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We know about long COVID. Should there be a medium COVID?


When our colleague Nina Feldman got sick with omicron, she thought she knew what to expect. She's a health reporter for WHYY in Philadelphia. She's young and otherwise healthy, so she knew of two possibilities - a short case of COVID that didn't harm her too much or long COVID, which was relatively rare. What she experienced, though, fell between, so she found out more about what she calls medium COVID.

NINA FELDMAN, BYLINE: I got COVID over the holidays. I had a sore throat, was super tired and had to take more than a week off work. I tested negative after eight days and thought I was feeling better. But pretty quickly, it became clear I wasn't. I started getting these waves of extreme fatigue. Soon, I realized they were brought on by physical activity - a walk in the cold, a ride on the exercise bike. I'd get bone crushingly weak a day after a workout. It would take days to recover. I couldn't drink alcohol. Even one glass of wine made me feel like I'd partied all night. All of this lasted for weeks, and I wasn't alone. My friend Kenny Cooper, another reporter at the station, got COVID when I did. Like me, he's physically active, vaccinated and boosted. Like me, he thought he knew what to expect from a case of what was almost certainly omicron - quick and mild.

KENNY COOPER, BYLINE: Mild for COVID is definitely on a different level.

FELDMAN: Kenny was sick for almost two weeks before testing negative. His symptoms kept going for at least two more weeks on top of that. It was scary.

COOPER: I just felt like there were weights on my chest. I couldn't sleep properly. Even when I woke up, if I moved around too much, I would start coughing immediately.

FELDMAN: His persistent cough kept him from leaving the house.

COOPER: I wasn't able to do much. Even when I wanted to, you know, go out for stories or hang out with friends and family, as soon as the outside air would touch me, I would just start coughing.

FELDMAN: Kenny and I have both been covering COVID-19 and the pandemic since it started, but neither of us were prepared for the recovery process to take this long. So was this long COVID? Various doctors and researchers define long COVID differently. Dr. Ben Abramoff treats long COVID patients at Penn Medicine in Philadelphia.

BEN ABRAMOFF: It's not always a quick bounce back right away after the initial infection.

FELDMAN: He says people like me and Kenny still suffering symptoms six or eight weeks out will usually get over the illness on their own if they take it really easy. If they come to his clinic during that period, which some do, he'll likely send them home and tell them to rest.

ABRAMOFF: We start by just taking it slow, working with primary care doctors, not rushing back into everything right at once.

FELDMAN: But he says that doesn't mean those six to eight weeks are a cakewalk.

ABRAMOFF: People were very sick even if they weren't in the hospital. This is still a very significant viral infection. And sometimes it's just a more gradual recovery process than people's previous viral illnesses.

FELDMAN: Abramoff focuses on patients who've been dealing with COVID symptoms for more than two months. Other doctors start diagnosing long COVID earlier. Dr. Stuart Katz is leading a national study that defines long COVID as symptoms persisting longer than a month. He estimates 30% of people who get COVID have symptoms that last that long. But he says most of those people do get better. If you're still sick after 30 days, it doesn't mean it's forever. Some people just need longer to recover, like I did.

STUART KATZ: There's this arbitrary cutoff at 30 days. So it's really more of a continuum.

FELDMAN: He also confirmed that other patients experienced the energy crashes I did. The clinical term is post-exertional malaise.

KATZ: If they do anything, they're totally wiped out the next day.

FELDMAN: I asked him, is it best to just take it easy, not dive back into work or exercise? He says there's not enough data to know yet what exactly to advise, but people should try to listen to their bodies.

KATZ: To me, it's just sort of common sense. Like, you know, OK, well, if it makes you feel bad, don't do it.

FELDMAN: So that's what I did. I stopped exercising. I didn't drink. And once I learned that it wasn't unusual for symptoms to linger for a couple months, I was less anxious. I stopped worrying that I'd feel this way forever. Understanding it as medium COVID gave me a framework. And for me, resting worked. About eight weeks after testing positive, my life finally got pretty much back to normal. The point here is that even if you don't end up with a debilitating, life-altering illness, COVID can require a very slow recovery. And it's important for patients, their families and employers to understand that. I was lucky. I could work from home and control the pace of my day. But what if I worked at a restaurant or any kind of job where I needed to be on my feet all day? And a bout of medium COVID or long COVID can happen to anyone, even young or otherwise healthy people like me. Again, Dr. Abramoff at Penn Medicine.

ABRAMOFF: If you're 20 and you get it or you're 30 and you get it, it's not like nothing happens, you know? It's still, you know, something that would kill, like, somebody who's in their 70s and it's the same thing in your body, it's not nothing.

FELDMAN: The omicron wave is ebbing now, but record numbers of Americans were infected. That means more people than ever before are now recovering from COVID, and they might be for a while. For NPR News, I'm Nina Feldman in Philadelphia.


INSKEEP: This story comes from NPR's partnership with WHYY and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

Nina Feldman