Although fears of the coronavirus pandemic have rattled people, the high rate of recoveries has provided some reassurance.

But with increasing reports of COVID-19 “long haulers,” or people whose symptoms linger for weeks or months after their initial illness, concerns have spread about what it really means to recover from the debilitating effects of the virus.

In fact, the numbers for recovered patients are largely based on assumptions about the normal course of an illness that still is not fully understood.

So, how do health officials decide when and how to report numbers for recoveries? Here’s what you need to know.

How are recoveries calculated?

Because COVID-19 recoveries are hard to track and aren’t used by the Centers for Disease Control and Prevention, not every health department reports them. But for those that do, many make estimates based on what has been deduced about the virus’s behavior.

At the state level, recovery estimates are based on a World Health Organization report published in February that found that as many as 80% of people who are infected with COVID-19 show only mild symptoms and recover. The report also estimates that the recovery time for mild cases is two to three weeks, while the recovery from severe cases takes three to six weeks.

Based on those observations, the state subtracts the number of deaths, as well as any older cases being newly reported, from the number of confirmed cases. Of the remaining number, the state assumes about 20% of cases require hospitalization. Finally, using the estimated recovery times, hospitalized patients are included in the recovery estimate after about 32 days, and all other patients are included after about 14.

According to that methodology, more than 692,000 people have recovered from COVID-19 in the state.

In Collin County, which has long reported coronavirus recoveries but delegated its reporting to the state in June, more than 15,000 people have recovered, according to the state’s estimate.

Other departments rely on information from the CDC, which doesn’t provide a definition of recovery but does advise when people no longer need to be isolated after they get sick.

The CDC says COVID-19 patients can be around other people after 10 days have passed since symptoms started, 24 hours have passed with no fever (without the use of fever-reducing medicine), and other symptoms — with the exception of the loss of taste or smell — are improving. For people who never experience symptoms, 10 days must pass from the date of a positive test before they don’t need to be isolated.

Jennifer Rainey, a public information officer for Denton County’s health department, said when symptoms start and end are verified with patients during their communication with the county.

In Dallas County, health officials don’t report recoveries because they don’t think they can reliably compile the data, said Dr. Philip Huang, director of Dallas County’s health department.

“When you consider we’ve had over 70,000 cases reported here, we can’t call them all back and say, ‘Hey, are you recovered yet? Are you feeling fine now?’ ” he said.

The CDC has acknowledged that for some patients, symptoms including loss of taste or smell can linger for weeks or months after someone is no longer contagious.

But across the country, patients have reported that a variety of symptoms, including fatigue and fogginess, persist long after the initial illness.

More long-term effects on the body have been identified, such as lasting damage to the heart, scarring of the lungs, brain damage that can cause strokes and seizures, and an increased likelihood of blood clots and blood vessel problems, according to the Mayo Clinic.

“We’re discovering more and more subacute and chronic complications of the infection, so it’s not just like the flu, where you get it for a few days and then you’re over it,” Dr. Richard Robbins, chairman of the department of medicine at Houston Methodist Hospital, told the Texas Medical Center.

But information about long-term effects remains unclear. Health experts still can’t say with certainty who is most at risk for lingering symptoms, why they occur in some patients but not others, and how long they might persist.

With long-haulers, the more common lasting effects are often similar to the initial symptoms of the virus, health experts have said.

“Their lung function and overall muscle mass take a long time to recover, often needing multiple medications, inhalers, oxygen and physical therapy to gain back strength,” Dr. Janice Johnston, medical director of Redirect Health in Scottsdale, Ariz., told HuffPost.

Some experts have guessed that the body’s immune response, which is often responsible for complications that occur during serious cases of the virus, may cause changes in different parts of the body, including the lungs, which makes symptoms linger.

Numbers are hard to track

It’s difficult to know what proportion of patients suffer lingering symptoms, authorities say. Long-term symptoms are managed primarily by personal physicians and aren’t likely to be reported to health departments.

Some early studies have indicated coronavirus long-haulers may be fairly common. A study published by the CDC in July found that of nearly 300 people, 35% said they didn’t feel they were at full health two to three weeks after they tested positive.

In Italy, 87% of a group of about 150 patients who were hospitalized with the virus said they were still experiencing symptoms about two months after their release, according to a study published in the Journal of the American Medical Association in July.

In Bergamo, Italy, which was especially hard-hit by the outbreak, doctors are following up with COVID-19 patients who had been hospitalized. Of the first 750 people who were screened, about 30% had trouble breathing or had scarring on their lungs, and 30% more had problems associated with inflammation and blood clotting, The New York Times reported.

Local health departments have recommended that people who experience lingering problems because of the virus manage their symptoms with their primary care providers. In Texas, state health officials said the number of long-haulers probably would not be known until a larger study is carried out.

Health experts say much more research is needed to understand the virus’s lasting effects.

“There are a lot of different areas to be looking at in terms of what symptoms patients could develop and what type of long-term … [conditions] they could have from this,” Dr. Jill Weatherhead, an assistant professor of tropical medicine and infectious diseases at Baylor College of Medicine, told the Texas Medical Center. “We don’t know who’s going to develop what. There’s just so much we don’t know yet about the disease.”


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