ABERDEEN PROVING GROUND, Md. –An emerging threat facing about 10 percent of individuals who have had coronavirus disease 2019, or COVID-19, is the potential for lingering symptoms experienced after initial recovery. Those suffering from these symptoms describe themselves as COVID-19 “long-haulers.”“Studies regarding the long-term effects to people who have become ill from COVID-19 are still being conducted,” said W. Scott Monks, Jr., a certified physician’s assistant with the Army Public Health Center. “The World Health Organization defines a typical recovery time from a mild infection to be around two weeks and for a severe infection between three to six weeks.”According to the Centers for Disease Control and Prevention, a survey of patients diagnosed with COVID-19 found that only 65 percent returned to a baseline health 14 to 21 days after diagnosis. Symptoms that were most likely to persist beyond 14 to 21 days included cough (43 percent) and fatigue (35 percent); fever and chills persisted in only 3 and 4 percent. Although a lack of return to baseline health was associated with older age and a greater number of underlying health issues, approximately one in five individuals aged 18 to 34 years who were previously healthy reported that they did not return to baseline within two to three weeks.According to the Mayo clinic, the elderly and people with multiple serious medical conditions are at highest risk of experiencing lingering COVID-19 symptoms. The most common lingering symptoms include fatigue, cough, shortness of breath, headache and joint pain.A recent article published by the Journal of the American Medical Association estimated approximately 10 percent of COVID-19 patients become “long-haulers”.“Research on long-haul COVID-19 complications is still in its infancy, but as studies are completed, research will be published,” said Dr. Kelly Forys-Donahue, an APHC clinical health psychologist. “The scientific literature can help Soldiers stay abreast of the latest treatments. Doctors are also learning as this virus progresses, so although it is important to stay engaged in medical treatment, providers might not yet have all the answers.”Some infectious disease experts, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, have speculated that long-term COVID-19 might be a variant of Chronic Fatigue Syndrome known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a complex disorder characterized by extreme fatigue that worsens with physical or mental activity, but doesn't improve with rest.According to the Mayo Clinic, because it's difficult to predict long-term outcomes from the new COVID-19 virus, scientists are looking at the long-term effects seen in related viruses, such as severe acute respiratory syndrome (SARS). Many people who have recovered from SARS have gone on to develop CFS.An article published in August 2020 by the British Medical Journal included an account from a “previously fit” 40-year-old man who described these symptoms more than eight weeks after initial diagnosis:“I have continued to experience the following: fatigued to the point of having to sleep in the day, inability to exercise, continued shortness of breath both motionless and when exerting, small waves of anxiety, considerable depression, continued loss of smell. These are all post-symptoms that I have had no experience or medical history with, and so it has been difficult to wrestle with the unexpectedness of them.”Forys-Donahue recommends Army leaders employ skills like active listening, empathy and problem solving when talking to their Soldiers about any type of chronic condition or difficult situation, including the small subset of their Soldiers who may experience long-haul COVID-19 symptoms.“Symptoms of long-haul COVID-19, like fatigue and cognitive impairment, may seem invisible to leaders,” said Forys-Donahue. “Trust that your Soldier is telling you the truth about how they are feeling. Leaders can help to make sure Soldiers have medical care in place and that they are getting adequate sleep, nutrition, and resting when they need to.”Forys-Donahue says that if Soldiers are suffering with long-haul COVID-19 symptoms, leaders need to ensure that Soldiers are receiving medical care and reassure Soldiers this is not all in their heads. Behavioral health providers, specifically a health psychologist if one is available, have experience with chronic illness and can support the Soldier through this trying time.Online forums of individuals with post COVID-19 symptoms are beginning to pop up. For example, sites like www.meaction.net/covid-19 allow participants to share experiences, provide support, and feel less alone a time that can be very isolating.“We know that other conditions that lead to isolation like PTSD, depression, trauma, and substance abuse can have negative consequences like suicide,” said Forys-Donahue. “Leaders may not be able to offer medical solutions, but they can execute the important task of staying connected and engaged with their Soldiers. That alone helps to reduce stress, and less stress boosts immune function and shuts down pain pathways.”Long-haul COVID-19 Information:CDC Long-Term COVID-19MAYO Clinic COVID-19 long termME/CFS Support NetworkThe Army Public Health Center focuses on promoting healthy people, communities, animals and workplaces through the prevention of disease, injury and disability of Soldiers, military retirees, their families, veterans, Army civilian employees, and animals through population-based monitoring, investigations, and technical consultations.