COVID symptoms that last for weeks may come as a surprise to some, especially after recent messaging from health authorities. In December, the Centers for Disease Control and Prevention announced that those who tested positive for the virus can exit isolation after just five days if they are symptom-free and continue to wear masks.

That recommendation is understandably focused on the period during which someone is contagious, and, as a result, doesn’t mention anything about longer-lasting or recurring symptoms that might continue after the person is no longer infectious. But it can have the effect of suggesting that, for most people, the recovery process is, if not five days, pretty quick.

That’s the message it sent to me, at least.

Managing my expectations

I’ve been reporting on COVID-19 since the pandemic started, and I thought I knew what an infection would be like for a young, otherwise healthy person like me. I knew there was a risk for long COVID, even with mild cases, but in my mind, there were two types of COVID: run-of-the-mill cases that didn’t last much longer than their isolation periods required, and long COVID, which was relatively rare.

Like so many Americans, I got COVID over Christmas. I was vaccinated and boosted, and my case was indeed mild: sore throat, sinus pressure and headache, extreme fatigue. After eight days, I was feeling better, and I tested negative two days in a row on a rapid antigen test. I was anxious to get back out into the world. Most people I know were still lying low to avoid an omicron infection, but I was armed with a bit of extra immunity, making me a low-risk hang. Party time!

Not quite. Soon after ending my isolation, I had dinner at a friend’s house. One glass of wine left me feeling the next day like I’d had a whole bottle (just guessing what that might feel like). I was bone-achingly exhausted, but couldn’t sleep that night.

In the days and weeks that followed, as I managed the insomnia, I was also contending with bouts of fatigue, brought on by physical activities that are usually easy and even energizing for me: going for a long walk in the cold; riding an exercise bike; taking a sauna. The waves of fatigue, which I started calling “crashes,” feel like I’m coming down with a sickness in real time: weakened muscles, body aches, that feeling where all you can do is lie down. The crashes last for a couple days, I recover slowly, and the cycle inevitably repeats when I accidentally push myself beyond my new and unfamiliar limit.

Miles Bryan/WHYY

Health reporter Nina Feldman, seen resting with her cat. She got COVID-19 over Christmas, like a lot of Americans, and is still not feeling 100%.

How doctors define long COVID, and what it means for treatment

Since it opened in June 2020, Abramoff has seen about 1,100 patients at the Penn Post COVID clinic. He said there is no official threshold at which someone officially becomes a long COVID patient. If people have only been feeling bad for a few weeks, he considers that to be the tail end of the illness itself. The clinic isn’t really in the business of treating COVID in its acute phase.

For those dealing with symptoms for months, the clinic takes a comprehensive approach, evaluating patients and referring them to specialists who can address their particular needs: a pulmonologist for breathing difficulty, a speech pathologist for someone struggling with cognitive issues, even social workers or other support staff who can help people navigate taking time off work and accessing various disability benefits.

But then there is that awkward gray area: people who have been feeling bad for six or eight weeks after their initial infection. Abramoff said those people will likely get better on their own if they take it easy, though if they don’t, there is some value in beginning work with them early on. For people in that position, his best advice is to take a “watchful waiting” approach: Keep the lines of communication with a primary care doctor open, and be very careful about not rushing back to life as normal.

“You have got to build based on your tolerance,” he said. “People were very sick, even if they weren’t in the hospital.”