In addition to the tally of confirmed COVID-19 cases, there is a secondary count of the number of people who have recovered from the infection. What does it mean, to be counted as someone who has recovered from COVID-19? What does that look like?
As it turns out, there is a strict methodology for how to count recovered cases, and, as is the case with so many illnesses, what counts as an official recovery doesn’t always mean the patient is left with no lingering effects.
According to the CDC, in order for a person to be considered recovered, they must be fever-free without the aid of fever-reducing medications for three consecutive days and they need to show an improvement in their other symptoms, such as coughing and shortness of breath.
In addition, a person must test negative for the coronavirus twice in tests taken at least 24 hours apart. That’s the official standard for a person to be considered among the tally of “recovered.”
However, your body successfully fighting off the virus and returning to the way you felt before you got sick are two separate things. For those with a more severe case of COVID-19, there are likely to be lingering effects, even after the virus is gone.
“To many people, what they consider “recovery” is very personal,” says Brad Butcher, founder and director of the Critical Illness Recovery Center at the University of Pittsburgh Medical Center Mercy. “Some may consider recovery as leaving the hospital, some may see it as a return to work or a favorite activity, even if they have lingering challenges and some may not define recovery until they feel as if they did before they fell ill.”
What this means it is that it is possible to be considered “officially” recovered from a COVID-19 infection, but to still experience lingering symptoms, including fatigue, muscle weakness and shortness of breath, as well as compromised lung, kidney or liver function. These are all symptoms that take time to resolve.
“Recovery is a marathon, not a sprint,” Butcher says. “It only takes days to get sick, but it can take weeks, if not months or years, to recover.”
Generally speaking, lingering symptoms seem to scale with the severity of the illness, meaning the more severe the original infection, the more likely a person is to have an extended recovery time. That said, given how new the coronavirus is, we still have a lot to learn.
“What happens with people long-term is yet to be determined,” says Howard Huang, a pulmonologist and director of the lung transplant program at Houston Methodist Hospital. We are still learning about the coronavirus, from the exact mechanisms by which it affects the body to the extent of its long-term effects. However, as Huang notes, generally the presence of lingering symptoms seems to correspond with the severity of the illness.
“If you develop a severe case, this is not something you are going to get over like your average cold,” Huang says.
Right now, some of the longer-term effects of COVID-19—including impaired organ function and blood clots or stroke—are thought to result from either the virus attacking the lining of blood vessels or from a hyperactive immune response. If you had a mild case, it’s less likely you’ll experience some of these effects.
Especially for cases that require hospitalization, recovery is often a long road, and can look different for everyone. “It really takes a severe toll on your body,” Huang says.