More than two months after Martha Pearse first got sick with COVID-19, she’s still working her way back to normal.
Pearse, 81, said she had “daunting” fatigue when she came down with the new coronavirus in mid-April. She also had severe headaches and night sweats, and lost her sense of taste and smell.
As July started, she still was getting brief, but intense, headaches, and has yet to recover her sense of taste and smell — though she’s hopeful those will come back, since her son reported they took time to return when he had the virus. The fatigue lingers, but Pearse said she’s seeing gradual improvement each week.
“You just have to be extremely patient,” she said. “It’s going to last for a lot longer than you think.”
The virus has shown it can cause anything from mild cold-like symptoms to death, and the recovery phase is proving equally hard to pin down. There’s no data yet on how many patients bounce back quickly and how many experience lingering symptoms, but most will eventually recover, said Dr. Connie Price, chief medical officer at Denver Health and a professor of infectious diseases at University of Colorado School of Medicine.
People who had COVID-19 can face three general types of problems. First, it takes time for the immune system to start “cleaning up the mess” of dead cells and debris the virus left in the lungs, Price said. Patients who were on ventilators or spent a long time in the hospital may have to deal with side effects. And some patients — likely a small percentage — will deal with long-term symptoms for reasons that aren’t clear, she said.
Some people, like MJ Vukovich, 38, have a mild illness and an easy recovery. Vukovich said he felt off for about a week, and his wife was sick for 10 days, but they both quickly returned to their normal activities. He isn’t sure if that’s because they were healthy before they got the virus, or if they just got lucky.
“I didn’t slow down or anything,” he said.
Being relatively young doesn’t guarantee an easy time, though. Krissy Schultz, 24, spent two days in the hospital with difficulty breathing, and said it’s taken a month to feel like her lungs are healing. She still has sinus pain, and some days she can’t smell and taste food, though other days those senses are normal.
“The sore throat and headache hurt less than they did when I had full blown symptoms, but they still hurt post-COVID,” she said. “They are about the same every time they come and go, but I’m seeing that they aren’t coming back as often so far.”
Even people with moderate symptoms sometimes find that the recovery process takes longer than expected. Jordana Gringrass, 39, said she was sick for about two weeks, with a few scary days where her fever spiked. She had significant fatigue and on-and-off lightheadedness for another two weeks before she started to feel normal.
“It was like these rollercoaster waves,” she said.
For others, recovery is far more complicated. Stu Howard, 68, had to be placed on a ventilator twice, was in the hospital for six weeks and then spent 20 days in a rehabilitation facility before he was strong enough to continue physical therapy at home.
Howard said he worked out three times a week before getting the virus, but after a long hospital stay with a tube down his throat, he had to practice basics like swallowing and walking. On the first day of rehab, his legs started shaking after standing for about one minute, but now he can climb a flight of stairs and take a walk around the neighborhood — albeit a slow one. He doesn’t feel back to normal yet, but he’s come a long way since his doctors told his wife he might not survive.
“I must have more to do in this lifetime, because I’m here,” he said.
Marc Lemon, CEO of the Denver market for Kindred Healthcare, said they’re seeing a wide variety of needs in patients who had been hospitalized with the virus. Kindred runs long-term acute care hospitals, which treat people who are still sick enough to need hospital-level care, but who can start therapy meant to allow them to go home or to a lower-level facility.
Some coronavirus patients come with lung complications, Lemon said, while others have damage to multiple organs from sepsis — basically the body’s out-of-control response to an infection. Many are dealing with anxiety and cognitive problems like confusion, particularly if they’ve spent a long time on a ventilator, he said.
“There’s not a one-size-fits-all for COVID-19 patients,” he said.
Most patients who need long-term hospital care are older and had chronic conditions before being hospitalized, Lemon said, but they’re seeing a handful of people as young as their 30s. He estimated about half of patients go home directly from their hospital, and the other half go to a nursing home or rehab facility to keep recovering.
“If you’ve been in a bed for 30 days on a ventilator, you’re not going to be able to just get up and start walking,” he said.
What remains to be seen is how many patients continue to have symptoms after the body has healed any damage from the virus itself or the treatment. A small percentage of people who had other severe coronaviruses, like SARS and MERS, developed chronic lung, heart or neurological problems, and anxiety and depression weren’t uncommon, Price said.
Scientists have different theories about why some people experience long-term symptoms, including an immune overreaction or that the virus triggers changes in the other microbes living in the body, Price said. It’s also not clear if the psychiatric effects were the result of the virus attacking the nervous system, or if they came from the fear of dealing with a new disease, she said.
Dr. Mitchell Miglis, an assistant professor of neurology at Stanford University, said he and other researchers are working on a study to try to answer some of those questions. They’re particularly interested in people who have long-term symptoms related to the body’s automatic functions, like excessive sweating, a fast heart rate and digestive problems, he said.
There’s precedent for people developing problems with the body’s automatic functions after an infection, though it’s not common, Miglis said. Scientists aren’t sure who’s at risk of long-term symptoms from COVID-19, though women are more likely to develop chronic conditions from other viruses, he said.
“Hopefully we’ll have more answers in six months or a year,” he said.
Ultimately, most people likely won’t have long-term symptoms, based on how patients recovered from previous coronaviruses, Price said. It’s important to be patient with your body, and to talk to your doctor about how to manage specific symptoms, she said.
“Most likely, you will fully recover,” she said. “Some will just take more time.”