COVID Long Haulers – What is a Coronavirus “Long Hauler”

As we learn more about coronavirus (COVID-19), it is becoming evident that some people suffer symptoms of the virus several weeks or even months after being infected. Data indicates that when it comes to COVID-19, people fall into one of two segments. Roughly 80% of people infected with COVID-19 have mild reactions that clear up in about two weeks. For those with more severe responses, three to six weeks may be needed to recover from the virus.

However, there is new concern regarding a third group of people that fall outside of these two segments. In roughly 10% of those who have had COVID-19, symptoms are prolonged and could last up to three months following infection. What makes this frustrating is the fact there appears to be no consistent cause for this to occur.

Referred to as post-COVID “long-haulers” in the United States, this group includes both those who had mild and severe cases. This condition does not discriminate and includes the young, elderly, those that were healthy, those with chronic conditions, those hospitalized, and those who were not. To shed light on the condition, this article will examine the various characteristics of COVID-19 long haulers.

Better Definition – and Name – of Long Haulers

People that still have symptoms 28 days following initial infection, are considered long haulers. Those who had COVID-19 can develop very different chronic illnesses as a result. The virus that causes COVID-19, SARS-CoV-2, has led the National Institutes of Health (NIH) to suggest a unifying name for long haulers: post-acute sequelae of SARS-CoV-2 infection, or PASC.

While most COVID-19 patients recover within a week or few months, some will suffer chronic heart, lung, brain, or kidney damage as a result of the virus. A formal definition of long COVID does not yet exist but has been suggested to include three points:

  • Medically diagnosed with COVID-19 based on symptoms and/or diagnostic testing for SARS-CoV-2.
  • Failure to return to pre-COVID-19 health level and function after six months.
  • Having symptoms suggesting long COVID-19 but no evidence of permanent damage to the kidneys, heart, or lungs that could be causing the symptoms.

How Common are Lingering Symptoms of COVID?

As of this writing, there have been almost 30 million cases of COVID-19 in the United States with tens of thousands suffering lingering effects following illness. Published patient group surveys and studies show that between 50% and 80% of people experience ongoing symptoms three months post-COVID-19 onset even if the virus is no longer detected in their body.

Which Symptoms Linger Most Frequently?

Shortness of breath, coughing, difficulty concentrating, body aches, headaches, inability to exercise, and trouble sleeping are amongst the most common symptoms that linger following COVID-19 infection. However, fatigue appears to be the most significant symptom experienced by long haulers and often leaves the patient feeling exhausted and run down. Even routine and simple tasks (like walking across the room) can leave them feeling tired.

Brain fog is another lingering symptom that can affect COVID long haulers. Those with this symptom often report being unusually confused, forgetful, or unable to concentrate on the most basic of tasks. Brain fog has been reported both in those hospitalized in intensive care and those who did not require hospitalization. Additionally, the condition could reoccur days or weeks after feeling better.

Who is at Higher Risk of Becoming a Long Hauler?

Unfortunately, the newness of COVID-19 makes it impossible to predict with any certainty who is at risk of becoming a COVID-19 long hauler. Age does not appear to be a factor as the long-term group includes both younger and older patients. The severity of a person’s symptoms is also not a great indicator of who may be a long hauler risk as indicated in an article published in Science. The article noted that those with mild COVID-19 can have lingering symptoms whereas those with severe illness, may be able to return to normal within two months.

Underlying health conditions could play a role but again, it is too early to know with certainty. Most long haulers appear to be categorized as high risk but an increasing percentage of otherwise healthy are being affected as well. As such, it still largely appears to be random regarding who has long-lasting symptoms and who does not. Because COVID-19 is new and only just began in December 2019, information on long-term recovery rates is not yet available.

Why Might Symptoms Linger for Long Haulers?

Several theories are currently being researched as to why COVID-19 symptoms may linger for long haulers. It is hypothesized that those with ME/CFS, and perhaps long COVID, could have one or more of the following:

  • Ongoing low level of brain inflammation
  • Autoimmune condition where antibodies attack the brain
  • Autonomic nervous system abnormalities that decrease blood flow to the brain
  • Trouble making adequate energy molecules needed to satisfy the body and brain

It is also theorized that people with long lasting COVID-19 symptoms may have some virus remaining in their body despite the fact most COVID-19 long haulers test negative for the virus. Symptoms could also be an overreaction from the immune system response after the infection passes.

Are COVID-19 Long Haulers Contagious Still?

It is unlikely but the question is difficult to answer. Generally, within a week of having an active infection, like coronavirus, recovery begins and the person is no longer contagious. Persistent fever is less common with this group which suggests they are likely not infectious months later. Despite lingering symptoms, the bulk of COVID-19 long haulers test negative for the virus.

Should Long Haulers Get the COVID-19 Vaccine?

The Centers for Disease Control recommends that vaccines not be withheld from people with prior COVID-19 infection regardless of them being symptomatic or not. Anyone that believes they had COVID-19 or tested positive for it, will need to wait 10 days or until symptoms resolve before receiving the vaccine. Patients with concerns or underlying health issues that could be influenced by a vaccine, should consult their physician before making an appointment the vaccine.

Treatments for COVID 19 Long Haulers