Sarah Gupta, MD September 16, 2020, 8:22AM (PT)
COVID-19 is caused by a brand new coronavirus (officially named “SARS-CoV-2”). So far, there’s a lot we know about COVID-19: what causes it, common symptoms, and how it spreads. But the virus has only been around for about 9 months. And because it’s so new, scientists and doctors are still struggling to understand it.
Case in point: Though we usually think of COVID-19 as a “respiratory” illness (an illness in the lungs), it may not be so simple. In fact, there’s a great deal of evidence that COVID-19 can have a big impact on other areas of your body — like your heart, kidneys, and gut.
There are also still many questions about how long it takes to recover from COVID-19. While most people only have mild symptoms for 1 to 2 weeks, other people can get very sick or even die. Some “long-haulers” can have ongoing symptoms for many months — even if they only had a mild case of COVID-19.
Here’s what we currently know about how long people are sick with coronavirus, and what the long-term effects may be.
What does COVID-19 do to the body?
The COVID-19 virus enters your body through your eyes, nose, or mouth. Once in your body, it attaches itself to a special “ACE2 receptor” on your cell surfaces. This receptor allows the virus to enter a cell and make copies of itself. This overwhelms the cell and causes it to die.
The lungs are a commonly affected part of the body. But you have ACE2 receptors all over your body — not just in your lungs. This means COVID-19 can cause damage almost anywhere. It can also affect your immune system and cause widespread inflammation and clotting. As a result, COVID-19 can have a wide variety of symptoms:
- Body: fever, muscle aches, skin rash, swelling in hands and feet
- Brain: headaches, dizziness, confusion
- Eyes: redness and pain
- Lungs: cough, trouble breathing
- Nose and throat: loss of taste and smell, sore throat
- Heart: irregular heartbeat
- Gut: abdominal pain, nausea, vomiting, diarrhea
- Kidneys: kidney failure
Sometimes an organ can become so damaged from the disease that it stops working. This is called “organ failure.” It is more likely to occur in people with severe COVID-19, and in people who already have other medical conditions (like diabetes or heart disease).
How long are you sick with coronavirus?
COVID-19 follows the same basic pattern as many other viruses:
- Incubation period of 2 to 14 days. This is the period of time between when you are exposed to the coronavirus (infected), and when you actually start to feel sick. During this period you can infect other people — even if you feel totally healthy.
- Prodrome phase of 1 to 2 days. During this time you may start to have some general mild symptoms.
- Illness phase of 1 to 3 weeks. This is the phase where you are the most sick. Your symptoms will depend on which parts of your body are involved. Common symptoms are fever, dry cough, fatigue, and loss of taste or smell. In the second week of illness, some people can become severely ill.
- Recovery phase of potentially 2 to 3 weeks or longer. During this phase, your symptoms start to get better. A full recovery is when you return to your previous level of health.
Unfortunately, there’s still not a lot of information about how long each phase lasts with COVID-19 — especially in people who have a mild, outpatient (not hospitalized) illness. But what we do know is that it can take a long time to recover from COVID-19, even for young people who don’t have many medical problems.
In a Centers for Disease Control and Prevention (CDC) survey of adults who had COVID-19, 35% of people still hadn’t recovered 2 to 3 weeks after getting sick. And 1 in 5 young healthy adults (age 18 to 34) still had at least one COVID-19 symptom 2 to 3 weeks after testing positive. In people who did recover, their symptoms usually lasted between 4 to 10 days. And in two international studies of hospitalized patients, more than 80% of people still had symptoms after 2 months.
The lasting effects of COVID-19 symptoms
Any viral illness can take a toll on your body — especially if you have other health conditions. We also know that other viruses can have ongoing consequences (like measles, hepatitis, and SARS). But the truth is, it’s just too early to know for sure how COVID-19 affects our bodies long term. It may take years before we fully understand it.
In the meantime, it’s clear that COVID-19 can make other health conditions worse (like COPD, asthma, and diabetes). This can make it hard for you to return to your previous level of health. And there is some evidence that COVID-19 may potentially cause long-lasting — or even permanent — damage to your heart, lungs, kidneys, or brain.
For example, in a study of 55 COVID-19 patients, 14 had abnormal lung scans 3 months after going home from the hospital. And in another small study, heart abnormalities were found in 78% of patients 10 weeks after they tested positive for coronavirus — even though most of the patients were relatively young, healthy, and had only experienced mild (or no) COVID-19 symptoms.
In addition, in nearly 4,000 patients hospitalized with COVID-19, over 40% developed kidney problems during their hospital stay. Even though most of these patients had previously healthy kidneys, 35% still had decreased kidney function when they left the hospital.
There is also a growing concern that some people can have ongoing symptoms for several months — even if they only had a mild case of COVID-19. There may be thousands of these “long-haulers.” Symptoms can vary widely. Common problems are extreme fatigue, chronic fever, brain fog, and headache. Understanding these long-term cases may entirely change how we think about COVID-19.
Who is most at risk for long-term problems?
Though there’s not a lot of evidence yet on who is at risk for long-term problems, there are some clues. In an early patient-led research study, over 75% of self-identified “long-haulers” were women under the age of 60. About 60% had at least one pre-existing medical condition, and over two-thirds were moderately or very physically active before getting COVID-19. Also, in a CDC survey of adults who tested positive for coronavirus, people with other medical conditions didn’t recover as quickly from COVID-19 as people who were previously healthy.
COVID-19 is a rapidly evolving situation
Again — it’s just too soon to know for sure how COVID-19 affects people over months or years. Until we have a better understanding of long-term COVID-19, diagnosis and treatment will continue to be a challenge.
Patients with ongoing symptoms can have a hard time getting their doctor to take their symptoms seriously. Some people with chronic COVID-19 may not even have had a positive test — which can make it confusing as to whether their symptoms are from COVID-19, or from another health condition. Patient-led advocacy groups like the Body Politic can be good sources of information, resources, and emotional support.
Fortunately, research is already underway on the lasting effects of coronavirus. Scientists are investigating why some people have chronic symptoms, while other people fully recover. For example, in July the U.K. pledged $11 million to studying the long-term effects of COVID-19. Understanding the different phases (and aftermath) of the virus will lead to quicker diagnosis and better care.
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