Triathletes are known for being some of the fittest, healthiest people on the planet—but for those battling what’s become known as “long-haul COVID,” fitness seems a very, very long way away. While many people who contract COVID-19 are able to recover fully from it, a growing body of research suggests there is a small but significant group of people who find themselves still ill and battling symptoms months after contracting the virus. 

Some put the estimates of long-haulers around 10% of those who contract COVID. One study found that nearly half of those who had COVID reported persistent fatigue 10 weeks after first experiencing symptoms, with many unable to return to work. Another larger study, from China, found that of those who were hospitalized the majority still had at least one symptom six months later.

The challenge with these long-term and persistent symptoms is both the lack of scientific knowledge around COVID-19 and the lack of clarity around symptoms—which can be vague and hard to pin down. According to the CDC, symptoms can range from fatigue and shortness of breath through to insomnia and cognitive dysfunction. Long-haul symptoms also seem to be uncorrelated to the severity of the initial illness, with many cases appearing mild or moderate initially—though a non-peer reviewed analysis of cases suggests that women are almost twice as likely as men to have long-term symptoms.

For endurance athletes, this months-long crippling fatigue and lack of answers can make returning to a workout regime or training plan seem like an impossibility.

Endurance athlete, author, and coach Matt Fitzgerald finds himself among this group and, after first developing COVID symptoms last March, he’s still struggling with elevated breathing, numbness and tingling in his extremities, a quickly changing heart-rate, brain fog, and exercise intolerance.

“Various symptoms come and go, and some days are better than others,” he said. “Overall, my health is neither improving nor degenerating.”

He said he was initially sick for about a month last March after a trip to Atlanta for the U.S. Marathon Olympic Trials, and then recovered fully—or so he thought. 

“In October, after six months of unimpeded training and (virtual) racing, I had a random bad workout that became the start of a downward spiral in my health. My theory is that this reversal was triggered by exposure to wildfire smoke.” Fitzgerald lives in California, where wildfires this summer blanketed the area in smoke.

He said his condition has been “continuously evolving” for the past few months, and long-haul COVID symptoms aside, perhaps one of the most frustrating parts of it all has been the lack of knowledge and understanding from the medical community. 

“I don’t even have a diagnosis, let alone a prognosis,” he said. “The doctors I’ve seen have been worse than useless. They clearly don’t believe I’m a long-hauler and are barking up all the wrong trees testing-wise in their efforts to figure out what’s wrong with me. I’m about 90% certain I have some form of dysautonomia [disorder of the autonomic nervous system], as many long-haulers do, but this condition is famously resistant to diagnosis because most doctors know little about it.”

Fortunately for Dr. Tamsin Lewis, a former pro triathlete, Ironman champion, and medical doctor who is based in London, England, she has been able to use her medical background to help alleviate some of the worst symptoms of her experience with long-haul COVID. Triathlete spoke to Lewis back in April last year, a month after she had first contracted the virus. Some nine months later, she said she is still battling symptoms, yet she feels she’s educated herself about possible ways to try to expedite recovery. 

“What we’re learning is that there’s a distinct subset of symptoms that persist after having COVID that can vary in intensity for different people. I have periods of feeling a bit better, but then I’ll do more, work more, sleep less, try to exercise, and it sets me back. I’ve had relapses when I’ve run just a few miles but it feels like I’ve run a marathon—and all I’ve done is a jog,” she said.

Muscle aches and soreness are a common recurrence, and she’s noticed an increase of histamine-related symptoms—that is, she wakes up with a swollen face or finds herself sensitive to new allergies, such as fabric softener, conditioner, or perfume. “Very recently I started on two prescription-level antihistamines, which have really started to help with the joint and face swelling,” she said. 

While the chest palpitations that dogged her when she first contracted the virus have mostly disappeared, she still has some chest pain, especially after drinking coffee or alcohol. And although athletes are often used to pacing in training or racing, Lewis said managing life with long-haul COVID has centered around pacing everything.  

“This [long COVID] has become a lesson in pacing,” she said. “On the days when I feel better I want to exercise more and try to run up a hill, but I’m completely deconditioned now. I’ve had to learn to bank my energy, otherwise it sets me back. I’ve also been paying a lot more attention to my diet, following a low histamine diet, and paying really close attention to my gut health, which it has become apparent plays an important role in determining who gets long COVID and how well you respond to hospital treatment.”

Like many dealing with the long recovery, Lewis believes that true recovery from long-haul COVID only comes from rest: “Rest and pace yourself. Rest like it’s your job. You really have to prioritize all aspects of your recovery.”

It’s a similar story for triathlete Patty Brockman who, after first falling ill last March, has only in the past few weeks turned a corner on the road to recovery. For her, the past 10 months have been dogged by coughing, chest pain, breathlessness, fever, GI distress, brain fog, and more. The 61-year-old developed a dry cough last March, which she initially attributed to having cleaned out her dusty basement.

“The next morning, I woke up and felt like a semi-truck had rammed into me at high speed and thrown me into a brick wall. I was completely done in by the pain,” she said.

Her resting heart rate, which usually hovers around 50 beats per minute, was up in the high 70s. She stayed in bed for two days and had a fever north of 100F.  She had no appetite, forced herself to drink a bottle of water each day, and had headaches she described as “all-consuming,” as well as an intense skin sensitivity. It wasn’t until May that she was able to get a COVID test, which officially confirmed she had the virus. While some of the symptoms dropped away throughout the summer, the brain fog remained.

She said: “Finally, information started coming out about long COVID symptoms and I was so relieved to find that brain fog was one of them. I’d had blackouts and an inability to focus, which had terrified me. I am still having trouble with focus and concentration, but just in the past few weeks I think I’m seeing some improvements.”

Brockman is an Ironman finisher and triathlon coach, so she knew her return to exercise and training would have to be slow and steady. Although she was given the all-clear by doctors last fall, she said the lingering cardiovascular issues associated with COVID have stayed with her until recently.

“I’ve definitely had to start all over again when it comes to working out,” she said. “I feel like I have lost all of my normal level of athletic fitness. I really do empathize with athletes going through this. There are so many different degrees of physical damage from this virus, so my advice is case-by-case. First and foremost, I would advise seeing a doctor before starting back to training post-COVID. Depending on the severity and duration of the illness, athletes may have to set aside all former training expectations and go back to a base-building phase.”

For anyone attempting to recover from long-haul COVID, it appears to take time and a lot of rest–and a certain amount of frustration around unanswered questions. For athletes, who also have to deal with a loss of fitness and anxiety around unmet expectations for themselves, there’s an extra level of needing to go slow.

“Slow it down,” Brockman said. “Patience is key—and try not to compare your post-COVID self to your pre-COVID self. In time, you will get back there.”