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“It’s been 3 weeks, why am I not feeling better? Can Coronavirus symptoms linger beyond 2 weeks?”

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Prolonged illness is well described in those patients who require hospitalization for COVID, but what is becoming more and more evident is that some people with relatively mild, but still life-altering symptoms, are not returning to their usual state of health for weeks and even in some cases, months. On July 24, 2020 the CDC released a report looking at this topic and while the study is small and imperfect, the data shows that for many people, COVID symptoms last longer than the expected 2 weeks. One in five previously healthy young adults (age 18-34) were not back to their usual health 14-21 days after testing positive and one in three of all survey respondents (with a higher percentage in those over 50 years old.) These results are certainly no surprise to those individuals who have become known as  “long-haulers” or “long-termers.” “Most people get the virus and after a few weeks their symptoms resolve,” said Dr. Robert Glatter, emergency physician at Lenox hill Hospital in New York City. “We’re seeing a different spectrum where people don’t recover, and they have symptoms from weeks to months.” 

No one knows exactly why this happens, but Akiko Iwasaki, an immunologist at Yale, offers three possibilities: “Long-haulers might still harbor infectious virus in some reservoir organ, which is missed by tests that use nasal swabs. Or persistent fragments of viral genes, though not infectious, may still be triggering a violent immune overreaction, as if “you’re reacting to a ghost of a virus,” Iwasaki says. More likely, the virus is gone but the immune system, having been provoked by it, is stuck in a lingering overactive state.” In fact, Glatter has said “we’re learning that these long-haulers are a population that often test negative. Some of these patients have never had a positive test,” implying that their diagnoses were made on a clinical basis given that the symptoms weren’t necessarily bad enough to warrant testing when tests were still limited. 

The most common long term symptoms are fairly non-specific and include ongoing fatigue and muscles aches, although some patients have reported prolonged daily fevers, persistent nighttime chills, breathlessness and some also have strange neurologic symptoms “brain-fog, hallucinations, delirium, short-term memory loss, or strange vibrating sensations when they touch surfaces.” Social media has connected many of these long-haulers in support groups, which patients find very helpful for coping. In a report generated by one such support group (Body Politic on Slack with 4000 people that have had symptoms for over 30 days and often double that), one author said “the symptoms wax, wane, and warp over time. It really is a grab bag…Every day you wake up and you might have a different symptom.”

We know that having more severe disease or chronic conditions makes people more likely to have long term effects, but of the otherwise healthy people that get COVID, we don’t know what makes one person more likely than another to have prolonged symptoms. Thus, the takeaway is yet again the following: wash your hands, wear a mask, and keep your distance from others. (July 29, 2020)