The COVID-19 ‘Long Haulers’

Coronavirus disease 2019 (COVID-19) has taken a terrible human toll, killing more than 415,000 people in the United States as of Jan. 26. Those were the most tragic outcomes of about 25 million cases total; most people with COVID-19 recover within two weeks.

But, it isn’t as simple as death or recovery: About 10 percent of survivors experience long-term health issues for a few months or even longer.

Known as “long haulers,” these individuals have lingering symptoms of COVID-19 that can include low energy, exhaustion, shortness of breath, body aches, decreased exercise tolerance, brain fog and difficulty sleeping, says UNC Health family medicine physician Sarah Ruff, MD.

“They can’t do the things that they used to be able to do,” she says. “And, they often have these lingering, nonspecific symptoms that last for months.”

Experiencing long-term symptoms after an illness is not unique to COVID-19. However, for other illnesses, long-lasting side effects tend to occur in those with severe illness who have spent weeks in the intensive care unit, often intubated. For example, a person who was hospitalized with a serious case of flu that turned into pneumonia is much more likely to have lingering effects than someone with a mild case of flu who recovered at home.

COVID-19 appears to be different: Many “long haulers” initially had mild to moderate symptoms that didn’t require time in the hospital.

“While it is more likely if you’re over (age) 50, have two to three chronic illnesses, and you were very ill with COVID, it’s been seen in patients who had only mild COVID symptoms,” Dr. Ruff says.

Two Types of COVID-19 Long-Hauler Patients

Dr. Ruff has seen two categories of long-haul COVID-19 patients.

First, there are people who experience permanent damage to an organ that affects its ability to function.

“This could be permanent lung damage, permanent gastrointestinal tract damage, permanent brain damage, permanent heart damage,” Dr. Ruff says.

Fortunately, these serious long-term complications appear to be less frequent.

More commonly, there is no evidence of organ damage, but one has lingering and inconsistent symptoms. Some people’s lingering symptoms are nothing like the original symptoms they had when they were first infected with COVID-19. Some individuals feel better for days or even weeks and then relapse.

The most commonly reported long-term symptoms include:

  • Fatigue
  • Shortness of breath
  • Cough
  • Joint pain
  • Chest pain

Other reported long-term symptoms include:

  • Difficulty with thinking and concentration (sometimes referred to as “brain fog”)
  • Depression
  • Muscle pain
  • Headache
  • Intermittent fever
  • Fast-beating or pounding heart (also known as heart palpitations)

Chronic fatigue syndrome is the most common lingering side effect of COVID-19 for these patients, Dr. Ruff says.

“Chronic fatigue syndrome is a medical diagnosis that’s really difficult to treat because you’re really tired all the time, you have no energy and you just don’t feel well, but there’s not a medical treatment for it,” Dr. Ruff says.

There’s No Way to Predict Who Might Have Lingering Symptoms or Side Effects of COVID-19

Just like with many aspects of COVID-19, it’s hard to predict who will recover in about two weeks and who might have long-lasting side effects.

“What’s hard about it is that there’s no way to predict. There are many young, healthy athletes who still can’t go running or work out like they used to do, and they don’t feel well months after they had COVID-19,” Dr. Ruff says. “Because COVID-19 is new, we don’t know how long these symptoms are going to last. But, it’s very possible that they’ll never be back to their normal selves, which is awful.”

The Best Way to Prevent Long-Hauler Syndrome

The availability of two COVID-19 vaccines is a big step forward in helping to beat the virus, and everyone who wants a vaccine will eventually get one.

You can contract COVID-19 more than once. If you previously had COVID-19, you should still be vaccinated, even if you still have lingering symptoms.

However, supplies will be limited for several months. In the meantime—and even after you get the vaccine, until the virus is not circulating at high levels—it’s important to adhere to the following safety measures:

“You need to take it seriously,” Dr. Ruff says, “and do all you can to NOT get COVID.”

UNC Health’s new COVID Recovery Clinic, led by John Baratta, MD, MBA, is now open and accepting new patients. To schedule an appointment, please call the UNC Center for Rehabilitation Care at (984) 974-9747.

Photo credit: © Justin Paget –