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More than 26 million cases of COVID-19 have been reported worldwide, while more than 863,000 people have died from the disease �� a loss that’s impossible to fathom.But it’s becoming increasingly clear that the novel coronavirus isn’t as simple as life or death: Emerging research and first-person accounts reveal that certain patients who have survived COVID-19 still suffer from side effects long after their initial illness. These people have been dubbed “long haulers.”“Many patients who have pneumonia expect to feel a lot better quicker than they actually do,�� says Robert Kotloff, M.D., professor of clinical medicine at the University of Pennsylvania and director of the Harron Lung Center, where he founded a post-COVID pulmonary clinic. “With COVID, the recovery period seems to be It seems to be taking patients at least several weeks, and in some cases several months, to really get back to feeling good again.”What are the chronic symptoms and effects of COVID-19?A February 2020 report from the World Health Organization states that recovering from a “mild�� case of COVID-19 takes about two weeks, while “severe or critical�� forms of the disease my take up to six weeks.But that’s not always the case. Some patients are ending up in a bit of limbo, saddled with symptoms that last for months, even as their initial illness (and their contagiousness) fades away. One woman who spoke with Prevention.com has been dealing with symptoms and side effects for more than 120 days.Related video: Man recovers from organ failure after mild COVID-19 symptoms“Even after the acute infection resolves, these patients experience shortness of breath, sometimes cough, and profound fatigue, usually for several months after they recover from the pneumonia,�� Dr. Kotloff says. “This is not the kind of thing that’s like a routine bacterial infection, where after a week or two they might be feeling better.”According to a survey conducted by Survivor Corps, a Facebook support group for COVID-19 survivors, and Natalie Lambert, Ph.D., of Indiana University’s School of Medicine, the most common effects reported by COVID-19 “long haulers,�� include: Fatigue Muscle or body aches Shortness of breath or difficulty breathing Difficulty concentrating or focusing Inability to exercise or be active Headache Difficulty sleeping Anxiety Memory problems Dizziness Persistent chest pain or pressure Cough Joint pain Heart palpitations Diarrhea But that’s just a fraction of the 50-item list, which also includes unusual effects like blurry vision, reflux or heartburn, and tremors. Other patients have experienced heart issues and blood clots, a persistent sore throat and even hair loss.Recent research has also linked COVID-19 to pulmonary fibrosis, a lung disease that makes breathing progressively difficult due to damaged, thickened lung tissue. In rare cases, lung transplants are necessary. Already, at least one American patient has received a lung transplant due to post-COVID fibrosis, joining others from China and Austria. Dr. Kotloff stresses that this is a last-case scenario, and does not impact the vast majority of recovering patients.As more and more people deal with the lasting effects of the virus, a new diagnosis called “post-COVID-19 syndrome�� has emerged, according to preliminary research. There’s little information on how to clearly define the condition, but it manifests in some patients as “persistent fatigue, diffuse myalgia, depressive symptoms, and non-restorative sleep,�� according to a group of European doctors who first named the syndrome. Dr. Kotloff hasn’t encountered any patients with post-COVID-19 syndrome yet, and considers it a rare diagnosis.On top of that, patients are also likely to experience psychological symptoms like depression, anxiety and PTSD, which often occur in people who have spent time in the ICU, have been intubated or spend months trying to recover, Dr. Kotloff says. Why does COVID-19 cause such a lasting impact on the body in certain people?For the most part, these side effects aren’t unique to the novel coronavirus—they’re common “in any patient who has been critically ill, COVID or otherwise,�� especially if they’ve been intubated, Dr. Kotloff explains. SARS-COV-2 is a newly discovered coronavirus, leaving doctors and scientists simply to observe its effects—long-lasting symptoms might be a hallmark of COVID-19 that we just don’t know about yet.One potential theory behind why this virus causes such an extreme systemic reaction in certain people comes down to an overactive immune response. When certain people encounter the new pathogen, their bodies have a hard time determining how to handle it, so they sometimes go into overdrive. This can cause symptoms to escalate and make medical intervention (like ventilator support) necessary—which, in turn, increases the chances of lasting side effects.Who is most likely to suffer from chronic COVID-19 symptoms and side effects?Anyone can experience chronic recovery symptoms, regardless of age, health or other factors. But Dr. Kotloff distinguishes two major types of coronavirus patients: those who required hospitalization and those who didn’t. People who ended up in the hospital are more likely to experience a long-term recovery, he explains, because they likely “also have very severe lung injury that has to heal over time.�� There are no set-in-stone predictive factors for who might experience a long recovery, but people who have a higher risk of developing severe COVID-19 �� those in older age or with underlying conditions and weakened immune systems �� “are more likely to take longer to recover,�� he says. “But I’ve also had a number of otherwise perfectly healthy individuals who developed COVID and are struggling to fully recover back to baseline,�� he adds.That means anyone who presented symptoms can stay sick for months, even after being deemed “recovered.�� One study published JAMA found that nearly 90% of observed COVID-19 patients were still suffering from symptoms two months after recovery �� and that more than half of them reported three or more of the symptoms listed above. However, there’s still no solid data on how many people end up taking months to recover.The only people with COVID-19 who aren’t going to take weeks or months to heal are those who remain asymptomatic �� up to an estimated 40% of infected people, according to the Centers for Disease Control and Prevention. “Those patients are obviously going to have no trouble recovering,�� Dr. Kotloff confirms.When will chronic COVID-19 patients start to feel better? There are the untold numbers of long-haulers, who no longer have the virus but still feel the damage.“It depends on how sick they were with their acute illness,�� Dr. Kotloff says. “With a mild infection, I might expect people to feel better after a couple of weeks. With more severe infections—in particular, patients who required hospitalization �� we’ve seen patients two and even three months out of that hospitalization who still have some lingering symptoms.”Most patients gradually feel better over time, and only a small fraction report no improvement.“We have not, at this point, documented long-term, permanent complications from COVID infection, although we’re still learning,�� Dr. Kotloff says.The people most likely to experience permanent effects, he notes, are the ones who develop pulmonary fibrosis or post-COVID-19 syndrome �� although experts still don’t have enough research to tell just how many patients, if any, will experience these complications.