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COVID-19 Long-Haul Recovery

Speaking at a conference in early July, Dr. Anthony Stephen Fauci, director of the National Institute of Allergy and Infectious Diseases, noted that long-hauler symptoms resemble those seen in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

There is no cure or test for ME/CFS but difficulty breathing, exercising, brain fog and sleep trouble are among the many symptoms similar to long-hauler.

Long-hauler refers to people who for weeks to months after mild symptomatic or asymptomatic COVID-19 infections experience ailments that are physically painful, diminish their quality of life or both.

The medical term is sequela, conditions caused by the primary infection. Lower-grade but debilitating effects include fatigue, hair loss, heart palpitations, musculoskeletal pain and shortness of breath

Alyssa Milano helped bring attention to hair loss and other long-hauler symptoms when she shared her experience on Twitter with a video.

See top 20 long-hauler symptoms identified to date.

Compounding the difficulties for this growing population, a large number of long-haulers did not get tested for COVID-19 or tested negative.

Learn more: Why antibody testing may be producing mixed results. 

Lack of "evidence" presents problems when trying to explain their situation to their employer 1 and challenges their ability to be heard by medical providers. 

As of Sept. 3, the data tracking site Worldometers reported 6,323,043 total cases in the US;

3,558,372 recoveries and 190,677 deaths. 

WHO: 80% of COVID-19 Cases are Mild Or Asymptomatic

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Validating Long-Hauler Concerns

It's well established that stress undermines the body's ability to heal. With that stated, one way that long-haulers can move forward is to continue to make their voices heard. The emergence of the possible long-hauler - ME/CFS connection may also provide useful treatment tips.

What Is ME/CFS?

ME/CFS is thought to develop from or be triggered by damage from a virus or a combination of illnesses. 

A National Academy of Medicine (NAM) report on ME/CFS states:

  • An estimated 836,000 to 2.5 million Americans suffer from ME/CFS.
  • About 90% of people with ME/CFS have not been diagnosed.
  • ME/CFS costs the US economy about $17 to $24 billion annually in medical bills and lost incomes.

Long-Term Recovery From COVID-19 

How can you recover from COVID-19?

Dr. Fauci advises anyone recovering from COVID-19 to treat themselves like they are recovering from an illness like the flu.  

You may also want to address specific symptoms and conditions. JK Rowling commented on Twitter how lung exercises helped her fully recover from respiratory symptoms.

Boosting Lung Health

Pulmonary rehabilitation may include exercise training such as walking, using a stationary bike and weights and the use of an incentive spirometer, a device that can help you take deep breaths correctly.2

Lung rehabilitation tool

How to use a spirometer3:

  • Sit up and hold the device.
  • Place the mouthpiece spirometer in your mouth. Make sure you make a good seal over the mouthpiece with your lips.
  • Breathe out (exhale) normally.
  • Breathe in (inhale) slowly.

Support Groups

Support groups on social media platforms like Facebook, Instagram and Twitter offer some refuge through emotional validation and shared knowledge. Additionally, post-COVID recovery centers are opening in some cities.

Look To Treatments for ME/CFS

You may find ME/CFS caregiver guidelines helpful for long-term COVID-19 recovery. Suggested care includes activity management and listening to your body (self-management).

While exercise and returning to regular activities as best as possible may be the goal, be aware of your exertion limits to avoid post-exertional malaise (PEM).

PEM is defined as worsening of symptoms after physical, mental or emotional exertion that would not have caused a problem before the illness. Success is likely to come with trial and error.

"Self-management goes beyond simply supplying patients with information. It includes a commitment to patient-centered care, providing clear and useful information to patients, helping patients set goals and make plans to live a healthier life, creating a team of clinicians and administrative staff with clearly understood roles and responsibilities, and using office systems to support followup and tracking of patients," according to the Agency for Healthcare Quality and Research.

Rebuilding Your Immune System

Your immune system is your body's natural defense. It consists of innate immunity (front end ) and adaptive immunity (back end).

Infection with COVID-19 usually means the virus has already infiltrated the body's front gate, so T cells and B cells, the primary components of adaptive immunity, dominate COVID research.

Although some researchers point to the role of IgA antibodies, which make up both innate and adaptive immunity. If produced in sufficient quantity in nasal mucosal membranes IgA may defeat COVID-19 early.4

Winning for either side depends on timing, quantity and quality.


The main paint of entry for COVID-19 is through human receptor angiotensin converting enzyme 2 (ACE2) present in mucosal membranes in the nose, mouth, throat and eyes.

COVID-19's spike protein binds to ACE2 in epithelial cells and disrupts ACE2's vital function as a biochemical pathway helping regulate processes such as blood pressure, wound healing and inflammation. 

IgA can neutralize SARS-CoV-2 cells before they can bind to epithelial cells.4 Testing saliva and tears for COVID-19 specific IgA proteins is used for early COVID-19 diagnosis.4 

ACE2 are also concentrated in the lungs but by the time the virus reaches the lungs, the infection may be more difficult to defeat.

Hence, the importance of mask wearing and social distancing. Even if your mask doesn't block out all of the virus droplets or aerosolized particles, ideally IgA antibodies, which develop in nasal mucosal membranes, attach to coronavirus cells and deactivate them.

kn95 mask sale

However, without a mask or in cases of an onslaught of virus cells, IgA may not prevail.4 In the early months of the pandemic, to the surprise of researchers, "healthy, young doctors" were dying from COVID-19. It turns out they did not have sufficient PPE and their mucosal membranes were exposed to massive amounts of the virus when caring for severely ill patients, especially during intubation.

The Role of B Cells In The COVID-19 Fight

B cells create specific antibodies to defeat antigens. Antigens are unique identifiers such as a molecule or molecular structure that may present itself on the outside of a pathogen. Adaptive immunity identifies antigens and then uses several methods to defeat the invading source.  

IgM, IgG, IgA

IgM make up 75% of serum antibodies in humans. It's usually the first to appear in the blood after exposure to a pathogen and may stay present in the body for long periods of time. IgM protective properties are only useful during the active infection.

Testing for IgM is a way to detect if someone has been exposed to COVID-19 antigen but it it not a reliable gauge for contagiousness.

IgA also develop early in the infection phase and their presence is a strong indicator of trasmission potential.

IgG (neutralizing antibodies) are secreted by memory B cells and can remain active in the blood to protect against new infections. 

All 3 antibodies are used in testing.

COVID-19 Antibody Production Differences Add To Complexity

COVID-19 studies are now acknowledging that it's possible that COVID-19 antibody test false negatives may be due to the science of the virus and not necessarily faulty technology.

A study published in NatureMedicine reported that through the use of real-time polymerise chain reaction (RT–PCR) testing, researchers identified patterns among the development of the antibodies IgG and IgM in symptomatic and asymptomatic cases.5

Asymptomatic individuals developed fewer IgG and IgM and the levels reduced in them early in the convalescent phases compared to the symptomatic patients.5

It's also been reported that some people may not develop antibodies at all. This could account for negative antibody tests. Additionally, men may be less likely to develop antibodies than women, which could attribute to the larger rate of severe cases among males.5

Can I Get Reinfected With COVID-19?

Research on COVID-19 IgG has not been conclusive to date on how long IgG offer protection. However, there is evidence that these antibodies and the memory of how to defeat COVID-19 may be tenacious in B cells and T cells.6,7

Multiple studies show T cells6—even at very low levels— had remained viable and were able to replicate themselves.7

T cells are required to recall memory cells into action so they can begin developing new, targeted antibodies to defeat a pathogen once again.

CT Scan Shows Lung Damage to Asymptomatic Covid-129 Survivor

As evidenced in imaging of COVID-19 survivors from very mild cases to extreme cases, there is little doubt that infection is something to try your best to avoid. 

Recommendations on mask wearing, social distancing and hygiene remain.

Additionally, groups of researchers continue to insist that coronavirus aerosol transmission is a serious threat. 

In July, 200 researchers sent the letter "It is Time to Address Airborne Transmission of COVID-19" to the WHO. An excerpt follows: 

"There is significant potential for inhalation exposure to viruses in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale), and we are advocating for the use of preventive measures to mitigate this route of airborne transmission."

Josh Santarpia, microbiologist at the University of Nebraska Medical Center, is one of the signatories. Santarpia was recently interviewed on NPR

What Are Long-Hauler Symptoms?

Dr. Natalie Lambert, of Indiana University School of Medicine, and Survivor Corps published survey results collected from a Facebook group for COVID-19 survivors. Over 1,567 survivors responded with every participant listing fatigue as a symptom. Muscle or body aches, shortness of breath or difficulty breathing were experienced by about 1,000.

Lambert included 50 of the most common symptoms. The complete list with the number of people reporting them can be found in her report.  Below are the top 20 symptoms cited in the order of frequency beginning in the left column.

Top 20 Reported COVID Long-Hauler Symptoms

Fatigue Persistent chest pain or pressure
Muscle or body aches Cough
Shortness of breath or difficulty breathing Joint pain
Difficulty concentrating or focusing Heart palpitations
Inability to exercise or be active Diarrhea
Headache Sore throat
Difficulty sleeping Night sweats
Anxiety Partial or complete loss of smell
Memory Problems Tachycardia (rapid heart rate)
Dizziness Fever or chills

CDC Releases Survey Results On Long-Hauler Symptoms

The CDC posted results from a 13 state telephone survey conducted April 15–June 25 of 274 adults aged 18 and over who were not hospitalized but had a positive first RT-PCR test result.

Data showed 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.

Posted results include a comparison of symptoms reported by survey participants at the time of their RT-PCR test results compared to lingering symptoms 14-21 days later.

More about supporting and restoring your health:

Do you know the difference between self-care and self medicating? Learn more: Self-Care vs Self-Medication 

In order to optimize your immune system, you must first understand the fundamentals. Learn more: Boost Your Innate & Adaptive Immunity


1 Tuller D. A dilemma for 'long-haulers': Many can't prove they had Covid-19 - STAT. Published 2020. Accessed September 3, 2020.

2 Pulmonary Rehabilitation | Cystic Fibrosis | COPD | MedlinePlus. Published 2020. Accessed September 3, 2020.

3 Using an incentive spirometer: MedlinePlus Medical Encyclopedia. Published 2020. Accessed September 3, 2020.

4 Chao YX, Rötzschke O, Tan EK. The role of IgA in COVID-19. Brain Behav Immun. 2020;87:182-183. doi:10.1016/j.bbi.2020.05.057

5 Long, Q., Tang, X., Shi, Q. et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med 26,1200–1204 (2020).

6 Wu K. Scientists See Signs of Lasting Immunity to Covid-19, Even After Mild Infections. Published 2020. Accessed September 3, 2020.

7 Ripperger T, Uhrlaub J, Watanabe M. et. al. Detection, prevalence, and duration of humoral responses to SARS-CoV-2 under conditions of limited population exposure. MedRxiv, the Preprint Server for Health Sciences Published 2020. Accessed September 3, 2020.

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