People with 'medium COVID' are caught in a gray area of recovery with little support

PO1 William "Chip" Nagel
..."How doctors define long COVID-19
Since the Penn Post-COVID clinic opened in June 2020, Abramoff has seen about 1,100 patients at it. He said there is no official threshold at which someone officially becomes a long COVID-19 patient. If people have been feeling bad for only a few weeks, he considers that to be the tail end of the illness itself. The clinic isn't really in the business of treating COVID-19 in its acute phase.

For those dealing with symptoms for months, the clinic takes a comprehensive approach, evaluating patients and referring them to specialists who can address their particular needs: a pulmonologist for breathing difficulty, a speech pathologist for someone struggling with cognitive issues, even social workers or other support staff who can help people navigate taking time off work and accessing various disability benefits.

But then there is that awkward gray area: people who have been feeling bad for six to eight weeks after their initial infection. Abramoff said when those people come into his clinic, which they often do, he generally sends them home and tells them to rest. They'll likely get better on their own if they take it easy.

For people in that position, his best advice is to take a "watchful waiting" approach: Keep the lines of communication with a primary care doctor open, and be very careful about not rushing back to life as normal.

"You have got to build based on your tolerance," he said. "People were very sick, even if they weren't in the hospital."

Other physicians have drawn a more definitive line demarcating when symptoms cross into long COVID-19. Stuart Katz, a cardiologist and professor at New York University's Grossman School of Medicine, is a principal investigator on a $470 million long COVID-19 study funded by the National Institutes of Health that will collect data from nearly 60,000 long COVID-19 patients across 200 sites nationwide.

For the purposes of his study, Katz and his team will classify symptoms lasting more than 30 days as long COVID-19. Using that benchmark, he estimates that about 25% to 30% of people with COVID infections will have persisting symptoms.

But he said, the 30 days is an arbitrary cutoff point.

"There's this whole spectrum of changing symptoms over time," said Katz.

One study published in Nature last year demonstrated exactly that. It tracked more than 4,000 COVID-19 patients from their initial infection until their symptoms subsided. Participants' infections varied in severity, and they self-reported their conditions through a smartphone app, mostly in the United Kingdom. Roughly 13% of participants reported symptoms that lasted more than 28 days. That dropped to 4.5% after eight weeks and 2.3% after 12, suggesting that many people still dealing with symptoms after a month recover in the following weeks.

But even a small percentage of infected people dealing with medium-range symptoms would mean millions of people: The U.S. has recorded nearly 80 million coronavirus infections to date. If about 9% of those individuals dealt with symptoms for roughly two months, that's 7 million people.

Aside from amounting to millions of people who feel ill and a lasting burden on the health care system, those numbers can add up to have a meaningful impact on the economy. Recent research from the Brookings Institution estimated that lasting COVID-19 symptoms could be responsible for up to 15% of the unfilled jobs in America's labor market.

I was lucky. I could work from home and control the pace of my day. But what if I worked in a restaurant? Or any kind of job where I needed to be on my feet all day? I would have needed to take medical leave. And if that hadn't been possible, maybe quit my job.

The point here is that even if you don't have long COVID-19, it can still take a long time to recover. A bout of medium COVID can happen to anyone — and it's important for patients, their families and their employers to understand that."...