When symptoms linger for weeks, is it long covid?

Many Americans are discovering that recovering from covid-19 may take weeks or even months longer than expected, leaving them with lingering symptoms like intense fatigue or a racing pulse. But does that mean they have what's known as long covid?

Though such cases may not always amount to debilitating long covid, which can leave people bedridden or unable to perform daily functions, it is common to take weeks to fully recover.

“There could be more to help people understand that it’s not always a quick bounce back right away after the initial infection,” said Dr. Ben Abramoff, director of the Post-COVID Assessment and Recovery Clinic at Penn Medicine in Philadelphia. “This is still a very significant viral infection, and sometimes it’s just a more gradual recovery process than people’s previous viral illnesses.“

Recent federal health guidelines — which recommend only five days of isolation for those who test positive and are symptom-free — may inadvertently suggest most recoveries are, if not just five days long, pretty quick.

That’s the message I got, at least.

I’ve reported on the coronavirus pandemic since it started, and I thought I knew what an infection would be like for a young, otherwise healthy person like me. I knew even mild cases could develop into long covid. I thought they were relatively rare.

Like many Americans, I found myself slowed by a recovery that took more than a month — far longer than I had expected.

I got covid over Christmas. I was vaccinated and boosted, and my symptoms were mild: sore throat, sinus pressure and headache, extreme fatigue. I felt better after eight days, and I tested negative two days in a row on a rapid antigen test.

Soon after ending isolation, I had dinner with a friend. One glass of wine left me feeling like I’d had a whole bottle. I was bone-achingly exhausted but couldn’t sleep.

The insomnia continued for weeks. Activities that once energized me — walking in the cold, riding an exercise bike, taking a sauna — instead left me intensely tired.

The waves of fatigue, which I started calling "crashes," felt like coming down with an illness in real time: weakened muscles, aches, the feeling that all you can do is lie down. The crashes would last a couple of days, and the cycle would repeat when I accidentally pushed myself beyond my new, unfamiliar limit.

My colleague Kenny Cooper is also young, healthy, vaccinated, and boosted. He was sick for almost two weeks before testing negative. His symptoms lingered a few more weeks. A persistent cough kept him from leaving the house.

“I just felt like there were weights on my chest. I couldn’t sleep properly. When I woke up, if I moved around too much, I would start coughing immediately,” he said.

Abramoff has seen about 1,100 patients since Penn's post-covid clinic opened in June 2020. There is no official threshold at which someone officially becomes a long-covid patient, he said.

The clinic takes a comprehensive approach to patients who have had symptoms for months, evaluating and referring them to specialists, like pulmonologists, or social workers who can assist with medical leave and disability benefits.

Those coming to the clinic with symptoms lasting six to eight weeks, Abramoff said, are generally sent home to rest. They will likely get better on their own. He advises patients with lingering symptoms to adopt a "watchful waiting" approach: Keep in contact with a primary care doctor, and take things slowly while recovering.

“You have got to build based on your tolerance,” he said. “People were very sick, even if they weren’t in the hospital.”

A National Institutes of Health-funded study on long covid, called Recover, designates any case with symptoms lasting more than 30 days as long covid.

Dr. Stuart Katz, a New York University cardiologist who is the study's principal investigator, said he estimates 25% to 30% of the nearly 60,000 covid patients in the study will fit the long-covid criteria.

The 30-day mark is an arbitrary cutoff, Katz said. “There’s this whole spectrum of changing symptoms over time.”

A study published in Nature last year tracked more than 4,000 covid patients from initial infection until symptoms subsided. Roughly 13% reported symptoms lasting more than 28 days. That dropped to 4.5% after eight weeks and 2.3% after 12 weeks, indicating most people with symptoms lasting more than a month will recover within another month or two.

That leaves potentially millions of Americans suffering from a variety of covid symptoms — some debilitating — and a lingering burden on the health care system and workforce.

Recent research from the Brookings Institution estimated that lasting covid symptoms could be responsible for up to 15% of the unfilled jobs in the U.S. labor market.

It took me about six weeks to start feeling better. My crashes got better, slowly, as a result of diligent rest and almost nothing else.

My colleague, Cooper, has also improved. His coughing fits have subsided, but he’s still dealing with brain fog.

The way most studies to date describe long covid would leave us out.

But what I've come to think of as my “medium covid” affected my life. I couldn't socialize much, drink, or stay up past 9:30 p.m. It took me 10 weeks to go for my first run — I’d been too afraid to try, fearing another crash that would set me back again.

Failing to treat covid as a serious condition could prolong recovery. Patients should monitor and care for themselves attentively, no matter how mild the infection may seem, Abramoff said.

“It’s something that could kill somebody who’s in their 70s,” he said. “It’s not nothing.”

This story is part of a partnership that includes WHYY, NPR, and KHN.