While the World Health Organization says long COVID starts three months after the original bout of illness or positive test result, the Centers for Disease Control and Prevention sets the timeline at just after one month.
Among the many confounding aspects of the coronavirus is the spectrum of possible symptoms, as well as their severity and duration. Some people develop mild illness and recover quickly, with no lasting effects. But studies estimate that 10% to 30% of people report persistent or new medical issues months after their initial coronavirus infections — a constellation of symptoms known as long COVID.
People who experience mild or moderate illness, as well as those without any underlying medical conditions, can nonetheless experience some debilitating long-term symptoms, including fatigue, shortness of breath, an erratic heart rate, headaches, dizziness, depression and problems with memory and concentration.
Such lingering medical issues are so varied that one study by a patient-led research group evaluated 203 symptoms that may fluctuate or even appear out of the blue after people seem to have recovered.
As Dr. Ziyad Al-Aly, the chief of research and development at the VA St. Louis Healthcare System and a clinical public health researcher at Washington University in St. Louis, said, “If you’ve seen one patient with long COVID, you’ve seen one patient with long COVID.”
How doctors currently diagnose long COVID
There is little consensus on the exact definition of long COVID, also known by the medical term PASC, or post-acute sequelae of COVID-19. While the World Health Organization says long COVID starts three months after the original bout of illness or positive test result, the Centers for Disease Control and Prevention sets the timeline at just after one month.
Some researchers and health care providers use other time frames, making efforts to study and quantify the condition more difficult, said Al-Aly, who has conducted many studies on long-term post-COVID issues.
When patients experiencing persistent symptoms go to their doctors, tests like electrocardiograms, chest X-rays, CT scans and blood work don’t always identify physiological problems, Al-Aly said. Researchers are working to pinpoint certain biological factors, called biomarkers, that correlate with persistent COVID symptoms. These could include signs of inflammation or certain molecules produced by the immune system that might be measured by blood tests, for example.
Long COVID is defined as symptoms that cannot be explained by an alternative diagnosis and last at least two months following an initial COVID-19 infection. It is usually after three months (12 weeks) of persistent symptoms when a patient is suspected of having long COVID.
Long COVID can affect anyone of any age, including children and adolescents. Even if you had mild or no symptoms when you were first infected, you can be impacted by long COVID.
For some, long COVID symptoms can be more severe than the acute COVID-19 infection itself. According to the World Health Organization (WHO), symptoms can persist from the initial illness or begin after recovery, and they may come and go or improve over time.
Long COVID can interfere with a person’s ability to perform normal, everyday activities, like work and household chores. With children, it can affect their ability to do their schoolwork. While it cannot be predicted how long a given patient may experience long COVID, some research has shown that patients can get better over time.
Long COVID Symptoms
Long COVID symptoms are different from acute COVID symptoms. Conditions can include, but are not limited to:
Persistent cough
Loss of (or changes in) taste and smell
Depression
Difficulty breathing or shortness of breath
Sleeping problems
Lightheadedness
Diarrhea
Fatigue
Anxiety
Chest pain
Palpitations
Headache
Joint and muscle pain
Poor appetite
How Does Long COVID Affect Children?
Some common symptoms seen in children include fatigue, headache, trouble sleeping and concentrating, muscle and joint pain, and cough. As with other medical conditions, young children may have trouble describing the problems they are experiencing.
According to the Centers for Disease Control and Prevention (CDC), information on long COVID in children and adolescents is limited, so it is possible other symptoms may be likely in younger age groups.
If your child is suffering from long COVID and is unable to complete their normal school assignments, it might be best to ask school administrators about accommodations such as extra time to complete tests and assignments, rest periods throughout the school day and modified class schedules, says the CDC.
What Causes Long COVID?
It is unknown why people experience long COVID. The cause is still an active area of research. Some experts believe the cause is potentially due to the body’s hyper-inflammatory immune response to a new germ.
When the novel coronavirus began to spread across the world in February 2020, Freya Sawbridge was caught in a bind. The 27-year-old was living in Scotland, but when businesses and borders began to close she packed up and flew home to Auckland, New Zealand. On arrival, she felt feverish and couldn’t smell or taste food.
In those early months of COVID-19, every new symptom made global headlines. Freya got tested and the result came back positive. Panic began to set in. “I was in the first wave,” she says.
“There weren’t many people that had had it by that stage, so I knew no-one could tell me anything about it, no-one could offer me any real guidance because it was a new disease.
“No-one can tell you anything about it or when it might end. You’re just existing in the unknown.”
Freya found herself on a vicious merry-go-round of symptoms — fever, sore throat, dizziness, muscle spasms, numbness, chest pains and fatigue. The symptoms kept coming around and around and around.
After 12 days, she stabilised, but four days later the pains returned with a vengeance. It would be a sign of things to come. Freya would relapse five more times over the next six months.
“Each relapse, the depth of it would last about 10 days and then I would take about four or five days emerging from it, have about two or three symptom-free days before another relapse would kick off,” Freya says. “The symptoms would come and then dissipate…
“I’d have a fever for an hour, a sore throat for four hours, then dizziness for two hours, then I was OK for an hour.
“…it was just a cycle like that.”
By April 2020, “long COVID” was being mentioned in Facebook support groups. It’s not an official medical term; it was coined out of necessity by the public. It’s sometimes also referred to as long-haul COVID, chronic COVID and post-acute sequelae of COVID-19 (PASC).
Exactly what constitutes long COVID remains extremely broad. Earlier this month, the World Health Organization released its clinical case definition of what it calls ‘post COVID-19 condition’, which affects people at least two months after a COVID-19 infection with symptoms that “cannot be explained by an alternative diagnosis”.
For Freya, symptoms like chest pain and a sore throat were manageable, but the dizziness and “brain pain” she experienced were debilitating. “It’s as if there was like a mini person in my brain and he was scraping my whole brain with a rake, it was just pain,” Freya says.
“And then it would feel like it would flip on itself continuously and so it makes it really hard to sleep because you’re lying there and it feels like your brain is doing somersaults and then it’s also spinning.”
The memory loss was especially unnerving. “Heaps of people say, ‘Oh, I get that and I’m young,’ but it just feels different… you’d be mid-sentence and then completely forget what you’re talking about.”
Doctors couldn’t give Freya any clarity about what was happening to her because the reality was no-one knew enough about COVID-19.
The hardest was month four, when Freya ended up in hospital from her long COVID symptoms. In a journal entry dated August 24, 2020, she wrote: “Must stay hopeful. Must believe I will get better.” After so many relapses, she had fallen into a depression filled with grief, for her healthy body and her old life.
To this day, we still know very little about long COVID, including just how many people it affects.
Various studies over the past 18 months estimate long COVID can affect anywhere from 2.3 per cent to 76 per cent of COVID-19 cases. It’s important to remember these studies vary in method, with some tracking only hospitalised cases and some relying on self-reported surveys.
A comprehensive study by the University of NSW places the figure at around 5 per cent. Researchers tracked 94 per cent of all COVID-19 cases in NSW from January to May 2020. Of the 3,000 people surveyed, 4.8 per cent still had symptoms after three months.
The uncertainty doesn’t end there. We also have no idea why long COVID hits certain people, but not others. It’s been likened to a kind of “Russian roulette”.
Studies have consistently found long COVID to be more prevalent in women, older people and those with underlying conditions, but there’s evidence to indicate children are capable of developing long COVID too.
Being young and fit is no guarantee you’re safe either, and nor is having a minor initial COVID case. The longer-term symptoms can strike even those who had few initial symptoms.
Those with long COVID report a constellation of symptoms including fatigue, dizziness, shortness of breath, brain fog, memory loss, loss of taste and smell, numbness, muscle spasms and irritable bowels.
One of Australia’s leading researchers in the area, Professor Gail Matthews, says long COVID is likely a spectrum of different pathologies.
Dr Matthews is the Head of Infectious Diseases at St Vincent’s Hospital and Head of the Therapeutic Vaccine and Research Program at the Kirby Institute at UNSW. She says the issue of long COVID will be huge on a global scale and it’s crucial to understand it better.
One theory is that COVID-19 can trigger the immune system to behave in an abnormal way, releasing cytokines that can make you feel unwell with fatigue and other symptoms.
Another is that there could be some elements of the virus — called antigen persistence — somewhere in the body that continues to trigger an ongoing activation in the immune system.
There’s also early evidence that vaccination might help reduce or even prevent long-term symptoms. Freya stopped relapsing around month seven, although her senses of taste and smell still haven’t fully recovered. She says rest was a big part of her recovery.
“Other people, if they don’t have parental support, or they have to work because they’ve got no savings, or they can’t rely on their parents, or they have young kids — I have no idea how they got through it, because it would have been impossible in my eyes,” Freya says.
Judy Li is in an impossible situation. An all-encompassing fatigue has taken hold of her mind and body, stripping away her ability to work, parent or plan for the future.
The 37-year-old got COVID-19 in March 2020 while an inpatient at a Melbourne hospital. She had been struggling after giving birth to her second child and was getting the help she needed.
Despite her anxieties, Judy’s case was very mild and it wasn’t until three months later when her three-year-old brought a bug home from day care that she realised something was wrong.
As day-care bugs so often do, it ripped through the young family. “It felt like I hit a brick wall, I was a lot worse than everyone else,” Judy says.
“It wasn’t the usual symptoms… I was just really lethargic, really fatigued and I remember at about the three-week mark of having those symptoms, that kind of fatigue, I thought, ‘this isn’t right, this is a bit odd.’”
Her fatigue is not like being tired, it’s a different kind of exhaustion, a severe lack of energy that doesn’t replenish after sleep.
“This is like something you feel in your limbs; you feel like they’re really heavy, they’ve got this kind of, I wouldn’t say ouch-kind of pain, but it’s sort of an achiness to your limbs,” she says.
The fatigue comes and goes, but Judy has noticed it can flare up when she gets sick or when she expends herself physically or mentally.
One of the worst episodes came after an eight-hour trip to Canberra for Christmas to visit her in-laws. “I woke up and I was completely paralysed,” Judy says. Distressed, in tears, she could only call out to her partner for help.
“I just did not have the strength to move my limbs and I kept trying and trying and trying and eventually he helped me up. “I sort of dragged my arm up, I could barely hold a glass of water and he’d help me to drink out of it. If I had to go to the toilet, he had to basically carry me.”
This fatigue has derailed Judy’s life because when it sets in, she never knows how long it’s going to last or whether it will go away. It makes work and parenting impossible. Judy’s two young children don’t understand what’s wrong with mum or why she can’t get out of bed.
“When the kids are crying at home, I can’t go and soothe them,” she says.
“This is not a lack of motivation, it’s like I want to get up and I want to go to my children.
“I want to get up, I’ve got work I need to do. I want to get up and even go get something to eat, I’m hungry, but I can’t actually tell my body to move in that way.”
Fatigue or post-exertional malaise is one of the most common symptoms of long COVID, but it’s also a very common symptom in myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), a biological disease affecting an estimated 250,000 Australians.
There are striking similarities between long COVID and ME/CFS. Both can cause symptoms such as fatigue, dizziness, memory loss or ‘brain fog’, and irritable bowel, and both are likely to encompass a range of different pathologies.
ME/CFS is usually triggered by a viral infection — ebola, dengue fever, glandular fever, epstein barr, ross river virus, SARS and even the more common influenza have all left trails of chronically ill people in their wake.
Experts have even questioned whether long COVID could be ME/CFS by another name, although the jury is still out on that theory. ME/CFS has been around for decades but we still don’t know much about it.
Australian advocacy groups desperately want to see more research and support to help people with this chronic illness navigate medical, financial and accommodation services. They also say doctors need better education to diagnose and treat the condition early on.
Bronwyn Caldwell knows what it’s like to live with a condition that no-one understands or knows how to treat. She’s lived with ME/CFS for 20 years, ever since a suspected case of glandular fever in her 20s.
The 46-year-old from South Australia is adamant the early advice from her doctor to rest was the reason her condition didn’t immediately worsen. She was able to work part-time as a brewer up until 2013 but a relapse has left her mostly bed-bound.
Bronwyn considers herself lucky — her illness was validated by doctors and family, she doesn’t have cognitive difficulties and isn’t in pain. But her voice begins to break when mentioning that most people with ME/CFS face stigma that they’re being lazy or faking their illness.
“I can’t imagine what it’s really like to have everyone in your life say you’re just being lazy, because the reality is all of us beat ourselves up to that all the time,” she says.
A 2018 study published in the Journal of Health Psychology looking at links between people with chronic illness and suicidal ideation found stigma, misunderstanding and unwarranted advice exacerbates patients’ feelings of overall hopelessness.
Long COVID is creating a cohort of people vulnerable to the same thing, and Judy herself has sometimes wondered whether her family would be better off without her (which, of course, it wouldn’t).
“I honestly go through periods where I wish COVID had killed me instead of just left me with this, this big burden,” she says. With no sick leave left, Judy has had to take unpaid time off work.
It’s a big blow for the high-earning, career-driven project manager who took pride in handling stressful situations and juggling multiple tasks. These days, her mind doesn’t work like it used to.
“It’s just little things like struggling to find the word that I just knew… I would know… sorry… like being able to construct sentences,” she says with an ironic laugh.
“I can try to read something but it just seems like I have to read it over and over and over again. “I frequently walk into a room and can’t remember why, when I would put something down, seriously, two minutes later I have no idea where it is. “I just feel like I’m losing my mind.”
In the COVID-ravaged UK, daily cases peaked at more than 68,000 and daily deaths at more than 1,300. It’s a situation few in Australia — where we have enjoyed long periods of little-to-no community transmission — can fully appreciate.
Adam Attia was living in London through most of 2020 and says it was almost rare if you hadn’t had COVID-19. “I’ve known of people that had given it to their parents and it killed their parents,” the 30-year-old Australian says. “People that we knew on our street had passed away.”
So one day around August, when Adam couldn’t taste the wasabi on his sushi, he immediately knew what was wrong. “I just started to go through the kitchen for things like garlic — I had a whole garlic, I couldn’t taste anything. I ate a lemon like an apple and couldn’t taste a thing.
“I ate ginger like a cannibal, like I ate it with all of the bumps and things on it and couldn’t taste a thing.”
But Adam’s infection was mild and he spent his 10-day isolation staying active. Life went on as normal until three months later, after a trip to Croatia. On the flight back to London, somewhere above Germany, Adam felt an excruciating pain in his stomach. He felt like he was going to vomit, he couldn’t breathe and his head began to spin.
The flight crew didn’t know what to do, contemplating an emergency landing in Berlin while Adam desperately sucked air from a vent they’d given to help him breathe.
The flight managed to land in London and Adam was escorted off the plane. At the hospital, doctors ran tests for internal bleeding and signs of reflux or gastritis but they all turned up empty.
In the weeks and months after that flight, as little as two hours of work would leave Adam shattered and disorientated.
His symptoms are like dominoes. Exhaustion leads to stomach pain, which leads to nausea, faintness and breathlessness.
Adam has learned to manage his symptoms and as soon as he feels the exhaustion creeping in he takes an anti-nausea pill, uses the asthma puffer he now has to carry with him and finds somewhere to lie down.
He ended up moving back to Australia to sort out his health issues, but it wasn’t until a doctor at St George Hospital in Sydney mentioned Adam’s symptoms could be an effect of COVID-19 that he twigged.
“Is it from COVID? Look, I could be shooting in the dark, I don’t actually know,” Adam says. “But what I do know is I didn’t have these [symptoms] before COVID, so I guess it’s more of an educated guess.”
Much about long COVID remains exactly that. More research is needed to really know what’s going on.
The US and UK have allocated billions of dollars into research and set up long COVID clinics to help patients find the right treatment. The Australian government has provided $15 million for research grants into the long-term health effects of COVID-19 and the nation’s vaccination efforts through the Medical Research Future Fund.
As Australia moves beyond lockdowns towards a future where most Australians are vaccinated, borders are open and COVID-19 is actively spreading through communities, this research will be crucial in our understanding of the long-term health issues and the impact on individuals, families, workplaces and the economy.
For now, Dr Matthews says the biggest take-home is that we don’t know who is or isn’t susceptible to long COVID.
“One of the biggest messages is that it’s very hard to know who this will strike.”
Health officials in Victoria have already highlighted the plight of long COVID patients as part of their drive to encourage more people to get vaccinated, as experts say it probably can prevent long COVID.
Dr Matthews says it’s important Australia recognises long COVID as a real issue and makes sure there is appropriate support to help people.
“Even if it’s just an understanding that this condition exists, and recognition that it exists, as opposed to expecting these people to return to full health,” she says.
But until we know more, those like Freya, Judy and Adam won’t have the closure of knowing exactly what’s happened to them.
“It’s hard to wrap your head around,” Judy says, “to say this is potentially a life sentence”. “There’s no defining this is as bad as it gets, you know? “This is just the big mystery question mark.”
Scientists are studying the potential consequences of asymptomatic COVID-19 and how many people may suffer long term health problems. Eric Topol was worried when he first saw images of the lungs of people who had been infected with COVID-19 aboard the Diamond Princess, a cruise ship that was quarantined off the coast of Japan in the earliest weeks of the pandemic.
A study of 104 passengers found that 76 of them had COVID but were asymptomatic. Of that group, CT scans showed that 54 percent had lung abnormalities—patchy grey spots known as ground glass opacities that signal fluid build-up in the lungs.
These CT scans were “disturbing,” wrote Topol, founder and director of the Scripps Research Translational Institute, with co-author Daniel Oran in a narrative review of asymptomatic disease published in the Annals of Internal Medicine. “If confirmed, this finding suggests that the absence of symptoms might not necessarily mean the absence of harm.”
But Topol says he hasn’t seen any further studies investigating lung abnormalities in asymptomatic people in the more than a year and a half since the Diamond Princess cases were first documented. “It’s like we just gave up on it.”
He argues that asymptomatic disease hasn’t gotten the attention it should amid the race to treat severe disease and develop vaccines to prevent it. As a result, scientists are still largely in the dark about the potential consequences of asymptomatic infections—or how many people are suffering those consequences.
One stumbling block that scientists worry could keep them from truly understanding the scope of the problem is that it’s incredibly challenging to pinpoint how many people had asymptomatic infections. “There’s probably a pool of people out there who had asymptomatic disease but were never tested so they don’t know they had COVID at that time,” says Ann Parker, assistant professor of medicine at Johns Hopkins and a specialist in post-acute COVID-19 care.
Still, there is some evidence that asymptomatic disease can cause serious harm among some people—including blood clots, heart damage, a mysterious inflammatory disorder, and long COVID, the syndrome marked by a range of symptoms from breathing difficulties to brain fog that linger after an infection. Here’s a look at what scientists know so far about the effects of asymptomatic COVID-19 and what they’re still trying to figure out.
Heart inflammation and blood clots
Just as imaging scans have revealed damage to the lungs of asymptomatic individuals, chest scans have also shown abnormalities in the hearts and blood of people with asymptomatic infections—including blood clots and inflammation.
Thrombosis Journal and other publications have described severalcases of blood clots in the kidneys, lungs, and brains of people who hadn’t had any symptoms. When these gel-like clumps get stuck in a vein, they prevent an organ from getting the blood it needs to function—which can lead to seizures, strokes, heart attacks, and death.
There have been relatively few of these case reports—and it’s unclear whether some patients might have had other underlying issues that could have caused a clot. But the Washington State researchers who reported on one case of renal blood clot write that it “suggests that unexplained thrombus in otherwise asymptomatic patients can be a direct result of COVID-19 infection, and serves as a call to action for emergency department clinicians to treat unexplained thrombotic events as evidence of COVID-19.”
Meanwhile, studies also suggest that asymptomatic infections could be causing harm to the heart. In May, cardiac MRI scans of 1,600 college athletes who had tested positive for COVID-19 revealed evidence of myocarditis, or inflammation of the heart muscle, in 37 people—28 of whom hadn’t had any symptoms, says Saurabh Rajpal, a cardiovascular disease specialist at the Ohio State University and lead author on the study.
Myocarditis can cause symptoms such as chest pain, palpitations, and fainting—but sometimes it doesn’t produce any symptoms at all. Rajpal says that while the athletes in the study were asymptomatic, “the changes on the MRI were similar to or almost the same as those who had clinical or symptomatic myocarditis.”
Although these chest scans are worrisome, Rajpal says that scientists don’t know yet what they ultimately mean for the health of asymptomatic patients. It’s possible that myocarditis might resolve over time—perhaps even before patients know they had it—or it could develop into a more serious long-term health issue. Long-term studies are necessary to suss that out.
The athletes’ heart inflammation might also be completely unrelated to their COVID-19 infection. Scientists would need to compare the scans with a set taken just before an individual was infected with COVID-19. So that, Rajpal says, will still need to be teased out.
Long COVID
Additionally, people with asymptomatic infections are at risk of becoming so-called COVID-19 long-haulers, a syndrome whose definition has been hard to pin down as it can include any combination of diverse and often overlapping symptoms such as pain, breathing difficulties, fatigue, brain fog, dizziness, sleep disturbance, and hypertension.
“There’s a myth out there that it only occurs with severe COVID, and obviously it occurs far more frequently in mild COVID,” Topol says.
Linda Geng, co-director of Stanford Health Care’s Post-Acute COVID-19 Syndrome Clinic in the U.S., agrees. “There is actually not a great predictive factor about the severity of your illness in the acute phase and whether you will get long COVID,” she says. “And long COVID can be quite debilitating, and we don’t know the endpoint for those who are suffering from it.”
Studies attempting to assess how many asymptomatic infections account for long COVID symptoms have varied. FAIR Health, a healthcare nonprofit in the U.S., found from an analysis of healthcare claims that about a fifth of asymptomatic patients went on to become long-haulers. Another study, which is under peer review, used data from the University of California’s electronic health records and estimated that number could be as high as 32 percent.
Melissa Pinto, a co-author of the latter study and associate professor in the Sue & Bill Gross School of Nursing at University of California Irvine, says the researchers examined healthcare records of people who tested positive for COVID-19 but hadn’t reported symptoms at the time of infection—only to come in later with symptoms associated with long COVID-19. To ensure they were identifying long-haulers, the researchers screened out anyone with a preexisting illness that could explain their later symptoms.
“This is not from another chronic disease,” she says. “These are new symptoms.”
But it’s unclear how accurate any of these estimates might be. Pinto says that some long-haulers are wary of seeking care after having their symptoms dismissed by physicians who weren’t familiar with long COVID-19 syndrome. That’s why she believes that the rates of asymptomatic infections among long-haulers are an underestimate.
Anecdotally, Geng and Parker both say that while they’ve seen plenty of patients with mild symptoms that initially went unrecognised, they’ve had little experience treating patients who were truly asymptomatic.
“We saw many patients who didn’t think they had symptoms except in retrospect because they found out that they had tested positive,” Geng says. “Because they’ve had these long unexplained symptoms of what’s presumed to be long COVID, they think, well, maybe that wasn’t allergies.”
But she thinks that most people who were truly asymptomatic are unlikely to have gotten tested and therefore wouldn’t think to consult a specialist in post-COVID-19 care if they started experiencing unexplained symptoms like brain fog and dizziness.
Parker says that ultimately physicians are still trying to understand the broad symptoms seen in long-haulers. “When a patient comes to see us, we do a very thorough evaluation because we still don’t know exactly what to attribute to COVID and what might be a pre-existing underlying syndrome,” she says. “The last thing I want to have happen is to say to a patient, yes, this is because you had COVID and miss something else that we could have addressed.”
Mysterious inflammation in children
Physicians have also seen troubling clinical manifestations of asymptomatic COVID-19 in children. Early in the pandemic, reports emerged of a rare and mysterious inflammatory syndrome similar to Kawasaki disease that typically sets in weeks after an initial infection.
“Six weeks down the line these people, especially children, will develop inflammation throughout their body,” Rajpal says.
The condition—now called multisystem inflammatory syndrome in children, or MIS-C—typically causes fever, rash, abdominal pain, vomiting, and diarrhoea. It can have harmful effects on multiple organs, from hearts that have trouble pumping blood to lungs that are scarred. It is typically seen among children under 14, although adults have also been diagnosed with this syndrome.
MIS-C is incredibly rare. Kanwal Farooqi, assistant professor of paediatrics at Columbia University Vagelos College of Physicians and Surgeons, says that less than one percent of paediatric COVID-19 patients present with some type of critical disease—and MIS-C is just one of them. However, asymptomatic infections do play a role in the syndrome: A recent study of 1,075 children who had been diagnosed with MIS-C showed that three-quarters had originally been asymptomatic.
But there’s reason to hope that this syndrome might not cause long-term effects in patients, symptomatic or otherwise. Farooqi was the lead author on a recent study of 45 paediatric patients showing that their heart problems—which ranged from leaky valves to enlarged coronary arteries—mostly resolved within six months.
“That is reassuring,” Farooqi says. Still, she recommends administering follow-up MRI scans even to patients whose heart troubles seem to have resolved to make sure there’s no longer-term damage, such as scarring. She also says that it’s “really reasonable” to be cautious about asymptomatic infections and encourages parents to have their child evaluated if they have any persistent symptoms even if the original infection was mild or asymptomatic.
“What’s important is that we can’t right now say that there are no consequences,” she says.
Calls for more studies
Scientists caution that there’s still so much we don’t know about the potential harm of asymptomatic infections. Many have called for more rigorous studies to get to the bottom of the long-term effects of asymptomatic disease, why those effects occur, and how to treat them.
Rajpal points out that his study was only possible because the Big 10 athletic conference requires athletes to get tested every few days. Regular testing is key for uncovering asymptomatic cases, he says, which means that most data on asymptomatic disease is likely to come from healthcare workers, athletes, and other workplaces with strict testing protocols.
It’s also unclear what could be causing these lingering side effects. Scientists hypothesise that it could be an inflammatory response of the body’s immune system that persists long after an infection has been cleared. Others suggest there could be remnants of the virus lingering in the body that continue to trigger an immune reaction months after the COVID-19 infection peaked.
“This is all unchartered, unproven, just a lot of theories,” Topol says.
Yet even if asymptomatic infections aren’t linked in high rates to death and hospitalisation, Pinto and others say it’s important to keep in mind that long COVID-19 symptoms can be debilitating to a patient’s quality of life.
“Even if people survive, we don’t want them to be having a lifelong chronic disease,” Pinto says. “We don’t know what this does to the body, so it’s not something that I would want to take my chances with.”
The bottom line
With so much we don’t know about the long-term effects of asymptomatic COVID-19, scientists insist it’s better to err on the side of caution.
“The full impact can take years to show,” Rajpal says. Although the chances are slim that an individual with asymptomatic infection will have a really bad outcome, he points out that the continuing high rate of infections means that more people are going to suffer.
“Even rare things can affect a lot of people,” he says. “From a public health perspective if you can reduce the number of people that get this infection, you will reduce the number of people who get severe outcomes.”
Parker agrees, adding that it’s particularly important to prevent infection now as the more transmissible Delta variant drives surges in cases and hospitalisations across the country.
“We have had an amazing breakthrough in terms of the rapid development of effective and safe vaccines,” she says. Although Parker and other scientists remain uncertain of the health effects of asymptomatic COVID-19, “we do know that vaccinations are safe and effective and available.”
I’m ashamed to say that when my husband told me he was terrified of cooked eggs, I mocked him and made jokes, from pretending that there was an egg in something he had just bitten into and waving my egg-based dishes under his nose.
I thought that his reactions of horror were a little exaggerated. There are plenty of foods I don’t like but I’m certainly not terrified at the thought of a kidney bean. It turns out that my reaction was wrong – and I still feel pangs of guilt for it. The fact is, my husband has a phobia. He doesn’t just hate eggs, they cause him trauma. He probably won’t read this as even the word egg is vile to him.
He won’t go to cafes due to the risk that a pan his breakfast has been cooked on had previously contained an egg. He has been physically sick at the smell of cooking eggs. If food he had ordered contained even a sliver of egg, he would not touch the entire dish, even parts that weren’t touching it.
Many people will be able to relate to his experience – or mine. It’s possible to have a phobia of anything, despite many believing only the obviously scary things – think spiders, flying, snakes – constitute a real, genuine fear. My sister has a fear of patterns; particularly dotted but any kind of repetitive pattern. Anything with hectic shapes, lines, dots or colours whether a piece of art, wallpaper or packaging terrifies her.
Other ‘weird’ phobias can include arachibutyrophobia, the fear of peanut butter sticking to the roof of your mouth. Octophobia is the fear of the number eight and hippopotomonstrosesquippedaliophobia is, ironically, the fear of long words. Celebrity phobias include Billy Bob Thornton’s ‘crippling’ fear of antique furniture, Kylie Minogue’s phobia of clothes hangers, Matthew McConaughey’s fear of revolving doors, and Khloe Kardashian’s horror at belly buttons.
My husband was satisfied at the feeling of vindication when he found out the name of his own phobia, which is ovophobia. Where do these phobias originate? Are they just innate? Or are they linked to childhood experiences that may have been forgotten, but which triggered a connection to the item of fear?
When does a fear become a phobia?
Fear is a normal part of human life. But it becomes a phobia when this fear is overwhelming and debilitating. Someone with a phobia will have an extreme or unrealistic sense of danger about a particular situation, sensation, animal, or object. It might not make sense to other people, because the focus of the phobia isn’t obviously dangerous.
Phobias come under the umbrella of anxiety disorders, and can cause physical symptoms such as:
My husband recently recalled, after years of trying to figure his egg fear out, that he was always terrified of visiting a relative’s house as a toddler. This relative had a booming voice, slammed his fist on the table without warning and threatened to lock him in the coal shed, as well as saying that there was a monster living inside the sink.
His mum recalls how she could feel both him and his brother physically sweating with fear while on her knee and the one consistent thing that was in that kitchen was fried eggs being cooked. It’s clear that he associates that smell of eggs and the sight of them with frightening times as a child. It makes perfect sense why that phobia has manifested itself into something like this.
According to Clinical Partners, who specialize in the treatment of phobias, around 5% of children and 16% of teenagers in the UK suffer from a phobia, with most phobias developing before the age of 10.
Children and teenagers with phobias often feel ashamed about their fears and keep them secret from their friends in case they are teased. This will be the same for adults in a workplace or social setting. I’m frightened of patterns, bananas, beards or the colour yellow is hardly a comfortable ice breaker.
And yet, working alongside a new colleague with a beard or all memos coming on yellow paper would be triggering for those suffering with said phobias; making for a very uncomfortable environment both for the sufferer and the colleagues who have no idea they’re causing alarm.
Clinical Partners explains: ‘Phobias arise for different reasons but a bad experience in early years can trigger a pattern of thoughts that result in a powerful fear of a situation – for instance if your child falls ill after having an injection, they may develop an ongoing fear to injections, which can get worse over time.
‘Children may also “learn” to have a phobia – for instance if a close family member is afraid of spiders and the child witnesses them screaming when they see one, they may also develop that fear.’ There are a lot of environmental factors at play here but for the less common phobias, we have to dig deeper to try and work out the source.
There is no guarantee that discovering that source will erase your phobia but if the phobia is seriously impacting your life to the point where you can’t work, go out, become ill and even fear dying, it’s a valid starting point to understand the root of it.
CBT and talking therapies are available for this. Start by talking to your GP; phobias are a recognized condition and for many, a gradual but very carefully carried out exposure to the item of fear by a professional can be an important first step.
For my husband, his knowledge of what caused his phobia is enough. He isn’t desperate to get over his fear of eggs and doesn’t want to spend weeks and months of treatment just to potentially be ok with an egg yolk dribbling onto his bacon.
But for others, treatment is vital in order to get to a place where the phobia is not ruling their life. What can the rest of us do? Showing compassion and understanding – and never poking fun – is key. It’s a hard and embarrassing thing to confess, so don’t break a person’s confidence by waving a peeled banana under the nose of someone who is scared of them.
At the same time, you don’t have to wrap a person with a phobia in cotton wool and treat them any differently; simply be conscious of their fear and check your own actions to ensure that you are not inadvertently causing them discomfort.
Phobias are very real and sometimes we don’t know where they originate from or why they affect us so much. It’s a condition we have been programmed to underestimate, but given the mental health impacts they can lead onto, we need to all be more accepting that people can be and are terrified of things we don’t understand.
Healthy snacking is an important part of anyone’s diet. But for athletes and active individuals, snacking ensures adequate fuel for exercise, improves muscle recovery, boosts mental performance, and helps maintain healthy body composition.
As a sports dietitian, athletes often ask me: What should I eat before and after a workout? What’s a good sports snack? These are great questions I’ll be happy to answer.
Healthy Snacking During Pre-Workout and Post-Workout
Snacks are “mini-meals” between our main meals and are necessary to get the calories and nutrients our bodies need. The number and type of snacks should be determined by your hunger signals, as well as your work, academic, athletic, or sleep schedules.The key is to make smart snack choices to keep you on track with your nutrition and performance goals. Here are my top tips on healthy snacking:
1. Combine Lean Protein with a Carbohydrate and/or Healthy Fat.
In general, think of balance when looking for snacks to curb hunger. Pair protein-rich foods with a carbohydrate or healthy fat for a balanced snack. It is crucial to have lean protein at every meal and snack to support muscle growth and repair. Protein also promotes fullness, helping ward off hunger until your next meal.
Carbohydrates provide both your body and your brain with energy. Choose whole grains, like whole-wheat bread or crackers or a high-fiber cereal, for long-lasting energy. Healthy fats, like nut butter or avocados, also provide energy with staying power.
Examples of balanced snacks include Greek yogurt with granola, half a turkey sandwich, a fruit smoothie made with Greek yogurt, a banana with peanut butter, string cheese and fruit, and trail mix.
2. Don’t Ignore Your Hunger Cues.
Listen to your body and pay attention to your hunger cues. Common signals include stomach rumbling or growling, fatigue, shakiness or dizziness, and poor concentration.
If you have these symptoms, too many hours have passed without fuel. Being able to recognize these signals is crucial for athletic performance. You’ll need energy to perform your best.
Typically, spacing meals and snacks out every 2-3 hours is adequate timing to avoid hunger pangs and to ensure your body has enough fuel. This amounts to 2-3 snacks in addition to three main meals per day.
3. Fuel Your Exercise with Pre-Workout Snacks.
Carbohydrates are the preferred source of fuel for exercising muscles. Timing is important: prioritize easy-to-digest carbs in your pre-workout snack.
A small amount of lean protein is okay, but limit or avoid fats, as they may cause digestive issues if eaten too close to the time of your workout. Timing will vary, but eating your snack one-hour pre-workout should allow enough time for digestion.
Examples of pre-workout snacks include a fruit smoothie or applesauce, a handful of dried fruit plus whole-grain cereal, Greek yogurt with berries, a piece of fruit plus a carbohydrate-electrolyte beverage, and a piece of whole-grain toast with jam.
4. Refuel, Repair, and Recover with Post-Workout Snacks.
A good post-workout snack should have three components: protein, carbohydrates, and fluids. The goal after exercise is to replace the fuel that was burned, restore fluids lost through sweat, and provide protein to promote muscle repair.
Aim for at least 20 grams of protein in your snack to prevent muscle breakdown and to promote muscle building. Eating your snack within the first hour after exercise is ideal for replenishment and rebuilding.
Examples of good recovery snacks include low-fat chocolate milk, a protein shake, a fruit and Greek yogurt smoothie, trail mix with dried fruit, whole grain bread with nut butter, and banana plus low-fat milk.
5. Snack Mindfully and Avoid Distractions.
Munching mindlessly is an easy way to end up with your hand at the bottom of an empty bag of chips without knowing how it got there.
First, make sure you chose a healthy snack that aligns with your performance and health goals. Then, stop what you’re doing for a few minutes – turn off the TV, put down your phone, and close your laptop – and eat your snack.
Eating without distractions will help you feel more satisfied and you’ll be less likely to overeat.
6. Don’t Get Tricked by Treats.
Distinguish a healthy snack from a treat. Healthy snacks are nutritious and satisfy hunger. Treats, such as sweets, fried foods, and chips lack useful nutrients and provide “empty” calories,” meaning they cannot help your body grow, recover or perform to the best of your ability.
Treats might satisfy a craving, but they rarely satisfy hunger, leaving you to reach for something else soon after. Treats often lead to overeating, which could eventually lead to weight gain. Instead, choose a healthy snack that can satisfy your craving while making you feel full.
7. Choose Healthy, Convenient Snacks to Fill Nutrition Gaps.
Whether you’re fueling for exercise, replenishing energy losses, or building and repairing muscles, your body needs constant nutrition. In my experience, many athletes are consistently hungry and can’t seem to get enough calories throughout the day.
When you’re on-the-go, choose a convenient snack such as a protein bar, fruit, or Greek yogurt. Snacking is a great way for active people to get the extra nutrition they need to achieve body composition and performance goals.
8. Plan Ahead.
Prepare healthy snacks at home to take with you to work, school, or training. Skip the vending machine and avoid buying snacks where healthy options are limited.
You’ll not only save money, but you’ll also get a bigger bang for your nutritional buck by preparing healthy snacks ahead of time. Pack portable snacks in your backpack or sports bag.
Planning ahead and knowing your schedule will keep you from missing your healthy snacks.
According to the Centers for Disease Control and Prevention (CDC), information on long COVID in children and adolescents is limited, so it is possible other symptoms may be likely in younger age groups.
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The key is to make smart snack choices to keep you on track with your nutrition and performance goals. Here are my top tips on healthy snacking:
