What are your expectations around recovery from COVID-19? Here's what to expect

As long as COVID-19 continues to spread within communities, it's likely that we will at some point experience the need to self-isolate (if we contract COVID-19) or self-quarantine (if we are exposed to COVID-19)

The main focus is on the time periods designated by local and global healthcare authorities for isolation and quarantine periods. Unfortunately, this has led many people expect that once their time in isolation or quarantine is over, they will feel well again. But (and particularly in the case of more serious bouts of COVID-19) this is far from the case. In reality, recovery can take weeks or even months.

Know the difference between isolation and quarantine

Isolation

• You have tested positive for the virus or you have symptoms and likely have COVID-19
• You need to avoid contact with other people for 10-days after your test if you have no symptoms
• 10-days after your symptoms started if you have mild disease
• 10-days from the last day you needed oxygen if you were treated in hospital with severe disease
• You do not need to re-test to confirm you are negative to de-isolate

Quarantine

• You have been in close contact with someone with the virus and you don't have symptoms and haven't tested positive
• You need to avoid contact with other people for 10-days after your exposure to the person with COVID-19
• If you do not develop symptoms you can de-isolate after 10-days
• If you develop symptoms, you are considered to also have COVID-19 and then you need to isolate for 10- days from the onset of symptoms

Dr Geraldine Timothy weighs in on COVID-19 recovery

"COVID-19 is an illness for which we have defined timelines around curbing the spread of illness but not around defining recovery times," reiterates Dr Geraldine Timothy. She is a public health medicine specialist. She also leads the Quality team in Strategic Risk Management at Discovery Health and is a member of the Discovery COVID-19 Business Support Team. Dr Timothy currently also works closely with the National Institute for Communicable Diseases (NICD), collaborating on COVID-19 insights and offering her clinical expertise.

Dr Timothy adds: "People are very unsure about what 'recovery' from COVID-19 really means and what they should expect. The period of recovery is individual and therefore variable. Currently, many people have a false sense that at the end of a period of self-isolation that all will be well, that they will go back to feeling their usual selves again. However, people who experience moderate to severe cases of COVID-19 could find themselves going through a prolonged recovery period for weeks or even months. Even in the case of mild illness many people report fatigue that is ongoing for several days and weeks."

"People who contract COVID-19 need to know it's okay to feel the effects of the illness for a while after the isolation period is over, and they should make peace with this likelihood. This will allay their anxiety about their symptoms and any guilt or worry about feeling that they should be recovered from COVID-19 'by now', and back to life and work or 100% functioning. Overall, we can expect most people who have moderate or severe COVID-19 to recover slowly. Again, that is okay, that is the reality of this disease."

What might recovery from a 'mild', 'moderate' or 'severe' bout of COVID-19 look like?

According to the NICD, the following experiences of COVID-19 apply:

• Mild COVID-19 illness: About 80% of people who are infected with COVID-19 will either be completely asymptomatic (have no symptoms) or experience mild symptoms. Someone with mild symptoms should recover within a week to 10 days. If you are experiencing mild illness you should expect the recovery process to be similar to that of other significant respiratory viral infections such as the flu.
• Moderate COVID-19 illness: This form of COVID-19 sees people experience more acute or alarming symptoms, which warrant a visit to an emergency room or even admission to hospital. The recovery process is lengthier than for those with milder symptoms and we can expect a prolonged (several weeks) experience of fatigue, coughing and shortness of breath along with other symptoms (which can vary from person to person).
• Severe COVID-19 illness: This form of COVID-19 may see a person end up in an intensive care unit (ICU) and possibly on a ventilator. It will then take anywhere from several weeks to months to recover as it can take time for affected body systems to return to full strength. For example, if the lungs have been affected, how much time is needed to return to normal function will depend on how much strength a person has lost and how much damage has been done to their lungs. And COVID-19 can affect multiple body systems.

Dr Timothy adds, "From a clinical perspective, we are learning more about COVID-19 every day and don't have a full list of how it can affect the body in the short and long term. So, it's very important that those who have experienced moderate or severe cases of COVID-19 continue to be managed by their attending doctor and continue to be vigilant for months and years after recovering from COVID-19, understanding that there are potential long-term consequences that we have not yet determined. Think about rheumatic fever. When the disease first originated, no one knew that within 15 or 20 years, patients who recovered from it could present with valvular disease, which is life-threatening. I must stress that we must all always check in with our doctor at any point if there are symptoms in the immediate short or longer term that are worrying us as they could be related to our having had COVID-19."

NICD's Prof Adrian Puren adds to what 'recovery' means

In late July 2020 the NICD conducted an interview with Prof Adrian Puren about COVID-19 recovery and reinfection, which was shared on their Facebook page.

Prof Puren explains that when it comes to defining 'recovery' it's expected that within five to seven days we should have eliminated the virus from the body. The guidelines give a little more time as a buffer, so by day 10 most people should have recovered from mild illness. "Fever is what we look at," says Prof Puren. "If over a period of 24 hours you have not had to take any medication to suppress fever, we call you 'recovered'."

Asked about symptoms that continue past the expected 10-day recovery period , Prof Puren says, "We do know that it's not unusual after recovering from COVID-19, for a cough to linger for a long time. In some people the virus has destroyed the lung epithelium and it needs to regrow. In others, there has been a loss of smell as a symptom (anosmia) and the olfactory mucosal cells which have been damaged by the virus also need a chance to regrow. Symptoms like fatigue [tiredness], a loss of smell (anosmia), a cough or more may linger but it does not mean you are still infectious."

Can we get COVID-19 more than once?

We know that we can have multiple colds or flus throughout the year and these are all viral infections. So can we be reinfected with the COVID-19 virus? Many people believe that once you've had COVID-19, reinfection is unlikely but this is not necessarily true. For some viruses, a person can have lasting immunity; for others, the immunity lasts only a limited time. More research is needed to reveal how the body responds to SARS-CoV-2, the virus that causes COVID-19.

Prof Puren explains: "With the current COVID-19 virus we know that the body mounts an immune response. There is evidence that the immune response may be long lasting - up to 90 days. But there are individuals who may have a shorter-lived response up to 30-odd days. There is concern about reinfection. There is no definitive proof at this time that people are being reinfected. And even where people have recovered from COVID-19, I would still recommend that people continue to adhere to the non-pharmaceutical preventive measures, such as hand hygiene and mask wearing, that prevent transmission."

Dr Timothy adds: "We don't know enough as yet to definitely say 'yes' or 'no' to this question. There are some anecdotal cases where people have said they have tested positive for COVID-19 again three months after a first bout of illness. But we are not sure if these are truly reinfections and there are no definitive studies or data regarding this. The current thinking seems to point to a three-month widow of immunity but the jury is out on the absoluteness of this theory and individual variability around this immunity."

What does a prolonged recovery period mean for employed people and businesses?

Dr Timothy adds that employers need to understand that there will be instances where people who have had moderate or severe cases of COVID-19, in particular, will may have prolonged coughing, fatigue or any number of other symptoms. Some employees may require additional sick leave and recovery time, and it's important that the process is driven by their attending doctor at all times.

"Staff will need to present their employers with a sick note," adds Dr Timothy. "But employers and colleagues should not assume that someone who required a visit to hospital or an admission to treat their COVID-19 will return to work once their isolation period has ended or they have been discharged. The employee may still have a roller-coaster ride of symptoms to navigate after discharge from hospital. Each individual experience may differ. This is the reality of recovery from moderate or severe COVID-19."

Is a second test recommended to show that a person has recovered from COVID-19?

At present, re-testing people who have recovered from COVID-19 is not recommended. Repeat tests are not a good idea as the presence of viral genetic material can still be detected after a person is no longer infectious. The person will test positive but they are not infectious.

Prof Puren adds, "There is; therefore, no reason for employers to demand that employees have a second test before returning to work."

Managing anxiety - recovery from COVID-19

"It's important to manage the anxiety a person may experience due to prolonged symptoms, as well as anxiety that their colleagues and those they interact with may feel," says Dr Timothy. "If you contract COVID-19 and develop an extreme form of respiratory disease, you cannot expect your cough to go away 10 days after your symptoms first developed. You need to remember that the epithelial cells lining your lungs have undergone damage and need to recover, so you may cough up to two to three weeks or more after your recovery. But it does not mean you are infectious. We need people to understand these dynamics as fear around contracting COVID-19 generates stigma, and this can be directed towards people who end up with prolonged coughing. Recovery for some may be lengthier than others especially in those who have had moderate to severe illness."

ALL MEDICAL INFORMATION FOUND ON THIS WEBSITE INCLUDING CONTENT, GRAPHICS AND IMAGES, IS FOR EDUCATIONAL AND INFORMATIONAL OBJECTIVES ONLY. DISCOVERY HEALTH PUBLISHES THIS CONTENT TO HELP TO PROTECT AND EMPOWER ALL SOUTH AFRICANS BY PROMOTING A BETTER UNDERSTANDING OF COVID-19.