Understanding COVID-19 Long-Haulers

Since it first caught our attention in March, the Centers for Disease Control and Prevention (CDC) reports that over 17 million people in the U.S. have contracted COVID-19. Though the majority of those infected have been able to eventually recover, researchers are beginning to understand that the effects of COVID-19 do not always stop when a patient has recovered from acute illness. In fact, according to a recent study in The Journal of the American Medical Association, an estimated 10% of patients may become “long-haulers.” 

What Is a Long-Hauler?

The term long-hauler is used to refer to the numerous people in the United States who have lingering or delayed symptoms from COVID-19. Though we are still learning about the long-term effects, early studies concluded that 50% to 80% of patients studied continued to suffer from symptoms even after a subsequent viral test comes back negative for the virus. These symptoms commonly include cough, fatigue, joint and chest pain, and shortness of breath. Other patients report difficulty concentrating and sleeping, headaches, muscle pain and depression. Brain fog is among the most debilitating of reported symptoms, with patients feeling unusually confused, forgetful or unable to concentrate, even for mundane activities such as watching television. 

What is puzzling to physicians is that there is currently no way to predict who these long-haulers might be. For many other illnesses, those who spend time in intensive care with severe symptoms can expect to have lingering effects. But for COVID-19 patients, many long-haulers initially experienced mild to moderate symptoms of the disease that did not require hospitalization. 

Rabih Bechara, M.D., is a professor of medicine within the Division of Pulmonary and Critical Care Medicine at Augusta University and Morehouse School of Medicine in Atlanta, Georgia. He has seen the long-term effects of COVID-19 firsthand. “One of my patients, a 55-year-old male essential worker, contracted COVID-19 three months ago, resulting in respiratory problems for which he was hospitalized. He received the FDA-approved standardized therapy during his acute phase, including supplemental oxygen. Luckily, he did well and was discharged from the hospital after two weeks,” Dr. Bechara explained. “Since his discharge, he still complains of difficulty breathing with moderate exertion, changes in smell (many food items have a bad smell, especially spicy ones), and has a daily dry cough. These symptoms were not present prior to his COVID-19 bout.”

Long-Term Effects

Though we can’t currently predict who is more likely to become a long-hauler, scientists are putting patients who have persistent symptoms into two groups. 

The first are patients whose symptoms suggest permanent damage to their lungs, heart, brain or other organs. This damage may in turn affect the ability of their body to function normally. The second group continue to experience symptoms, but without apparent damage to vital organs.  Unfortunately, as Anthony Fauci, M.D., director of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, has reported, “it will take months to a year or more to know whether lingering COVID-19 symptoms could be chronic illnesses.”

“The long-term significance of these symptoms is not yet known,” Dr. Bechara said. “There are many ongoing clinical trials investigating long-term effects of a post-COVID-19 infection. The best way to avoid these long-term complications is to prevent COVID-19.”

You can learn more and find resources on post-COVID-19 recovery at Lung.org