a new disease, and this is all a work in progress. There’s so much we don’t know yet.”

But scientists are learning more every day. Here's what we know so far.

Almost Anyone Can Become a Long-Hauler
Anybody who’s had COVID-19 — even a young, otherwise healthy adult — can experience lingering symptoms long after being “officially” better. “Some people have post-acute syndrome after being severely ill in the ICU,” says Dr. Sandrock, “but I’ve seen patients who were never critically ill, or who never even went to the hospital.” For reasons we don’t yet fully understand, women are more likely to be long-haulers than men. Age can be a factor, too. Last spring, when 292 people who’d tested positive for coronavirus were contacted by the Centers for Disease Control and Prevention (CDC), those older than 50 were nearly twice as likely to report lingering symptoms as those between 18 and 34.

There’s a Constellation of Symptoms
Some of the most common symptoms of post-acute COVID syndrome are:

• Fatigue
• Muscle weakness
• Cough
• Shortness of breath
• Chest pain
• Headache
• Loss of smell or taste
• Difficulty concentrating
• Insomnia

Rarer symptoms, like rashes, hair loss and kidney injury, can happen, too. “We’ve seen so many different kinds of post-acute COVID patients,” says Dr. Sandrock. “Some are really sick and knocked down, and others have symptoms like low-grade fever or fatigue that gets a little better, then gets a little worse.”

Brain Fog Is Common
Many people report trouble concentrating or thinking clearly after they’ve had COVID-19. You may have mental health challenges, too, like depression or anxiety. “If you feel lethargic or depressed or have brain fog, you’re not crazy,” says Dr. Sandrock. “It may be caused by limited blood flow to the frontal lobe of your brain.”

Having an Underlying Health Condition Makes You More Susceptible
Although even healthy young adults can experience post-acute COVID syndrome, people with underlying medical conditions are more likely to suffer. The CDC poll found that 48 percent of patients with high blood pressure — and 55 percent of patients dealing with obesity — experienced long-haul COVID.

Special Long-Haul Clinics Are Opening Around the Country
There are now some outpatient clinics that focus specifically on treating post-acute COVID syndrome. You’ll likely need to go for testing in person. “Expect blood work, a pulmonary function test to see how well your lungs are working, and perhaps an echocardiogram or magnetic resonance imaging (MRI) scan,” says Dr. Sandrock.

Treatment will depend on the findings. “I’ll usually do an EKG in the office. Then if I’m concerned, I’ll send the patient for a follow-up with a cardiologist,” says Dr. Boling. “That’s because post-COVID inflammation can put you at risk for heart problems. Or I may order a CT scan of the lungs to look for underlying damage. That might be treated with inhalers.” The most important advice: Don’t wait for problems. If you’re not feeling right in a week or two, call your provider and arrange a telehealth visit, or book an in-person visit as soon as you’re no longer infectious.

“There is hope,” says Dr. Boling. “The most likely thing is that you will get better. It may just take some time.

The information in this story is accurate as of press time and posting. To limit the spread of the coronavirus, it’s important to continue practicing social distancing (keeping at least 6 feet away from people outside your household) and washing your hands frequently. You should also be appropriately masked any time you’ll be in public. According to the CDC’s latest guidance, this means layering a disposable surgical mask underneath a snug-fitting cloth mask or placing a mask fitter over your cloth mask to ensure a tight fit. Because the situation surrounding COVID-19 continues to evolve, we encourage readers to follow the news and recommendations for their own communities by using the resources from the CDC, WHO, and their local public health department.