What It Means to Be a Coronavirus “Long-Hauler”

A Q&A about lingering symptoms of COVID-19
man with corona at home in isolation

This article was updated on January 26, 2021, to reflect new information about this rapidly evolving situation. Originally published July 10, 2020.

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In the ever-evolving story of coronavirus (COVID-19), experts have now learned that some people can experience symptoms of the illness many weeks or even months after having it.

According to one report, most people fall into one of two groups when it comes to the virus. Approximately 80% of those with COVID-19 end up having a mild reaction and most of those cases resolve in about two weeks. For people who have a severe response to the virus, it can take between three and six weeks to recover.

But now, there is growing concern over a separate group of people who don’t seem to fall into either of those two categories. One study states that about 10% of people who’ve had COVID-19 will experience prolonged symptoms one, two or even three months after they were infected. One of the most frustrating parts? There seems to be no consistent reason for this to happen.

This group, which many refer to as “long-haulers,” is mixed with those who experienced both mild and severe cases. And this condition can affect anyone – young, old, those who were healthy, those who had a chronic condition, those who were hospitalized and those who weren’t.

“We’re now seeing these patients whose symptoms seem to be lingering for quite a while,” says family medicine provider Christopher Babiuch, MD. “This is challenging because everyone’s needs are so unique. We’re finding that collaborating as a team between different specialists helps to manage and support these patients, but there’s a lot that we’re still learning.”

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Here Dr. Babiuch answers your questions about everything we know (and don’t know yet) about coronavirus long-haulers.

Q: What is the average age of a long-hauler?

A. At this point we can’t determine the average age or predict who may have long-term symptoms. There is a mix of relatively young, healthy people who we’re seeing in this long-term group as well as older individuals. Hospitals are still working to analyze the data about this group and a lot of collaboration and research is happening.

Q: Do most long-haulers have underlying or chronic medical conditions?

A: We think so, but it’s still too early to say for sure. Our experience shows most long-haulers tend to fall into the high risk category, but there’s also a growing percentage of people who were otherwise healthy before they became infected. From what we know so far, it still seems random as to who experiences these long-lasting symptoms and who doesn’t.

Q: What symptoms do coronavirus long-haulers typically experience?

A: Long-lasting symptoms often include: coughing, tightness in the chest, shortness of breath, headaches, muscle aches and diarrhea. But perhaps the most significant symptom that is being seen across the board in coronavirus long-haulers is fatigue. Often times this group feels very run down and tired. They can’t exert themselves or exercise and simple tasks (like walking to the mailbox) will often leave them feeling exhausted. Chronic fatigue like we’re seeing in this group can be incredibly debilitating and frustrating. Many long-haulers also report brain fog, difficultly concentrating or feel like they aren’t as sharp as they used to be.

Q: Are coronavirus long-haulers still contagious?

A: It’s not very likely, but it’s a sticky question to answer. Typically after having an active infection like COVID-19, the contagiousness goes away after a week or so and you start to recover. We less commonly see persistent fevers in this group, which hints that they probably aren’t infectious months later, but it can vary. The vast majority of long-haulers test negative for COVID-19, despite lingering symptoms. We define a long-hauler as still having some sort of symptom 28 days or later after they were first infected.

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Q: Why are some people experiencing long-lasting symptoms and others aren’t?

A: We know that COVID-19 starts an inflammatory response in the body, which can cause a chain of events with many different symptoms and outcomes. Unfortunately at this time, more research needs to be done to help us explain why this can lead to prolonged symptoms in some people. In the future, we’ll be able to tell the full long-term effects that COVID-19 has on the kidneys, lungs and heart, but we just aren’t there yet.

Q: If someone is experiencing symptoms months after testing positive for COVID-19 (or if they believed they had it in the past), what should they do?

A: If someone tested positive (or believes that they were infected) at least 28 days ago and is still experiencing symptoms – they should contact their doctor.

Q: How are healthcare providers treating and managing coronavirus long-haulers?

A: Many health systems are starting to streamline care for this group of patients. Long-haulers should go through testing involving behavioral, pulmonary, respiratory, cardiovascular and neurological health. From there a care path and treatment is recommended and a team of providers will monitor the patient moving forward. It’s also important to drink fluids to stay hydrated, rest, focus on sleep, manage stress and eat well.

There is a lot of collaboration and research happening as more data is collected and we start to piece together the long-term effects of COVID-19 on the body. The team is there to identify symptoms that worsen and get them to the right level of care. We’re also seeing that depression and anxiety are big issues for these long-haulers, so checking in to see how they’re doing is another important aspect in the monitoring program.

Q: Should long-haulers still get the COVID-19 vaccine?

A: The CDC has recommended that the vaccines should not be withheld from those with a prior infection of COVID-19, regardless of being symptomatic or asymptomatic. If you’ve tested positive for the virus (or believe you had it), you’ll need to wait 10 days or until you are no longer showing symptoms to receive the vaccine.

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