After COVID-19 FAQs

I Had COVID-19: What Now?

Updated April 30, 2021

In this document, the Blue Ribbon Committee on Health addresses questions about recovering from COVID-19 once a person has had a confirmed infection with the virus. If you are currently actively infected, you must isolate and follow the NH Governor's and DHHS guidelines

How long does a COVID-19 infection last?

For those who experience symptoms, the symptoms typically develop between 2 and 14 days after becoming infected with the COVID-19 virus. These symptoms include fever, dry cough, cough with phlegm, fatigue, achy muscles and joints, chills, nausea, vomiting, and diarrhea. Some people also lose the sense of taste and/or smell and, others develop skin rashes and dark toes (“COVID toes”).  Some people report being unable to take a deep breath and feeling as if a band is tightened around their chest making it hard to breathe. 

In terms of symptoms, some people compare the illness to a mild-to-bad cold, while others report feeling "the sickest they have ever felt."  There is so much variety in symptoms that it impossible to predict any one person’s experience with a COVID-19 infection.

How long do the symptoms commonly associated with COVID-19 last?

Most people with mild cases appear to recover within one to two weeks. For those with more severe cases (requiring hospitalization and/or intensive care), it can take up to 6 weeks before beginning to feel “normal” again.  Recent surveys conducted by the CDC found that recovery may take longer than previously thought, even for adults with milder cases who do not require hospitalization, based on a person’s age, pre-existing health condition and overall health.

Recovery rates vary, based on information from confirmed cases (i.e. those who had a positive test result) as there is no data about illness length or recovery in people who have not had COVID-19 tests. Information about the outcome of every infection is not being collected. However, early estimates predict that the overall COVID-19 recovery rate is between 97% and 99.75%. [source?]

The most commonly-reported lingering symptoms are fatigue, headache, and breathing problems.

How will I know if I have completely recovered from COVID-19?

Knowing when you have recovered from COVID-19 will depend on whether or not you had symptoms and how long the symptoms lasted.

  • Someone who had a positive test but no symptoms: the CDC and NH DHHS consider that you are recovered 10 days after the positive test. At this time, you can end isolation and resume normal activities keeping in mind that you are still required to wear a mask and maintain physical distancing.
  • Someone who experienced symptoms with or without a positive test is considered recovered when they have had no fever for 24 hours without using a fever reducing medicine such as acetaminophen [Tylenolä], aspirin, or ibuprofen [Advilä, Motrinä], when symptoms are steadily improving, AND when it has been at least 10 days since symptoms other than the loss of taste and/or smell started. The loss of taste or smell may persist for weeks or months; so you do not have to wait for those symptoms to go away.

Should I have another COVID-19 test once I have completed the isolation period?

No. According to the CDC after recovering from COVID-19 symptoms and a confirmed positive test, you may continue to test positive for three months or more without being contagious. This is because you may have non-infectious remnants of the virus in your nasal passages.

You should be tested only if you develop new symptoms of COVID-19. That decision should be discussed with your healthcare provider, especially if you have been in close contact with another person who has tested positive for COVID-19 in the last 14 days.

Should I have an antibody test after having COVID-19?

This is a question you should discuss with your health care provider. It can take several weeks for your immune system to produce enough antibodies for an antibody test to be positive; and it is also not known how long these antibodies will be detectable in your blood.

Antibody tests are blood tests that require a technician to draw a sample of blood. The blood then undergoes a serology test looking for COVID-19 antibodies (also called immunoglobulins and abbreviated Ig). A positive result might mean you have some immunity to the coronavirus but it is too early to know how strong the immunity might be or how long it will last.

A negative result means you haven’t come into contact with the virus or you haven’t had COVID-19 long enough to make antibodies. You could also have been exposed and not have antibodies. This is called a false negative. It’s also possible to get a “false positive” if you have antibodies but had a different kind of coronavirus.

If your antibody test is positive you may want to consider donating blood for use in treating persons hospitalized with an experimental treatment for COVID-19 called convalescent plasma. Plasma is the liquid part of your blood. Researchers are studying how antibodies in plasma donated by people who’ve recovered from COVID-19 might help those who are ill with the virus. Early research shows that this plasma may help sick people get better faster.

You can volunteer to donate plasma through the National COVID-19 Convalescent Plasma Project. Or ask your local blood donation center for information.

Are there any studies on the long term complications of COVID-19?  What is “Long-COVID” or a COVID Long-hauler?”

Articles in medical journals report that anywhere from 10%* to 80%^ of persons continue to experience troublesome symptoms after 3 or more months following initial COVID-19 infection. Sometimes the symptoms are new and sometimes they continue to linger beyond the usual recovery period.  “COVID long-hauler” is the common term used to describe this phenomenon.  As more people experience lingering and/or new symptoms following recovery from the initial infection, the medical community has come to understand that there is no “one” pattern to these post-COVID symptoms.  Very different chronic illnesses may develop in some people who have had COVID-19.

Persistent symptoms of Long-COVID-19

The NH DHHS and CDC  both reported (January 27, 2021)

  • 76% of all COVID patients, hospitalized and not, experience Long COVID symptoms.
  • And the treatment is symptomatic. Data still being collected.
  • Extensive diagnostic testing doesn't seem warranted. 
  • Long-COVID is real. Does seem to increase with the severity of the COVID experience, but otherwise healthy individuals can experience it and/or develop worsening symptoms 4-6 months after. 
  • Patients are getting better.
  • "Brain fog does not equal dementia."

If I have lasting symptoms what should I do?

The CDC along with the health care community is actively working to learn more about the type and effect of symptoms that seem to last a long time (now described as "Long-COVID"). In February 2021 the National Institutes of Health [NIH] announced a major initiative to study long-COVID.  For more information on this initiative click here.

Because COVID-19 is a new illness, and as with any illness, it will take the medical community time to understand the nature of the illness and its short- and long-term effects. Studies are in progress to follow persons with continuing symptoms.

In the beginning COVID-19 infection was viewed as a respiratory (lung) disease; we now know that it can also affect the heart, vascular system (blood vessels), kidneys, skin, brain and mood.

 

If you have any of the following symptoms and they are not improving after two to three weeks you should contact your health care provider to discuss strategies for improving your health, including a referral to the Dartmouth Hitchcock clinic.

Depending on your symptoms there may be diagnostic tests that show changes in function, most commonly for lingering respiratory problems.  However, it is important to know that many of the symptoms have NO specific tests or test findings to explain the symptoms.  This does not mean your symptoms should be minimized – it just means there are no current tests for those symptoms.  While there are investigational treatments for those with an active infection, there are no widely available treatments for the post-infection period.  Your health care provider may discuss with you specific strategies for symptom management and precautions you should be taking to prevent further complications. 

If you have any of the following symptoms and they are not improving after two to three weeks you should contact your health care provider to discuss strategies for improving your health. While there are treatments for those with an active infection, there are no widely available treatments for the post-infection period. Your health care provider may suggest specific strategies for symptom management and precautions you should be taking to prevent further complications.

The most commonly reported long-term symptoms include:

  • Fatigue
  • Shortness of breath
  • Cough
  • Joint pain
  • Chest pain

Other reported long-term symptoms include:

  • Difficulty with thinking and concentration (sometimes referred to as “brain fog”)
  • Depression
  • Muscle pain
  • Headache
  • Intermittent fever
  • Fast-beating or pounding heart (also known as heart palpitations)

More serious long-term complications that appear to be less common but have been reported include:

  • Cardiovascular: inflammation of the heart muscle
  • Respiratory: lung function abnormalities
  • Renal: acute kidney injury
  • Dermatologic: rash, hair loss
  • Neurological: smell and taste problems, sleep issues, difficulty with concentration, memory problems
  • Psychiatric: depression, anxiety, changes in mood

What is a COVID-19 “long-hauler”?

People who experience the above symptoms for months after contracting COVID-19 refer to themselves as “long haulers” and have what has been labeled post-COVID-19 syndrome or "long COVID-19."

Older people and people with many serious medical conditions are the most likely to experience lingering COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for weeks to months after infection. 

For more information on post-COVID-19 syndrome, click here.

Have any treatments been helpful in dealing with long-COVID?

Those experiencing breathing difficulty have improved with pulmonary rehabilitation efforts focused on guided exercise or gradual, slow increases in activity.  In these programs a physical or respiratory therapist develops and supervises a plan of breathing exercises to improve lung function so that normal daily activities and exercise start getting easier. The amount of time needed depends on many factors, though some programs report that improvement is a slow, steady process that may take between 6 and 12 months.

While breathing and pulmonary problems respond more readily to treatment there are no easy “fixes” for the neurological symptoms that many experience as part of long-COVID syndrome.  Until more is known about the causes of these symptoms those affected will need to adjust their lifestyle to accommodate.  It is a good idea to stay in touch with your primary care provider so that new information or strategies to treat long-COVID can be incorporated in your health care.

 

To meet the needs of the growing number of people in New England impacted by post-acute symptoms, Dartmouth-Hitchcock Medical Center (DHMC) has launched the first post-COVID-19 program in northern New England. Led by Infectious Disease physician Jeffrey Parsonnet, MD, the team consists of 10 DHMC physicians across medical disciplines. The DHMC post-COVID-19 program will accept referrals of adult patients from the patient’s primary care provider who meet the following criteria:

  • A history of documented or likely COVID-19 infection, as defined by one of these criteria:
    • Positive respiratory PCR or antigen test during acute illness.
    • Positive serum antibody test.        
    • A history of acute COVID-19, based on typical symptoms and/or suggestive epidemiology.
  • Symptoms that started after the onset of COVID-19 and are persisting for 12 weeks or more after the onset of symptoms.
  • Have a primary care provider who places the referral and will be available for collaborative patient management and after-visit care.

For more information about the post-acute COVID-19 program, call 603-650-9484 or email postcovid@hitchcock.org.

Am I at risk for getting COVID-19 again?

"Reinfection" means a person was infected once, recovered, and then later became infected again. According to the CDC and based similar viruses, some reinfections are expected. 

The CDC is actively working to learn more about reinfection and has developed recommendations for public health professionals to help decide when and how to test someone for suspected reinfection. The best way to prevent reinfection is to follow the recommendations for preventing infection whether you have had COVID-19 or not:

  • Wear a nose- and mouth-covering mask in all public places; be sure the covering has a tight weave and consider double masking and/or adding a filter between mask layers for enhanced protection
  • Stay at least 6 feet away from other people who are not living with you in your household and limit the time you are in any gathering outside your household
  • Wash your hands and avoid touching your face
  • Avoid crowds and confined spaces – outdoors is always safer than indoors if you must leave your home.  When outdoors remember that how close you are to others, how long you stay in one place, how many people are present, how long you are there, temperature and sunshine all affect the possibility you will come in contact with enough virus to become infected.  While the risk of outdoor infection is lower than indoors the safest way to avoid infection is to stay at home.

Should I get a vaccination even though I’ve had COVID-19?

Yes! According to the CDC, even people who have already gotten sick with COVID-19 may benefit from the vaccine.  If you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Talk to your doctor if you are unsure what treatments you received or if you have more questions about getting a COVID-19 vaccine.

COVID-19 can lead to serious illness and long-term complications, even in younger people and those without underlying medical conditions. It is possible for someone who has already had COVID-19 to be re-infected, though this is not common.

It is not yet known how long natural immunity to COVID-19 lasts or if the strength or duration of natural immunity varies based on the severity of the initial illness.

If I had COVID-19 AND I get a vaccination do I still need to follow the mask recommendation?

Yes. 

Research continues to understand more about the protection that COVID-19 vaccines provide in real-world conditions before making that decision. Other factors, including how many people get vaccinated and how the virus is spreading in communities, will also affect this decision. It is not yet known whether getting a COVID-19 vaccine will prevent you from spreading the virus that causes COVID-19 to other people, even if you don’t get sick yourself.

While experts learn more about the protection that COVID-19 vaccines provide under real-life conditions, it will be important for everyone to continue using all the tools available to help stop this pandemic.

Resources:

CDC Vaccine FAQs

CDC: When to end home isolation for COVID-19

CDC: COVID-19 Long-term effects