As an elite competitive triathlete, César Villalba, 34, of Los Angeles knows his body. So, though he can perform “acceptably” on a pulmonary test months after his initial bout with COVID-19, that’s anything but “acceptable” for the professional designer who is used to racing around the world.
“I can do that with 60 percent of my lung capacity,” Villalba says with the heavy sigh of a man who would really just like to be better.
Villalba was never officially diagnosed with COVID-19, because he got sick before the pandemic hit full steam. “I had pneumonia, sore throat, fever for a week, and persistent coughing.”
After a couple of months, he thought he was better. Then on a plane trip to see his family in Spain, he got shortness of breath and his hands went numb. He went to the hospital when he landed, but they could find nothing wrong.
Villalba, who uses a Whoop strap to track his training, continued to see weird changes in his heart rate variability and recovery heart rate that didn’t match what he was doing in training. “And the shortness of breath would not go away. I was struggling to have a conversation over a coffee.”
His doctor eventually prescribed asthma medication. But it didn’t help. With no explanation, they ran blood scans and found that his blood clotting test showed a high risk for clotting—another symptom that can be linked to the coronavirus.
At that point, all signs pointed to COVID,” Villalba says. “The doctors are finding a lot of people with similar cases and in similar situations to me. They don’t know exactly how to treat them.”
Indeed, a paper published in the August 2020 edition of the British Medical Journal (BMJ) reported that approximately 10 percent of people who get COVID-19 experience prolonged illness.
In a JAMA research letter, Italian doctors reported that 125 of the 143 people who had been hospitalized with COVID-19 (none of whom had been on ventilators) they studied still had symptoms an average of two months after their first symptoms emerged.
Epidemiologist Tim Spector, M.D., of King’s College in London who developed the COVID-19 Symptom Tracker app, which is being used to study the symptoms of COVID-19 and track the spread of the virus, reported that though the average time to recovery for most symptomatic people is 10 to 12 days, the data he has analyzed from the U.K. shows that 12 percent have symptoms longer than 30 days, and one in 200 have symptoms that persist for more than 90 days.
The symptoms that commonly persist include fatigue, cough, difficulty concentrating (a.k.a. brain fog), muscle or body aches, shortness of breath, and/or difficulty breathing.
Those suffering from post-COVID syndrome, or “long haulers” as they’re often called, were often young and healthy when the disease struck, says Mark Tenforde, M.D., M.P.H., who is part of the CDC COVID-19 Response Team.
“From a telephone survey we conducted of adults diagnosed with SARS-CoV-2, almost 20 percent of young adults (18 to 34 years of age) with no baseline medical conditions reported not being back to their usual health two to three weeks after testing positive,” Tenforde says.
“COVID-19 isn’t ‘just a cold’ and even people who are generally healthy and active like runners or other athletes can experience a bad illness and/or a prolonged road to recovery,” Tenforde says. “People should take measures to reduce their risk of infection, including wearing masks, washing hands regularly, and taking social distancing measures.”
The underlying reasons behind this prolonged illness remain somewhat of a mystery, Spector says. “We don’t know for sure [why the symptoms persist],” Spector says, “but after two weeks, the virus is likely to be dead and not replicating. We think it’s the immune system overreacting.”
It’s also possible that you can feel okay when you’re just walking around, but then get hit with symptoms when you try to go for a run or a ride, Tenforde says.
“COVID-19 can cause stress or injury throughout the body including in the lungs, the heart, as well as other organs, and some of these symptoms like fatigue after infection may become more apparent with increased activity,” Tenforde says.
That’s something Villalba, who is is riding the long COVID rollercoaster, knows all too well.
“There are a lot of ups and downs. I’ll feel slightly better for two weeks and then for no reason, get worse for three weeks. I’m better than I was at the beginning of the year. But I’m not able to do the same things I used to be able to do, and it’s very frustrating sometimes, but at least I am able to get out and exercise,” Villalba says.
“Swimming is what feels the best right now, and I am able to enjoy cycling, though I can’t go hard. Running is what I struggle with the most, just getting enough oxygen. I’m just trying to deal with it and stay positive,” he says.
Long Haul COVID Bootcamp and Rehabilitation
Life as a long hauler can be scary, confusing, and frustrating, especially for active folks like Villalba who are used to a straightforward approach to rehabbing injuries and getting over illness, says Noah Greenspan, a doctor of physical therapy specializing in the care of cardiovascular, pulmonary and complex medical patients, who has just launched a new COVID-19 Rehabilitation and Recovery Center at H&D Physical Therapy at the The Pulmonary Wellness Foundation (PWF) in New York City.
“I’ve been in practice for almost 30 years and this is like nothing I’ve ever seen,” Greenspan says. “This plays by its own rules. Usually my average pulmonary or cardiovascular rehabilitation patient is 80 years old. With COVID long haulers they’re 30s, 40s, and 50s. The majority are people we see were athletic and fit.”
The COVID-19 Rehabilitation and Recovery Center will provide medical support to recovered COVID-19 patients in New York and the surrounding tri-state area as they continue to work on getting healthy. Greenspan describes long-haulers as patients who recovered from the acute virus, but after 30, 60, 90 and even 120 days, are still experiencing symptoms.
For those who are not able to come into the center, Greenspan also offers an online COVID Rehabilitation & Recovery Bootcamp, which he launched in August.
The bootcamp includes online exercise and stress reduction sessions including breathing, walking, balance, strength, and flexibility training, as well as patient education and support for COVID long-haulers. As of today, 1,300 COVID long-haulers globally have participated in the Bootcamp.
“It’s been a very challenging time, but we are definitely seeing a trend in individuals getting better. It takes time. But there is hope,” Greenspan says.
To help with the understanding and tracking of the disease, you can download the COVID Symptom Study app here. The Centers for Disease Control has regularly updated information available at cdc.gov/coronavirus.