It was when the doctor showed up at the door to James’s student house in full protective gear that he realised it could be coronavirus.
“I’d just woken up – it was about 4 AM – and he just was standing there in this full all-in-one body suit with a visor and gloves,” the 20-year-old says. “It was like some kind of nuclear radiation suit. It hit me then that it was probably something serious.”
The symptoms had started suddenly. One morning in mid-March, James developed a fever, then a splitting headache. He felt like he couldn’t walk to the bathroom without a break, sitting on the stairs to settle his rapid breathing. Later in the day, he started vomiting. Aware that he had all the symptoms of mild COVID-19, James called 111 for advice and was sent an isolation notice by email telling him he should stay home for two weeks.
“I was really down, just stuck in the uni house on my own,” he explains. “Everyone else had managed to get home, so I was just sat around all day on my phone… I felt a bit lost. It’s all a waiting game, really – just waiting to see when you’ll get better.”
Seven weeks on, James’s symptoms have started to subside, but he still feels some aftereffects of the virus.
“If I try and run around, I’m, like… Jesus! I get tired so quickly now after very little exercise and I keep having to take rests. It’s really weird.”
James isn’t the only one experiencing the long tail of coronavirus. Tessa, 26, first experienced symptoms in mid-March. At first, she felt exhausted, sleeping for 15 hours a day. Then she lost her sense of smell and developed severe headaches.
After being admitted to hospital following episodes of breathlessness, she was clinically diagnosed with COVID-19. Now in week eight, she has relapsed several times and says she expects a long and bumpy road to recovery.
“I still feel far from 100 percent,” she explains. “I’m used to running and being outside, so it’s scary to be so up and down. You can have one day when you feel pretty good and then are back in bed the next. It’s two steps forward and then one back the whole time.”
In February, the World Health Organisation published a report estimating that recovery times for mild cases of coronavirus could be expected to take around two weeks, stretching to six weeks in more severe cases.
But many say that, despite weeks of recuperation, they’re still noticing some symptoms. Medics say fatigue, breathlessness and other mild after-effects are to be expected.
“We have to acknowledge that a body fighting off coronavirus has gone through the wringer,” says Dr James Gill, a clinical lecturer at the University of Warwick. “If we’d run a marathon, it would hurt and we’d feel exhausted afterwards. This is much the same. We have to give ourselves a chance to recover.”
“If somebody is finding they can’t do three steps without needing a break, then that’s what your body is telling you to do: take a break,” Gill adds. “It’s not like a marathon, pushing for distance and time. We have to increase very slowly. Start off slow and go low.”
With little information or support available to those in recovery, many have turned to online support networks to share their experiences.
Fiona Lowenstein, a writer based in the US, set up a support group on Slack for people to discuss their symptoms and concerns, having been hospitalised for two nights with coronavirus. Now with over 4,000 members, she says many members rely on the group for information and a sense of community.
A survey conducted last week by Fiona’s group found that 90.6 percent of people had not recovered two weeks after the onset of symptoms. The average time for those who remain symptomatic is 39 days, with the majority experiencing a high fever and fatigue for five to seven weeks. Most of the respondents were not hospitalised, but the majority visited emergency rooms to seek treatment and advice.
Fiona says group discussions surrounding mental health have been particularly active.
**“**The most popular topics of discussion seem to be anxiety and fears about relapsing and depression about how long the recovery seems to take,” she explains. “We’ve had to create smaller threads for specific conversations because these discussions are so common: things like ‘need to vent’, ‘gratitude’, ‘grief’, and ‘victories.’”
Thomas, 28, regularly participates in the Slack group. He says his mental health has been of more concern than his physical health over the course of the last eight weeks.
“I keep thinking: Will it get better? Why is it taking so long? What’s wrong with me? There’s a real loneliness to all this. That’s why talking about it with other people really helps.”
“My everyday life has been totally disrupted,” he adds. “It’s meant having to adapt to a miniature version of my own life. Every time you think, ‘Surely this is all over now’, it returns with a vengeance.”
Tessa, too, says that, alongside the physical symptoms, she has noticed her anxiety levels climbing.
“At first it wasn’t too bad, but now I notice I feel really worried, the longer it goes on. I had no idea the effects would last this long and it just feels like everyone is figuring out coronavirus as we go along. I just don’t know what the next few months are going to look like in terms of me getting back to normal.”
Dr Carmine Pariante, a clinical psychiatrist at King’s College London, says mental health concerns must be considered alongside physical recovery. He anticipates high rates of depression and anxiety for those in recovery.
“It’s all one thing – the brain is in the body, so physical difficulties will have an impact on everything, including the brain,” Pariante explains. “We know this virus will have consequences for our mental health. Social isolation, financial difficulties, personal relationship problems, unemployment… People are struggling.”
Another concern among those in recovery is which sources of information they can trust. Some say that while the focus is, rightly, on the more severe cases, they believe not enough is being done to help those who have survived the illness.
“I am worried about my lungs, just because it feels like it is all lasting much longer than the average, but I don’t know who to ask about that,” Tessa says. “Even though GPs are very sympathetic, there is very little advice or research for people like me who are struggling with symptoms for many weeks after.”
Medics acknowledge they don’t have all the answers, particularly given this is a new strain of the virus.
“One thing we lack is data,” says Dr James Gill. “We can draw parallels from SARS, where up to 20 percent have impaired lung function up to a year later, so it may follow a similar line – but we still don’t know why one person may feel better quickly, while the same symptoms puts someone else at risk.”
One aspect becoming clear to medical researchers is the likelihood of fatigue among those in recovery. Last week, the ME Association published guidelines, which stated that post-viral fatigue – common following a virus like COVID-19 – can lead to more chronic health conditions if symptoms like exhaustion continue beyond the three-month mark.
“There’s nothing strange about chronic fatigue – it happens often after a virus,” says Dr Charles Shepherd, Medical Advisor for the ME Association. “Most people get over it in a few weeks, but some may find they go back to work and try to exercise their way out of it. That has a very negative impact on recovery.”
Medics advise that, rather than forcing the body to return to pre-COVID activities, patients should follow basic health maintenance. Periods of rest and relaxation; good nutrition, including five portions of fruit and vegetables a day, complex carbohydrates and high-quality proteins; and deep breathing exercises to develop lung muscles can all help.
Activity management is also recommended, with a phased return to work and tasks that reduce stress and anxiety levels.
But for those like Tessa, frustrated about the slow road to recovery, lockdown is a confusing and lonely time.
“I just want everything to get back to normal. I want to feel normal again, to understand what is happening to my body and to feel like I’m on my way to a full recovery.”
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